CCO - Lumbar Notes

List some Global Integration methods for the spine?

Core link Cranial Technique Fascia, wrist/ankles (flex fingers/thumb) working cross chains

List some Regional Integration methods for the spine?

GOT all Lumbars thoracic/pelvic diaphragm QL/Psoas muscles

Steps of a Osteoarticular Technique

Goal: change in tissue quality, not crack 1) position patient to favour direction of correction 2) Vertical axis 3) Accumulation of parameters into/toward spring and restriction (don't want wobbly joint) 4) Palpate the passage - softening of parameters, neurophysiological reflex which resets muscle spindle 5) Exhalation and Impluse 6) Integration - Locally, Regionally, Globally 7) Retest

Superior Facet is ________, Inferior Facet is _________. Of an individual vertebrae.

Lateral, Medial

Pelvic Diaphragm

Levator Ani (A-P): - Puborectalis - Pubococcygeus - Iliococcygeus Obturator Internus (lateral) Coccygeus (Ischiococcygeus) Piriformis (sacrum 2-4 - greater trochanter) Males: - Holds the rectum, urethra, and deep dorsal vein of penis Female: - Holds the Rectum, Vagina, Urethra, Deep dorsal vein of the clitoris Lumbar Compensates for pelvic diaphragmn spasm, acts like an anchor, involved when patients have problems with sitting

Sutherland Functional Technique Contraindications

NONE

Quadratus Lumborum

O: Medial half of inferior border of 12th Rib, tips of lumbar transverse processes I: Iliolumbar Ligament, internal lip of iliac crest Action: Extends and laterally flexes vertebrae column

Iliacus

O: Superios Iliac Fossa, sacrum, anterior sacro-iliac ligs. I: Lesser trochanter of femur and shaft, psoas major tendon - connection with thoarcic diaphragm - pain=change breathing

Thoracic Diaphragm - insertion

O: Xiphoid Process, lower six costal cartilages, L1-L3 vertebrae I: Converges into central tendon Action: draws central tendon down and forward during inspiration(respiratory)

Prone: right TP posterior Sphinx: right TP posterior Prayer: right TP posterior

OA lesion, will not change with muscles, or anatomical large TP

Prone: TP's symmetrical Sphinx: right TP posterior Prayer: TP's symmetrical =?

PRSright

PRSright what should TP's do in prone, sphinx, and prayer?

Prone: right TP posterior Sphinx: TP's symmetrical Prayer: right TP more posterior

ARSright, what should TP's do in prone, sphinx, and prayer?

Prone: right TP posterior Sphinx: right TP more posterior Prayer: TP's symmetrical

Normal Physiology: TP's should _______ in prone? sphinx? prayer?

Prone: symmertrical Sphinx: close down facets symmetrically (testing closed) Prayer: open facets symmetrically (testing opening)

Lesion Hierarchy

Scars Compactions Sheers Non Physiological with out respect (single segment, abnormal motion) Non Physiological with respect (single segment, normal motion) Physiological (Group Lesion) Restrictions (find the major problem somewhere else) Adaptations

Base Bones

basi occiput (sphenobasilar) basi sphenoid (sphenobasilar) petrious portion of temporal bones ethmoid lesser wing of sphenoid (debatable)

Sidebend Right - what do facets do?

right facet closes, left opens

List some Local Integration methods for the spine?

touch vertebrae listen to vertebrae facets

1) Ligamenta Flava

- 'yellow ligament' protein allows it to be elastic

Frontal Bone

- 2 bones - Roof of the orbit = eyes - Nasal Spine, Lateral angles - Neighbours: with other frontal bone -metopic suture 2 parietals - coronal suture 2 nasal bones 2 Lacromal bones ethmoid bone greater/lesser wings of sphenoid 2 zygoma 2 maxilla - all fascial bones hang from frontal bone

Suture

- A form of articulation characterized by the presence of a thin layer of fibrous tissue uniting the margins of the contiguous bones; found only in the skull. - site of active bone growth, and that it is at the same time a firm bond of union between the neighboring bones, which nevertheless allows a little movement

ARS vs. PRS for pain

- ARS, pain is on opposite side because of stretch, and then moves to same side - PRS, pain is on same side

Deep Tendon Reflex S1

- Achilles (prone/supine/kneeling)

Myotome L4

- Ankle Dorsiflexion

Myotome S1

- Ankle Plantarfleion/Eversion

Myotome L1

- Hip Flexion

Myotome L2

- Hip Flexion

Dermatome L1

- Inguinal region

Myotome S3

- Intrinsic Foot (FHB, EDB, FDB

Myotome L3

- Knee Extension

Myotome S2

- Knee Flexion

Small Intestine - Duodenum and center

- L1-L4 - Pancrease - L1/L2

Large Intestine - Descending Colon

- L1-L5

Large Intestine - Ascending Colon

- L2-L5

Large Intestine - Transverse Colon

- L3

Lumbar Veins from Inferior Vena Cava

- L5 - Ascending lumbar veins and each segment

What can you find at L5, with a Right Backwards Torsion of the sacrum?

