prev care ch 22

Lumbar facet pathology may involve:

-subluxation or dislocation of the facet -facet joint syndrome -degeneration

A person with sciatica, with sensory and reflex changes, muscle weakness, and normal bowel and bladder function, may return to sports participation:

12-24 weeks

Hip flexion tests which nerve root myotome segment?

L1-L2

If an individual has a diminished patellar reflex and weak ankle dorsiflexion, which nerve root is injured?

L4

If an individual has a diminished quadriceps reflex and weak ankle dorsiflexion, what nerve root is injured?

L4

The top of the iliac crest is the landmark for which vertebra?

L4

_____ ____ causes the abnormal growth of usually the thoracic (upper back) vertebrae, but it can aslo be found in the lumbar vertebrae

Scheuermann's disease

characterized by some sensory changes, mild or no reflex change, normal muscle strength, and normal bowel and bladder function, refers to...

Sciatica with hard signs

common trigger point sites associated with extended sitting, standing, running, and walking activities?

The piriformis muscle & quadratus lumborum

Describe strategies for reducing low back pain in runners.

To decrease the incidence of LBP, training techniques should allow for adequate progression of distance, speed, and hill work, and include extensive flexibility exercises for the hip and thigh region. Runners should also make sure they're wearing proper footwear. Passive stretching of the low back can help relieve muscle spasm

Muscles of trunk Paired ______ : produce lateral flexion and/or rotation of the trunk Bilaterally: trunk _____ or extension

Unilaterally; flexion

During the straight leg raising test, pain that occurs opposite the leg lifted indicates....

a herniated disc (large space-occupying lesion)

If at ANY time, a patient complains of acute pain in the spine, mentions a change in sensation ANYWHERE on the body, a careful and thorough examination should be conducted prior to moving the patient to determine if ...

activation of EMS is warranted.

when the body is in upright position the line of gravity passes where in relation to the spinal column?

anterior to the spinal column

Because the spinal cord ends at about the L1 or L2 level, fractures of the lumbar vertebrae below this point do not pose a serious threat but should be handled with care to minimize potential nerve damage to the ____ ____

cauda equina.

Poor posture during walking, sitting, standing, lying down, and running may lead to ...

chronic low back strain or ligamentous sprains.

Treatment for ____ pain includes analgesics, use of padding for protection, and a ring seat to alleviate compression during sitting.

coccygeal

Collectively, the primary movers for back extension are called the

erector spinae

During spondylolysis and spondylolisthesis, muscle spasms often occur in the:

erector spinae and hamstrings

When disc nuclear material moves into the spinal canal and impinges on adjacent nerve roots, it is called a(n):

extruded disc

Although most of the axial compression load is borne by the vertebral bodies and disks, the ____ ____ may bear up to 30% of the load when the spine is in hyperextension.

facet joints

The focus of a rehabilitation program following spondylolisthesis should be:

flexibility of the hamstrings and gluteal muscles; strengthening of the abdomen and back extensors

In assessing lumbar spine disorders, the ______ test is used to determine if the patient is a malingerer.

hoover

Palpation: L4 = top of _____ ____ L5 = demarcated by bilateral dimples S2 = level of posterior superior____ _____ (PSIS)

iliac crest; iliac spine

Sacrum articulates with ______ —sacroiliac joint

ilium

Because the ____ ____ are avascular, they rely on changes in posture and body position to produce a pumping action to bring in nutrients.

intervertebral discs

Ipsilateral pain during the first 70 degrees of a straight leg raising test indicates a possible:

irritation of the sacroiliac joint

Runners are prone to low back pain resulting from tight hip flexors and hamstrings. Symptoms include

localized pain that increases w active and resisted back extension but radiating pain Anterior pelvic tilt and hyperlordosis of the lumbar spine may be present.

The ____ plexus is formed by the T12 through L5 nerve roots.

lumbar

lumbar (T12-L5) = _____ plexus

lumbar

The sacral & thoracic curve: convex ______ Lumbar & cervical curve: convex _____

posteriorly; anteriorly

A rehabilitation program should focus on ??

reducing pain and spasms -restoring motion and balance -developing strength -endurance and power, and maintaining cardiovascular fitness.

