6300back
How many muscles act directly on the SI joint?
0
name 5 examples of disk problems
1-Degenerated disk 2- Bulging disk 3-Herniated disk 4-Thinning disk 5-Disk degeneration with Ostophyte Formation
Name two functions of the vertebral column
1-Protect the spinal chord 2- Provide postural control
What are the three sections of the Sciatic Nerve?
1-Tibial nerve 2-Connon Peroneal Nerve 3-Tibial Nerve slip
How is the SI joint influenced
1-muscles that originate on the sacrum function to control the hip 2- Muscles that attach to the pelvic bones cause rotation of the pelvis.
____ -___ % of athletic injuries occur to the spine
10 to 15
Spinal injuries during athletic competition account for what percentage of all spinal injuries?
10% to 15%
Amount of stress placed on the lumbar intervertebral disks when a person is standing?
100 kg of pressure
How many Thoracic vertebrae?
12
The facet joints transfer what percentage of the weight-bearing forces in the spine?
20%
how much weight do the facet joints transmit through the spine?
20%
the synovial facet joints transmit what percent of the weight bearing forces through the spine
20%
How many intervertebral disks are found along the spinal column?
23
How many intervertebral disks are there?
23
how may disks are found along the spinal column
23
The stress placed on the lumbar intervertebral disks when a person is sitting and leaning forward increases to what amount?
275 kg of pressure
How many pairs of nerve roots exit the spinal column
31
How many total number of nerve root pairs exist in the spinal column?
31 pairs
How many vertebrae comprise the spinal column?
33
How many vertebral segments make up the spine?
33
how many sections of the vertebral column are there?
4
How many pairs of foramina perforate the sacral bone allowing for the passage of the dorsal and ventral primary divisions of the sacral plexus?
4 pairs
how many pairs of foramen in the sacrum
4 pairs
the disks are full hydrated until which age
40
the disk is fully hydrated at age __ but fully dehydrated by age __.
40, 60
How many Lumbar vertebrae
5
How many pairs of sacral nerves?
6
what percentage of athletic injuries include damage to the spinal chord/nerves?
6-10 %
At what age have we reached maximum dehydration of the disks
60
the nucleus pulposus is a highly elastic semigelatinous substance that is __ to __ percent water
60% - 70%
how many cervical vertebrae?
7
what percentage of adults will experience back pain?
70%
What percentage of adults experience back or neck pain in their lives compared with the percentage of injuries to the spine during athletic competition?
70%: 10% to 15%
Amount of stress placed on the lumbar intervertebral disks when a person is in the supine position?
75 kg of pressure
How many cervical nerves?
8
At what angle of hip flexion differentiates between nerve root impingement and disc pathology during a single leg raise?
> 70 deg of hip flex. indicates nerve root impingement. < 70 deg indicates disc pathology
What is spondylolysis?
A fracture of the pars interarticularis
What is spondylolisthesis?
An anterior displacement of a vertebra with pars interarticularis fracture
What is the name of the tough, dense, outer-layer of the intervertebral disks
Annulus fibrosus
Provide ligamentous support the entire length of the spine
Anterior and Posterior longitudinal ligaments
What forms the Obturator Nerve?
Anterior branches of L2-L4
What is the thinnest ligament in the spine
Anterior longitudinal ligament
During the Long Sit/Leg Length Discrepancy test if the patient's non-involved side is longer which way is the ilium rotated?
Anterior rotation
Where is the most common location of herniated or prolapsed discs?
At L4/L5 and L5/S1
test for throacic nerve innervation dysfunction and the umbilicus pulls to one side
Beevor's sign
What alleviates the pain felt with a positive Kernig/Brudzinski's Test?
Bending the knee.
Where are there not invtervertebral disks?
Between C0/C1/C2, the sacrum and the coccyx
Which two levels in the spinal column do NOT have intervertebral discs between the vertebral levels?
C0-C1, C1-2
What are signs and symptoms of spondylolysis and spondylolisthesis?
Centralized pain over spine, increased pain with hyperextension of spine, muscle spasm, decreased ROM
What is the most mobile section of the spinal column
Cervical
name the 4 sections of the spinal column
Cervical Thoracic Lumbar Sacral
When two nerves combine to form one
Convergent pathway
What does the Quadrant Test test?