- L5 would have ARSleft, above L5 may have group lesion - this means L5 and Sacrum are compacted and moving together which is BAD, body seeks dissociation

Muscles Effecting Lumbar Spine

- Latissimus dorsi T7-L5 (pelvis and scapular girdle relationship) - need normal dissociation betweeo shoulder and pelvic girdle - Psoas T12-L5 - Serratus Posterior T11-L2 - Erector Spinae - Iliocostalis/Longissimus/Spinalis - Multifidus - segmental stability - work on with ME techniques - pain will cause inhibition here and do not function properly - becomes cause of problem - recurrent back problems - Transversus Abdominis - needs to be strong for techniques to stay, belt of strength

Root of Mescentary

- Left TP of L2, down to anterior sacral base - peretineal sack hangs off posterior abdominal wall

Deep Tendon Reflex L5

- Medial hamstring (prone)

In an OA technique, what side should be on top when patient lays on side?

- PROBLEM SIDE ALWAYS ON TOP

Deep Tendon Reflex L3

- Patella (supine or sitting)

12th Rib

- Quadratus Lumborum fixes 12th rib during inspiration

Spinal Arteries

- Supply the spinal cord

Psterion

- Suture (meeting point) between greater wing of sphenoid, frontal bone, parietal bone and temporal bone

Myotome L5

- Toe Extension

What happens where the posterior longitudinal ligament does not attach to the vertebrae?

- Venous Plexus - Drain blood from vertebrae

Dermatome L5

- above the knee, lateral portion of thigh, fibular head, anterior/lateral tibia, down to top of foot, including half of the 1 MPJ, and every toe other then 5th

Gravitational Line

- ascending/descending forces - triangles?? - passes through L3 - effects posture - how person manages gravity

Dermatome L4

- below greater trochanter, across the later portion of the thigh, infront of the knee, anterior/medial tibia, to the medial malleolus and 1st MPJ

Dorsal Spine Rotational axis

- body of vertebrae, becasue of kyphosis

Postflexion of Vertabrae

- closing down facets - spinous process closing (ligament relaxes) - pressure on disc moves anterior

Jugular Foramen

- continuation of occipital mastoid suture

Lymphatic Nodes

- drained into the cisterna chyli (L1/L2) - motion moves lymph systerm (diaphragm and activity)

Vault Bones

- embryologically derived by membrane - adaptive, why linked with lumbar - may still have primary lesion 2 Frontal Bones 2 Parietals Squame of temporal bones Squame of occiput greater wing of sphenoid

Frontanelle

- feature of an infant, soft membranous gaps between cranial bones, not fused

Contraindications to Osteoarticular Testing

- fracture - acute injury - herniated disc - injury to disc - spinal fusion/rods - everything is stiff, have to treat a few times before you can see the problem

Dermatome L3

- greater trochanter area, across the thigh, towards the inner knee, down the the gastrocnemius

Lumbar Arteries comes off Aorta

- important for strength of lumbars

Cranial Inspiration vs. expiration, what does spine do?

- inspiration = elongation of the spine - expiration = reformation of the curves

Lamboid Suture

- lamda to asterion - suture between occiput and parietal

Dermatome S1

- lateral portion of posterior glut/thigh/leg, lateral malleolus and 5th MPJ

Characteristics of a Pivot Point

- level of facet - transatory axis - can be mobile - not compacted (specially when lesion held by muscle) - fixed (fixity) = fibrotic (not compacted) - person has lesion so long, the pain switches sides, irritates facet, inflammation, fibrosis, now pain on pivot point side (opp) - if we don't address the fibrosis, lesion will always come back, need to manual mobilize facet

Stomach

- low as L4

Liver

- low as T12/L1

Dermatome S2

- medial potions of posterior glut/thigh/leg, and medial heal

Fryette's 2nd Law

- non physiological with respect (or without, depending on A/P of spine) - a single vertebrae in lesion - when a single vertebrae sidebends and rotates to the same side - facets are engaged, either hyper flexed or hyper open - Traumatic - always compare to the vertebrae below when labeling - labelled with RSright, the direction coinciding with both the rotation and sidebend, named by what it can do

Fryette's 1st Law

- normal biomechanical motion of walking - facets are neutral - when a vertebrae sidebends, it will horizontally rotate to the opposite side (torsion = combined motion) - these lesions are usually a group of vertebrae - these are physiological lesions - these are labeled SRright, the direction coinciding with the rotational component, therefore the side bending direction would be the opposite, named by what it can do

Antiflexion of Vertabrae

- open facet - spinous process separates (ligament tightens) - pressure on disc moves posterior (squeezing front)

Synu Vertebral Nerve

- originate in spine, exit vetebral foramen and come back into foramen - innervate dura

Posterior Posture vs. Anterior Posture

- osteoarthritis - facet problems vs - muscle imbalance

Splanchnic Nerves

- paired visceral nerves (nerves that contribute to the innervation of the internal organs), carrying fibers of the autonomic nervous system (visceral efferent fibers) as well as sensory fibers from the organs (visceral afferent fibers).

