Post on 12-Jan-2016
Ed Bezkor DPT, OCS, MTC
Orthopedic Neurologic Evaluation 2
Week 9
GoalsGoals
• Understanding of lumbar spine anatomy and patho-anatomy
• Perform lumbar spine Active Range of Motion (AROM) with/without overpressure
• Assess Passive Intervertebral Motion (PIVM) of lumbar spine
• Perform lumbar spine special tests
Intervertebral DiscIntervertebral Disc
•Annulus fibrosus
•Nucleus polposus
Intervertebral DiscIntervertebral Disc
•Allows movement
•Provides shock absorption
Method of InjuryMethod of Injury
•Posterior annular fibers are less and thinner
•Posterior longitudinal ligament is weaker and narrower than anterior longitudinal ligament
Disc InjuryDisc Injury
Spinal StenosisSpinal Stenosis
Stenosis vs HerniationStenosis vs Herniation
Lumbar Contractile TissueLumbar Contractile Tissue
• Extensors– 3 layer – superficial to
deep• Erector Spinae
• Multifidus
• Intrinsics
• Flexors– Ilio Psoas
• Iliacus
• Psoas Major
• Psoas Minor
– Rectus Abdominus
NeuroanatomyNeuroanatomy
• Lumbosacral Plexus L4-S3
– Sciatic Nerve
• Nerve made of Lumbar and sacral plexus
• The Plexus
• L-4 to S-3
SciaticaSciatica
– Pain and paresthesia into buttock post. thigh and lower leg
– Compression on sciatic nerve
– 11% of people, the peroneal nerve splits from tibial nerve and goes through the piriformis
• Piriformis Syndrome
– 85% sciatic nerve passes posterior to external rotators
NeuroanatomyNeuroanatomy
• Lumbar Plexus L1-4
– Lateral Femoral Cutaneous
– Femoral Nerve
OsteoporosisOsteoporosis
• Factors
– Age
– Poor nutrition
– Lifestyle
• Lack of activity
• Lack of resistance weight bearing exercise
AssessmentAssessment
•Posture
•AROM
•PIVM
•Special Tests
Fear-Avoidance Beliefs QuestionnaireFear-Avoidance Beliefs Questionnaire
•Patients beliefs on how physical activity and work affect their low back pain
•Specific fear-avoidance beliefs about work are strongly related to work loss due to low back pain
The End The End