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80 Cards in this Set

  • Front
  • Back
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?
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
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
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
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 _
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
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
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
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 _
- 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
Heart and lungs sympathetics levels
Upper abdominal viscera – liver, gallbladder, stomach, pancreas, spleen and duodenum sympathetic levels
Rest of small bowel, kidney, ureter, gonads and right colon - sympathetics levels
Left colon and pelvic organs - sympathetics
Greatest motion in thoracic spine
What dictates degree of rotation in thoracic spine
Articular facets
Second greatest motion in thoracic spine
Lateral bending
Least motions in thoracic spine
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
Level for sternal angle
Level for xiphisternal junction
Levels for scapular spine and scapular inferior angle
T3; T7
Inhalation somatic dysfunction
- Rib is in position of inspiration
- Exhalation restriction
Exhalation somatic dysfunction
- Rib is in position of exhalation
- Inhalation restriction
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