Actions involving stimulation of a motor neuron by a sensory neuron in the spinal cord without involvement of the brain are called:

reflexes

The ____ plexus supplies the muscles of the buttock region and, through the sciatic nerve, the muscles of the posterior thigh and entire lower leg.

sacral

The _____ nerve can be palpated midway between the ischial tuberosity and the greater trochanter.

sciatic

_____ may be caused by a herniated disk, annular tear, myogenic or muscle related disease, spinal stenosis, facet joint anthropathy, or compression of the nerve between the piriformis muscle

sciatic

A potential sign of ____ due to disc herniation is pain that increases with forward sitting, coughing, and sneezing.

sciatica

compression loads on the lumbar spine are greatest when..

sitting in a slouched position

An individual with lumbar _____ _____ develops back and leg pain after walking a limited distance, which concomitantly increases as distance increases.

spinal stenosis

A bilateral separation in the pars interarticularis that leads to anterior displacement of a vertebra is:

spondylolisthesis

repetitive trunk extension and rotation may lead to....

spondylolysis

excessive side to side or up and down motion during running may lead to..

sprains of SI joint

Runners are often at risk for low back pain due to

tight hip flexors and hamstring muscles

If nerve root L5 is irritated or damaged, myotome weakness will be found in:

toe extension

sciatica with soft signs:

§Some sensory changes §Mild or no reflex change §Normal muscle strength §Normal bowel and bladder function §Remove from sport participation for 6 to 12 weeks

oLumbar disk conditions -_____ disk (A) Eccentric accumulation of nucleus with slight deformity of annulus -_____ disk (B) Eccentric nucleus produces a definite deformity as it works its way through fibers of annulus fibrosus -______ disk (C) Nuclear material bulges into spinal canal and runs risk of impinging adjacent nerve roots -Sequestrated disk (D) oNuclear material from intervertebral disk is separated from disk itself and potentially migrates

A. Protruded B. Prolapsed C. Extruded

susceptible to lumbar / spine injuries?

Female gymnasts, interior football linemen, weight lifters, volleyball players, pole vaulters, wrestlers, and rowers

lumbar spine

Forms convex curve anteriorly Five lumbar, five fused sacral, and four small, fused coccygeal vertebrae

___ _____ consists of anteriorly directed sagittal plane rotation of the femur with respect to the pelvic girdle

Hip flexion

_____ is often associated with weak abdominal muscles and a forward tilt

lordosis

Anatomical variations of the low back region that can predispose a patient to spinal injuries include:

lordosis, sway back, flat back, and part interarticularis fractures , which can lead to spondylosis or spondylolisthesis.

The flexion/extension capability of the _____ ____ is cumulatively 83 degrees w more motion allowed at the L2-L3 motion segment and diminishing through L4-L5.

lumbar spine

The most commonly herniated disks are the lower 2 __ disks at L4-L5 and L5-S1, followed by the lower ____ disks. Most ruptures move in a posterior or posterolateral direction as a result of torsion and compression.

lumbar; cervical

The assessment of a spinal injury should begin w a thorough History of the injury and should include _____ tests to determine possible nerve involvement. The severity of pain and the presence or absence of neurological symptoms, spasms, and tenderness can indicate when a backboard and ______ are needed.

neurological; stabilization

Reg flags that warrant immobilization and immediate referral to physician / transportation to nearest medical facility:

o Severe pain point tenderness or deformity along vertebral column o Pain radiating into the extremities o Trunk/abdominal pain that may be referred to the visceral organs o Loss or change in sensation anywhere in the body o Paralysis or inability to move a body part o Any injury in which uncertainty exists regarding the severity or nature o Diminished or absent reflexes o Muscle weakness in a myotome

Signs and symptoms of HERNIATED DISK

oSharp pain and spasm at site of herniation; pain shoots down extremity oWalk in slightly crouched position, leaning away from side of lesion oCompression on spinal nerve oSensory and motor deficits oAlteration in tendon reflex

A condition of reduced bone mineralization that is more commonly seen in women in the lumbar region is called:

osteopenia

Repeated, extreme lumbar hyperextension is associated with increased risk of a stress fracture of the___ _______ region of the spine.

pars interarticularis