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Anatomy
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Band 5 IST 3/11/09 Ronan Donohoe
Range of Movement
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Annulus fibrosus
• consists of water and collagen fibres
arranged in sheets and concentric rings
surround the nucleus
• Collagen fibres lie at an angle of 65-70 from
vertical and firmly attach to the body above and below
• Each successive layer alternates the direction of
the collagen fibres thus resisting movement
both vertically and horizontally &
providing stability against shear & torsion
NB: Lumbar spinal discs are avascular and depend on fluid exchange by
passive diffusion. Regular movement & activity are vital for this!
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Band 5 IST 3/11/09 Ronan Donohoe
Ligaments
• anterior longitudinal
• posterior longitudinal
• articular capsules
• ligamentum flava
• interspinous ligts
• supraspinous ligts
• intertransverse ligts
• transforaminal ligts
• ligamentum flavum ligts
Dermatomes / Myotomes
The most common sites for a herniated lumbar disc are L4-5 and L5-S1,
resulting in back pain and pain radiating down the posterior and lateral leg, to
below the knee
Articulations
• Intervertebral joint - Each disc forms a cartilaginous joint to allow slight
movement of the vertebrae, and acts as a ligament to hold the vertebrae
together.
• Zygapophyseal (facet) joint- synovial joint between superior and inferior
articular process. Interlocking in vertical plane in lumbar spine. Prevent
rotation in the transverse plane, whilst allowing sagittal rotation (flexion and
extension) and a small amount of frontal rotation (lateral bending)
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Intradiscal pressures
Relative increases and decreases in intradiscal pressure in relation to
different body positions. Note that seated and bending postures apply more
pressure to the disc than do standing and recumbent positions. This explains
the exacerbation
of symptoms of
herniated disc
when patients are
in the former
positions.
Centre of gravity: The line of gravity of passes ventral to the fourth lumbar
vertebral body
Functional Scoliosis – ensure to assess for corrective orthotics
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Common conditions
• Spondylosis
• Spondyloysthesis
• Ankylosing spondylitis
• Nerve root pain
• Cauda Equina
• Red Flags – Briefly – to be done Feb 9th
• Yellow Flags - ABCDEFW
Spondylolisthesis
• Bilateral Pars Interarticularis defect
• Forward slippage of one vertebra on another
• Usually L5-S1
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Other Treatments
• Mobilisation
• Core Strengthening –Trans abs
• McKenzke
Red flags
Possible serious spinal pathology, (cauda equina syndrome, spinal fracture,
cancer or infection) Fill in the boxes: C.E., # or Ca below
• Saddle anaesthesia
• Age onset <20 of >55
• Violent trauma
• Constant, progressive, non mechanical pain
• Thoracic pain
• PMH - carcinoma
• Systemic steroids
• Drug abuse, HIV
• Weight loss
• Recent onset of bladder or dysfunction
• Persisting severe restriction of Lx Flexion
• Widespread neurology
• Structural deformity .
ACTION: Usually immediate referral to hospital.
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References:
Burton, A. K., Balagué, F., Cardon, G., Eriksen, H. R., Henrotin, Y., Lahad,
A., Leclerc, A., Müller, G., van der Beek, A. J., Henrotin, Y., Hänninen, O.,
and Harvey, E. (2004) European guidelines for prevention in low back pain
[online]. European Commission, Research Directorate General, [cited on
1/3/08]. Available from the World Wide Web:
<http://www.backpaineurope.org/web/files/WG3_Guidelines.pdf>.
Norris, C. M. (2008) Back Stability: Integrating Science and Therapy, 2nd ed.
Maniadakis, N. and Gray, A. (2000) The economic burden of back pain in the
UK. Pain, 84(1), pp.95-103.