Depends where pain is. Radicular pain indicates nerve impingement, pain over spine indicates facet joint dysfunction, pain over PSIS indicates SI joint dysfucntion
What condition is associated with mannequin posture?
Disc herniation
Considered the gold standard for diagnosing an intervertebral disc lesion?
Discography
When one nerve splits to form two
Divergent pathway
Muscle group that is the primary mover for spinal extension and controls the rate of spinal flexion against gravity through eccentric contractions?
Erector spinae group
The primary function of the anterior longitudinal ligament (ALL) is to limit what spinal motion?
Extension
(True or False) An athlete with a suspected nerve root impingement may self-report pain during urination.
FALSE
(True or False) The Tibial Nerve and Femoral Nerve are branches of the sciatic nerve.
FALSE
Lumbarization is a condition that is normally symptomatic and will require one to seek medical attention.
FALSE
The back's intrinsic muscles' primary function is to provide respiration.
FALSE
The primary movement occurring between the L1-L4 vertebrae is rotation.
FALSE
True or false Kernig's Test involves flexion of the cervical spine
False, the Brudzinski's portion of the test involves the cervical spine.
What motion does the posterior longitudinal ligament limit?
Flexion
What spinal motion is limited by the posterior longitudinal ligament (PLL)?
Flexion
what position does a disc have the most pressure placed on it?
Flexion
Whiat two motions will best relieve the pain if an athlete is suffering from spinal stenosis? Select all that apply.
Flexion and Extension
What could cause an traumatic spondylolysis or spondylolisthesis?
Forced hyperextension of the back.
What special test is used to place a rotator stress on the SI joint by forcing one hip into hyperextension?
Gaenslen's test
What is a classic procedure used to determine whether an individual is malingering during the performance of functional and special tests?
Hoover test
What is the difference between the Well (Cross) Straight Leg Raise and the Straight Leg Raise?
In the Well (Cross) Straight Leg Raise the unaffected leg is tested. In the Straight Leg Raise the affected leg is tested.
Which of the following ligament(s) resist flexion and rotation?
Interspinous Ligament, Ligamentum Flavum
An exiting point for spinal nerve roots?
Intervertebral foramen
What is the space where the spinal nerve roots exit the vertebral column?
Intervertebral foramen
test for nerve root entrapment, bulgind disk, and dural sheath stretch
Kernig
What type of curve occurs in the Thoracic spine
Kyphotic
The femoral nerve is formed by the posterior branches of which nerves?
L2, L3, L4
What can cause an traumatic SI joint dysfunction ?
Landing hard on one leg or a blow to the back.
reinforces facet joints, highly elastic, returns spine to neutral from flexion
Ligamentum Flavum
What is the ligament that reinforces the facet joints and has an elastic property that assists the trunk in returning from flexion to the neutral position?
Ligamentum flavum
Which ligament forms the posterior margin of the vertebral canal?
Ligamentum flavum
What type of curve occurs in the cervical spine
Lordodic
what type of curve occurs in the Lumbar spine
Lordodic
When the first sacral vertebra fails to unite with the sacrum
Lumbarization
Which of the following describes the first sacral vertebra failing to unite with the remainder of the sacrum?
Lumbarization
What position is the patient in when performing the Gaenslen's Test?
Lying supine with one leg off the edge of the table
During a functional assessment, the patient is standing with the involved-side leg flexed at the hip and knee with the pelvis tilted to the involved side. What is the name for this posture?
Mannequin
test for lumbar verve root pressure
Milgram
What special tests differentiate between nerve root impingement and herniated disc?
Milgram Test, Well (Cross) Straight Leg Raise, Valsalva Maneuver, and Straight Leg Raise w/ pain below 70 deg hip flex.
Which test does not test for SI joint dysfunction Gaenslen's test, Milgram's test, or Fabere/Patrick's test?
Milgram's test is a test for herniated disc.
what are coupled motions
Motions that occur synergistically (i.e. lateral flexion and rotation)
What are some of the signs and symptoms of a herniated or prolapsed disc?
