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80 Cards in this Set

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Goals of muscle energy technique
- Strengthen the weaker side of asymmetry
- Decrease hypertonicity
- Lengthen muscle fibers
- Reduce the restraint of movement
- Alter related respiratory and circulatory function
2 physiological principles of muscle energy
- Postisometric relaxation - increased tension on Golgi organ proprioceptors in the tendons - inhibits active muscles contraction
- Reciprocal inhibition - used when antagonistic muscles are contracted
Contraindications for muscle energy technique
- Painful muscle or muscle group
- Patient with low vitality who could further be compromised by adding active muscular exertion - post surgical patient or patient on monitor in ICU who is post MI
Muscle energy technique is direct/indirect?
Direct
Describe lumbar vertebral bodies
- Largest vertebra
- Wider transversely
- Wedge shaped - higher in front, maintains lordosis
Lumbar spinous processes
- Long
- Quadrangular
- Directed dorsally
Lumbar transverse processes
- Long and thin
- Directed laterally
Body and processes all in same spinal level - T/F
True
Angle of joints between vertebrae is _
almost vertical
Flexion/extension is coupled with _
ventral /dorsal translatory slide
Lateral flexion couples with _
contralateral translatory slide
Rotation is coupled with _
Disc compression
Which motion is greatest at all levels
Flexion/extension
Is there lateral flexion in lumbar spine
Some lateral flexion with limited rotation
Latissimus dorsi - origin, insertion, action, innervation
ORIGIN - humerus
INSERTION - T 7-12, iliac crest, thoracolumbar fascia
ACTION - humerus motion and raises body to arms during climbing
INNERVATION - Thoracodorsal nerve (C6-8)
Gluteus maximus - origin, insertion, action, innervation
ORIGIN - thoracolumbar fascia, dorsal sacrum
INSERTION - iliotibial band and femur
ACTION- extends hip and stabilizes torso
INNERVATION - Inferior gluteal nerve (L5, S1-S2)
Erector spinae - origin and insertion, includes _ , action
ORIGIN and INSERTION - sacrum to cervical
INCLUDES - spinalis, longissimus, iliocostalis
ACTION - bilateral contraction extension, unilateral contraction extension, ipsilateral sidebending
Quadratus Lumborum - origin, insertion, action, innervation
ORIGIN - inferior border of 12th rib and tips of lumbar transverse processes
INSERTION - iliolumbar ligament and iliac crest
ACTION - bilateral contraction creates extension, unilateral contraction causes extension with ipsilateral sidebending
INNERVATION - T12, L1-4 ventral rami
Multifidus and rotatores
ORIGIN + INSERTION - vertebrae to vertebrae
ACTION - control individual vertebral motions, bilateral contraction - local extension, unilateral contraction-lateral flexion with contralateral rotation
Abdominal muscles
- Work antagonistically with lumbar muscles
- Synergistic action creates forward bending
- Coordinated mechanism for controlling dangerous torque, bending, and shear stresses in lumbar spine
Psoas major
- ORIGIN - TP of T12-L5
- COURSE - along pelvic brim behing inguinal ligament in front of hip joint
- INSERTION - lesser trochanter of femur
- ACTION - flexes and internally rotates hip
- INNERVATION - L1-3 (2-4) ventral rami
Iliacus
ORIGIN - superior 2/3 of iliac fossa, inner lip of iliac crest, ventral sacroiliac and iliolumbar ligaments, upper lateral sacrum
COURSE - iliac spines & capsule of hip joint
INSERTION - lateral tendon of psoas
Iliopsoas actions
- Important in function and stability
- ACTION - flexes thigh on pelvis, flexes trunk forward, lateral trunk flexion (unilateral contraction), constant activity in erect posture, prevents hyperextension of hip in standing
Psoas minor
ORIGIN - TP of T12-L1
INSERTION - pectineal line
ACTION - flexes hip
INNERVATION - L1 ventral rami
Name deep lumbar musculature
- Transversospinalis
- Interspinalis
- Spinalis
- Serratus posterior inferior
- Longissimus
- Iliocostalis
- Lat dorsi aponeurosis
Anterior longitudinal ligament
- From base of the occiput to anterior sacrum
Posterior longitudinal ligament
- From posterior body of the axis down to sacrum
Anterior and posterior longitudinal ligaments are attached to _
Discs
Iliolumbar ligament attaches _
TP of L4 and L5 and iliac crest
First lumbar ligament to become tender with lumbar posture changes
Iliolumbar ligament
Function of iliolumbar ligament
- Increase stability at lumbosacral junction - commonly strained in traumatic injuries
Severe low back pain with sudden onset and without history of trauma indicates
Dissecting aortic aneurysm
Pain that wakes patient from sleep indicates _ unless proven otherwise
Malignancy
Rapidly progressing neurological deficits together with low back pain indicate _
Epidural abscess /infection
Claudication symptoms with back pain indicate _
Spinal stenosis
Type I lesion
- Neutral
- SB and Rotation in opposite directions
