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what is the point of balanced tension
where the treatment begin .this hold the still point that will make the treatment possible;" fix itself"
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balanced tension
- inherent forces that can act on areasof strain to correct SD
- there forces are only perceptible as the point of BLT is reached
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nociceptor reflex
we have the largest concentration in our joint and they can help to reset the tension around the joint
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what happens to blood when muscles are contracted ?
blood is shunted away
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BLT/LAS
the point in the ROM of an articulation where the ligament and membranes are poised btwn normal tension of free Rom and increase tension proceeding strain
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principle of BLT/BLT
- exaggeration
- point of balance
- Direct action
- opposing physiologic motion
- molding
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what are the 4 forces on lumbar
- compression
- torque
- shear
- tension (traction)
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what is the predominant force acting on the lumbar spine?
compression
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what are external contact forces of lumbar spine
- gravity
- contact forces
- muscle,tendons
- fascia,ligaments
- organs
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what position of the lumbar generates the highest force ?
Flexed w/ weight
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what position of the lumbar generates the lowest force ?
lying down
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what is the range of extension of the thoracolumbar spine?
30 degrees
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what are the mucles of the lumbar spine
- erector spinae
- multifudus and rotatres
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quadratus lumborum
- attached to the 12th rib, VT, and illiac crest
- it assists in respiration by fixing the rib and stabilize the diaphragm
- impoirtant for bain in lower back
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how does the ab muscles affect the lumbar spin
- important to spinal mechanics and core stability
- prevent ab and pelvic muscles from falling forward and inferiorly
- influences the lordosis in the lumbar spine and its ability to handle and generate various forces
- essential to spinal mechanis
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what is the origin of the psoas
L1-L5 and inserts on the lesser trochanter of the femur
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what is the attaches of the illiacus muscle
iliac fossa and lateral sacrum and inserts in to the psoas tendon
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Lumbar spine unique characteristics
- facets are oriented saggitally, this is why flexion and extension as the primary motion for the lumbar spine
- there are zygapophyseal joints where the superior and inferior articular facts articulate w/ each other
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what ligaments are involved in the lumbar spine
- Supraspinous
- Interspinous
- Intertransverse
- Anterior longitudinal ligament
- posterior longitudinal ligament
- Ligamentum flavum
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what is the purpose of the anterior longitudinal ligament?
- wide
- strongly attached at the discs and the VB maring
- prevents hyperextension
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what is the purpose of the posterior longitudinal ligament?
prevents hyperflexion narrow
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what is the purpose of the posterior longitudinal ligament?
- Ligamentum flava
- connects lamina of adj vertebrae
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how is the lumbar spine diff from thoracic
- larger
- SP at level of VT
- sagittally oriention of the facet joints
- stronger
- close integration with sacral, pelvic, and lower extremeties
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SPondylosis
- gradual degeneration of spine and disc bcz of aging
- referred to as spinal arthristis
- doesn't have to be symptomatic
- can be cause by imfection, inflamation, or trauma
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Sponddylolysis
- defect in pars interarticularis
- looks like a scotty long dog with collar
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findings for lumbar spine spondylolisthesis
- step off sign
- walking affected
- straight leg raise can trigger lower back time
- radiographs
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which part if the lumbar spine experiences the most degenerative lumbar change ?
- L4-L5
- L5-S1
- disc because they experience the greatest load
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what motions move the nucleus pulposus
- flexion ( pulposus move back)
- extenstion ( pulposus move anterior)
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what is the greatest range of motion in the lumabr spine
flexion
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In what direction are most disc herniation happen?
posteriolateral
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what is the major force actin on the spine?
axial compression
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what is shearing force?
a side to side force
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what are the 5 things that you dod not want to miss for lox back complaint
- fracture
- infection
- cancer
- neurologic emergency referred pain
- Preganancy
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thomas test for iliopsoas tightness ?
pt bend on knee to chect and if the other thigh rest on the table there is no tightness and vice versa
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what does the hip drop test tell you ?
- how much freedom we have in lumbar side bending
- if the pelvis does not drop an expected amount this could be cause by tight paraspinal muscles or the quadradua lumborum tightness on one side
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What are some tell tale signs of lumbar radiculopathy from disc herniation ?
- shooting pain often to below the knee
- parathesias and weakness
- typically unilateral
- worsens with bending , lifting, coughin, and sneezing
- positive straight leg test
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Lumbar stenosis
narrowing of the spinal canal due to bony and ligamentous overgrowth
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symptoms of Spinal stenosis
- buttocks and lower extremity pain, claudication
- pain worsens with extension
- improved with forward beinding
- negative straight leg raising
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