Muscle weakness, decreased sensation and diminished reflexes along affected dermatomes and myotomes
Beevor's sign evaluates what?
Nerve root pathology
What is a positive Hoover test
No downward pressure in the examiner's hand cupping opposite the leg being raised
What is the name of the flexible inner layer of the intervertebral disks
Nucleus pulposus
What do the posterior branches of nerve roots L2, L3, and L4 converge to form?
Obturator nerve
Where does the Spine attach to the lower extremity?
PSIS
What is the space between the superior and inferior facet called?
Pars interarticularis
what is a common site for stress fractures
Pars interarticularis
Sciatic nerve dysfunction symptoms can result commonly from a muscle spasm of which of the following?
Piriformis
What forms the Femoral Nerve?
Posterior branches of L2-L4
During the Long Sit/Leg Length Discrepancy test if the patient's involved side is longer which way is the ilium rotated?
Posterior rotation
What is the primary flexor of the spine?
Rectus abdominis
Spondylo
Relating to the spinal column or vertebrae
What is conservative management for a herniated disc entail ?
Rest, core stabilization, core strengthening, modalities, etc.
What level does the spinal chord exit the spinal column
Sacral level
What condition is present when the fifth lumbar vertebra fuses to the sacrum?
Sacralization
when the 5th lumbar vertebrae fuses to the sacrum
Sacralization
What is the name of the fracture that is seen on an x-ray of an athlete with spondylolysis
Scotty dog fracture
Spondylolysis
Scotty dog fracture, Defect in Pars interarticularis. Often caused by repetitive hyperextension of the lumbar spine.
Side 1 (Question)
Side 2 (Answer)
SPECT
Single Positron Emission Computed tomography, a form of radiography that allows for best viewing of Spondylolysis. Uses injection of radioactive dyes.
test for sciatic nerve pain, disk disfunction at 30 degrees
Straight leg raise
Which vertebrae only articulate with one rib?
T1, T10-T12
where are the costovertebral joints
T2-T9
Which vertebrae normally align with the medial border of the scapula spine?
T3
(True or False) Gaenslen's test is used to place a rotarty stress on the SI joint.
TRUE
(True or False) Hoover's test would NOT place tension on a nerve or nerve root, or cause dural irritation irritation?
TRUE
A rehabilitation program should include exercises that result in centralization of the pain.
TRUE
Goniometric measurements of the low back are more reliable if taken at the same time every day.
TRUE
The amount of motion between any two vertebrae is small, but motion of the entire column is large.
TRUE
True or false Compensatory posture is named based on the side one leans to?
TRUE
What is the special test for spondylolysis and spondylolisthesis?
The Single Leg Stance/Stork Stand
Which is a better test for a herniated disc, the Straight Leg Raise or Milgram's Test?
The Straight Leg Raise, it's sensitivity is 91%. Milgram's test has an inconclusive sensitivity and specificity.
Define sensitivity
The ability of a test to identify the patients that do have a specific condition, relative to the gold standard (True Positive)
Define specificity
The ability of a test to identify the patients that do not have the condition (True Negative)
What is retrolisthesis
The opposite of spondylolisthesis, a posterior displacement of a vertebrae
Pars interarticularis
The segment of bone between the superior and inferior facet joints, especially in the lumbar spine
Posterior internal fixation
The surgical implantation of screws to hold the spine in place and stabilize facet joints. Used to stabilize spondylolysis and spondylolisthesis
What is the most protective section of the spinal column
Thoracic
What is the function of the intervertebral discs?
To increase the total ROM available to the spinal column, To serve as shock absorbers of longitudinal forces, To serve as shock absorbers of rotational forces
Muscle group that is formed by the semispinalis, multifidus, and rotator muscles?
Transversospinal group
Which test is not a test for a nerve root pathology, Femoral Nerve Stretch, Tension/Bowstring Test, or Well (Cross) Straight Leg Raise?