- Group curve
Type II lesion
- Flexed or SB
- SB and Rotation in same directions
- Single segment
3 planes of motion taken into account in muscle energy treatment
- Coronal (SB)
- Horizontal (rotation)
- Sagittal (forward or backward bending)
Seated flexion test shows what_
- Lateralizes dysfunction (which side is in trouble)
- Also confirms that it is SACRAL problem and not necessarily a problem with ilium
Standing flexion test shows _
Problem is with ilium
Positive Sphinx test shows what _
Unilateral sacral flexion
Unilateral sacral extension
Describe anterior sacral base
- Also called bilateral sacral flexion or flexed sacrum
- LANDMARKS
Sacral base - anterior
Sacral sulci - deep bilateral
ILA - bilateral posterior
ST ligament - tight bilaterally
SPHINX TEST - negative
SPRING TEST - negative
SACRAL BASE - bilaterally positive (will move)
ILA - bilaterally negative (will not move)
Bilateral sacral flexion usually occurs when + common findings
- Following birth
- Look for discontinuity at lumbo-sacral junction
- Low back pain is main complaint
- Increased lumbar curve - lumbar is forced to extend to compensate sacrum
Describe posterior sacral base
- Also called posterior sacral base, bilateral sacral extension, extended bent sacrum
- LANDMARKS - sacral base posterior bilaterally, sacral sulci are bilaterally shallow, ILA are bilaterally anterior, sacrotuberous ligament is bilaterally loose
SPHINX TEST - positive
SPRING TEST - positive
SACRAL BASE - bilaterally negative - will not move
ILA - bilaterally positive - will move
Bilateral sacral extension is commonly found in _
- Post op patients
- Low back pain worse with forward bending
- Decreased lumbar curve - lumbar is forced into flexion to compensate for sacrum
Which axes are axes of ambulation
OBLIQUE
Sacral motion about oblique axis results in
- Neutral or non-neutral dysfunctions (compensatory) of L5
Describe right unilateral sacral flexion
- Right side of sacral base is stuck anteriorly
- Positive seated flexion test on the right
- Right sacral sulcus will be deep
- Right sacral base will be anterior
- RIght ILA is posterior and inferior
Motion testing for right unilateral sacral flexion
- There will be no motion at the right inferior ILA - its locked down
- The base on the same side is likely to have adequate motion
- There is generally good motion at any of other locations
- Negative spring and sphynx test
Describe right unilateral sacral extension
- Right side of sacral base is stuck anteriorly
- Positive seated flexion on the right
- Right sacral sulcus are shallow
- Right sacral base is posterior
- RIght ILA is anterior/superior
- Positive spring and sphinx test
Motion testing for right unilateral sacral extension
- Restricted spring of right superior pole
- Good motion at other location
Degree of kyphosis varies with _
-Age
- Postural habits
- Pathologic conditions (osteoporosis)
Splenius capitis and cervicis difficulties lead to _
Decrease of motion in cervical spine and distal dysfunctions in thoracic spine
Internal and external oblique muscles attach to _ and serve as _
- Lower ribs
- Trunk rotators
Difficulties with internal and external oblique muscles lead to
- Diaphragmatic problems and difficulties breathing
Erector spinae muscles unilateral contraction does _
bilateral contraction _
Unilateral - SB trunk
Bilateral - extend trunk
Head and neck sympathetics levels
T1-T4
Heart and lungs sympathetics levels
T1-T6
Upper abdominal viscera – liver, gallbladder, stomach, pancreas, spleen and duodenum sympathetic levels
T5-T9
Rest of small bowel, kidney, ureter, gonads and right colon - sympathetics levels
T10-T11
Left colon and pelvic organs - sympathetics
T12-L2
Greatest motion in thoracic spine
ROTATION
What dictates degree of rotation in thoracic spine
Articular facets
Second greatest motion in thoracic spine
Lateral bending
Least motions in thoracic spine
Flexion/extension
Lateral bending in thoracic spine is restricted by _
- Articular impingement
- Ligamentous attachments
- Resistance by costal cage
T 1-T4 - type _ dysfunction
Type I
T5-T9 - type _ dysfunction
Mix - type I and type II
T10-T11 - type _ dysfunction
Mix - type I and type II
T12 - type dysfunction
Type II
Pectus carinatum
Abnormal prominence of the sternum - pigeon chest
Pectus excavatum
Abnormal depression of the chest - funnel breast
Level for sternal notch
T2
Level for sternal angle
T4
Level for xiphisternal junction
T9
Levels for scapular spine and scapular inferior angle
T3; T7
Inhalation somatic dysfunction
- Rib is in position of inspiration
- Exhalation restriction
- Rib is ELEVATED
Exhalation somatic dysfunction
- Rib is in position of exhalation
- Inhalation restriction
- Rib is DEPRESSED
Depressed rib
- Space between it and the rib below is narrowed
- Space between it and one above is increased
Elevated rib
- Space between it and one above is narrowed
- Space between it and one below is increased