Piriformus

- scaitic nerve

Dermatome L2

- superior, anterior/medial portion of thigh

Asterion

- suture (meeting point) between occipital bone, temporal bone, and parietal bone

Frontalsquamosal suture

- suture between frontal and greater wing of sphenoid

Coronal Suture

- suture between frontal and parietal bones

Occipital mastoid suture

- suture between occiput and mastoid of temporal bone

Parietal Squamal Suture

- suture between parietal and temporal bones - frequently in lesion

Sphenopetrous Suture

- suture between sphenoid bone and petrious portion of the temporal bone

Sphenosquamosal suture

- suture between temporal bone and greater wing of sphenoid

Metopic Suture

- suture between two frontal bones

Sagital Suture

- suture between two parietal bones

Non physiological with respect vs. without respect for ARS/PRS

- the vertebrae will be named by what it normal position is. If it is L1/L2 which is usually in P, and is lesioned in P, it is a non physiological with respect, but if it is L1/L2 which is usually in P, and it is lesioned in A, then it is physiological without respect. - L3 is determined by the whole of the lumbar spine, if it is lordotic then it's normal tendency is P, if it is kyphotic it lives in A. If it does not follow the whole pattern of lumbar then no phys with OUT respect

Kidneys

- thoracolumbar junction

Rotational axis of Lumbar spine

- vertical axis - level mid way of spinous process, b/c lumbars are lordotic is more posterior

Fryette's 3rd Law

- when motion is produced in one plane, it will limit motion in the two other planes

Muscle Energy Contraindications

1) Acute 2) non-normal nervous system 3) stoke 4) reflexes

Role of Lumbar Spine

1) Adaptive Spine - ascending/descending forces 2) Central Line of Gravity - L3 3) Meeting Place for Functions - walking (diaphragm)/ breathing (iliopsoas) 4) Peripheral Innervation to lower extremities - e.g sciatica/problem in lower extremity 5) Anatomically/neurologically related to majority of the abdominal organs - elimination organs

Osteoarticular Indications

1) To increase the tissue and articular mobility and amplitude in quantity of a specific segment 2) Presence of increased stiffness, rigidity, density of a specific segment 3) Associated with traumatic lesion but not exclusively

Sutherland Functional Technique Indications

1) remove the strain embedded in the tissue 2) to restore tissue and articular mobility and vitality 3) OA is contraindicated 4) acute spasm, children, pregnancy

Steps of a Muscle Energy Technique

1) reverse position, direct correction 2) palpate problematic facet (stretched for A, closed for P) into direct correction 3) ask for minimal contraction 4) Relax - tissue responds 5) Relocalize - move backwards (SB, R, AorP)

Muscle Energy Indications

1) to restore mobility and amplitude to the tissue and articulation 2) when the lesion is maintained by a muscle or a group of muscles 3) preparation/integration for OA adjustment 4) muscle re-education

Pivot Point is Mobile - because held with muscle constraction, the lesion is problem What is the troubled facet in: ARSright ARSleft PRSright PRSleft

ARSright: left ARSleft: right PRSright: right PRSleft: right

Osteoarticular Contraindications

B - Bone pathology, fracture, osteoporosis, cancer, hodgkins, infection L - Ligament, laxity, hypermobility, instability, disease or conditions which change the ligament such as pregnancy, end stage rheumatoid arthritis A - arterial pathology, calcification, uncontrolled high BP, cardiac or vascular insufficiency, blood thinners, diabetes N - Nervous system pathology, cord compression, disease of the CNS/PNS, neuropathy, diabetic neuopathy, CP, Stroke D - Disease-systemic inflammation, rheumatoid arthritis, Ankylosing spondylitis (inflammation in spine, fusion), lupus or local acute inflammation of the segment or joint/facet

FLIP! 1) Frontal (IN) /Parietal (EXT) - Superior (Coronal) 2) Frontal (EXT) /Parietal (IN) - Lateral (Coronal) 3) Frontal (EXT) / Greater Wing (IN) (Psterion) 4) Greater Wing (EXT)/Temporal (IN) (sphenosquamosal) 5) Temporal (EXT)/Sphenoid (IN) (Sphenopetrous) 6) Parietal (EXT) /Temporal (IN) (Parietalsquamosal) 7) Parietal (IN)/ Temporal (EXT) - Inferior 8) Patietal (EXT) / Temporal (IN) - Inferior/posterior (Asterion) 9) Temporal (IN) / Occiput (EXT) (Asterion) 10) Temporal (EXT) / Occiput (IN) - Inferior (Occipital mastoid suture) 11) Occiput (EXT) / Parietal (IN) - Inferior (Lamdoid) 12) Occiput (IN)/ Parietal (EXT) - Superior (Lamdoid)

Bevels of the Skulls - important for techniques

Evolution of the Curves of the Spine

Cervical - head and neck extention Side Bend - crawl Lumbar - standing Muscles - managing the forces of gravity