Well (Cross) Straight Leg Raise tests for a herniated disc
Schuermann's disease
a disease process involving the disks of the thoracic spine
Spinal Stenosis
a narrowing of the spinal canal or intervertebral foramen.
stability of the spinal segment comes form
active restraints Passive restraints neural control
What is a purpose of he coccyx
an attachment site for muscles of the pelvic floor
each disk is formed by a tough dense outer layer called...
annulus fibrosus
What does the lumbar plexus innervate?
anterior and medial muscles of the thigh and medial muscles of the leg and foot
the entire length of the spinal column is reinforced by what 2 ligaments
anterior and posterior longitudinal ligaments
Spondylolisthesis
bilateral fracture of Pars Interarticularis
cauda equine syndrome
bilateral leg pain, absent deep tendon reflexes, or changes in bowel or bladder function.
spondylopathies
bony disorders of the posterior elements of the spinal column
lysis
breaking apart
how are individual disks referenced
by the vertebrae between which they are found; example - the disk located between the fourth and fifth lumbar vertebrae is known as the L4-L5 intervertebral disk
the articulation between each pair of vertebrae is formed by what type of 2 joints
cartilaginous and synovial joints
a relatively immobile joint in which two bones are fused by cartilage
cartilaginous joints
the union between an intervertebral dik and the superior and inferior vertebrae forms what joint
cartilaginous joints
the part of the spine that provides the greatest amount of ROM
cervical
The spinal column plays a role in protection and ROM. The _______ segment has the greatest ROM and the _______ segment offers the greatest protection.
cervical; thoracic
two nerves combining together to form a single nerve
convergent
what type of joint is formed between each rib and the vertebral body
costovertebral joint
lateral flexion occurs concurrently with rotation and vice versa: neither is a pure, single plane movement
coupled motions
the concurrent and necessary association of a motion around one axis with a different motion around another axis
coupled motions
There is a significant association between back pain and ______?
depression
well or cross straight leg raise
discriminates between sciatic neuropathy or disk herniations
one nerve splitting to form two individual nerves
divergent
the anterior and posterior surfaces of the articulation are strengthened by what ligaments
dorsal and ventral sacroiliac ligaments
the anterior longitudinal ligament functions to limit what motion of the spine
extension
what motion does the anterior longitudinal ligament limit?
extension
the type of muscles primary function to provide respiration and movement associated with the upper extemity and scapula and indirectly influencing the spinal column.
extrinsic
quadrant test
facet joint compression
tests to identify intervertebral disk lesions
femoral nerve stretch tension sign
hyporeflexia
flaccidity of the muscles, and denervation atrophy.
the posterior longitudinal ligament serves primarily to limit what movement of the spine
flexion
the spinal column allows for what three degrees of freedom of movement
flexion and extension, rotation, tilting, resulting in lateral bending
What does the interspinous ligament limit?
flexion and rotation in the spine
Discography
gold standard for diagnosing intervertebral disk lesions
Schmorl's nodes
herniation of the nucleus pulposus through the vertebral endplate
test for malingerers
hoover
Hoover Test
identification of malingering patients
Kernig's test
identify disk pathology or inflammation of nerve or its dural sheath
slump test
identify possible compression of the lumbar nerve roots
2 main functions of intervertebral discs
increase ROM and absorb shock
What is the purpose of intervertebral disks
increase ROM and provide shock absorption
Straight let raise test
indicates sciatic nerve irritation or a herniated intervertebral disk
when these muscles contract, the torso bends to that side
internal and external obliques
what ligaments are formed by strong fibers spanning the anterior portion of the ilium and the posterior portion of the sacrum, filling the void behind the articular surfaces of these bones
interosseous sacroiliac
a series of what ligaments serve to bind the sacrum to the pelvis
interosseous sacroiliac, dorsal and ventral sacroiliac, sacrotuberous, and sacrospinous
filling the space formed between the spinous processes, what ligament limits flexion and rotation of the spine
interspinous ligaments
the space where spinal nerve roots exit the vertebral column
intervertebral foramen
muscles that lie close to the spinal columnand directly influence its motion
intrinsic
where is the ligamentum Nuchae
intrinsic to adjoining vertebrae
how is the formation of the annulus fibrosus beneficial to its function
it leaves some portion of the disk taut regardless of the position of the vertebral column and increases the loverall strength of the tissue
what positions place the largest shear loads on the disk
lateral bending, flexion, lateral shear, and compression
the posterior muscles acting on the spinal column
latissimus dorse, levator scapulae, rhomboid major and minor, trapezius
Where does the supraspinous ligament go?
length of the spine attaches to the posterior apes of each spinous process
Intrinsic muscles
lie close to the spinal column and directly influence motion
the posterior margin of the vertebral canal is formed by what ligament
ligamentum flavum
this ligament reinforces the facet joints, and its unusual elastic property assists the trunk in returning from flexion to the neutral position
ligamentum flavum
in the the cervical spine, the supraspinous ligament becomes what ligament
ligamentum nuchae
the part of the spine that provides a balance of protection and ROM
lumbar
where is the ALL the thinnest
lumbar area
this occurs when the first sacral vertebra fails to unite with the remainder of the sacrum, forming a separate vertebra having characteristics similar to those of the lumbar spine, essentiall becoming a sixth lumbar vertebra.
lumbarization
hook lying position
lying supine with hips and knees flex and feet flat on table
how is the annulus fibrosus formed
multilayered fibers that cross in opposite directions forming an X pattern
the protective tunnel through which the spinal cord passes
neural arch
surrounding a flexible inner layer called...
nucleus pulposus
the broader, thicker anterior longitudinal ligament spans the length of the vertebral column from the ____ to the ____, attaching to both the vertebrasl bodies and the intervertebral disks
occuput, sacrum
the posterior longitudinal ligament attaches to what parts of the spine
originates: from the occiput as a thick structure, lines the anterior portion of the vertebral canal
What is diskogenic pain?
pain associated with disk degeneration or herniation
the common site of stress fractures in the lumbar spine
pars interarticularis
Extrinsic muscles
provide respiration/ movement related to upper extremity and scapula. Indirectly influence the spinal column
the primary flexor of the spine that also influences spinalposture by rotating the pelvis posteriroly, flattening the lumbar spine
rectus abdominis
what hormone increases the extensibility of ligament around the birth canal
relaxin
which ribs do not articulate
ribs 11 -12
this occurs when the fifth lumbar vertebra becomes fused to the sacrum; may occur unilaterally or bilaterally resulting in complete fusion of these segments.
sacralization
the weight of the torso and skull is transmitted to the lower extremity through which joints
sacroiliac joints
this ligament indirectly supports the sacrum and originates from the sacrum's ishial spine and attaches to the coccyx
sacrospinous ligament
what ligament arises from the ishial tuberosity to blend with the inferior fibers of the dorsal SI ligaments
sacrotuberous ligament
molded by 5 fused vertebrae, this bone fixates the spinal conumn to the pelvis and is responsible for stabilizing the pelvic girdle
sacrum
What does Adams forward bend test
scoliosis
listhesis
slipping
ground reaction forces from the lower extremities are transmitted through the SI joints up the ______ ______
spinal column
how much pressure is on the intervertebral disks
supine - 75 kg standing- 100 kg leaning forward- 275 kg
this ligament transverses the length of the spinal column and attaches to the posterior apex of each spinous process
supraspinous ligament
the facet joints represent the _______articulations
synovial
the superior facets of the vertebrae articulate with the inferior facets of the vertebrae immediately above form what type of joints
synovial facet joints, aka zygapophyseal joints
Valsalva test Milgram test
tests used to clinically identify intrathecal pressure
Anterior spinal fusion
the surgical implantation of a metal plate on the anterior side of the vertebrae. Used to stabilize spondylolysis and spondylolisthesis
Facet joints
the synovial joints between the interarticular processes of the vertebrae
the part of the spine that provides the greatest amount of protection
thoracic
Where is the weight of the sacrum transmitted
through the SI joints to the lower extremity
muscle that assists in stabilizing the lumbar spine by acting like a corset
transverse abdominis
what is the smallest functional unit of the spine
two adjacent vertebral bodies and the intervening disk
a test that tests for hernia or nerve root pain
valsalva
intrathecal
within the spinal canal
other name for facet joints
zygapophyseal joints
