1. LUMBAR SPINE

2. Bony Anatomy Made of two parts - vertebral body and vertebral arch
Pedicles – attach body to arch

3. Bony Anatomy Vertebral foramen – space where spinal nerves exit
Articular process (facets) – junction of pedicle and laminae

4. Bony Anatomy Pars interarticularis – area between facets
Transverse process – attachment site for muscles
Spinous process – attachment site for muscles and ligaments

6. Vertebral Ligaments Anterior longitudinal Posterior longitudinal
extends anterior region of spine
thin in cervical and thickens as it moves inferior
strongly attaches to periosteum (membrane that snugly covers the bones)
Posterior longitudinal
extends skull to sacrum
widest in cervical region
loosely attaches to vertebral bodies

8. Spinous Ligaments Interspinous ligaments Intertransverse ligaments
between spinous processes
Intertransverse ligaments
between transverse processes

9. Intervertebral Disc Makes up ¼ of the spine Components
Nucleus Pulposus
Annulus Fibrosus

10. Nucleus Pulposus Occupies central portion of disc
Large water content and small amount of collagen fibers
Highly viscus; strong affinity to water (hydrophilic)
Water amount decreases with age
Creates internal disc pressure – pushes against vertebrae and annulus fibrosus
major function is to redistribute compressive forces
pathology = herniation

11. Annulus Fibrosus made up of concentric fiberous rings
Firmly attached to vertebral body
Movements of compression, torsion, and shearing to spine increase tension on annulus
Pressure of nucleus is important because it maintains pressure on annulus which enhances stability

12. Types of Disc Pathology
Protrusion
disc bulges (nucleus pulposus) posterior without rupture of annulus
Extrusion
annulus fibrosus is
perforated and disc material
moves into epidural space

13. Extrusion

14. Activites that increase disc pressure
Coughing
Walking
Side Bending
Small jumps
Laughing
Lifting with knees bent
Forward bending
Lifting 20 lbs. with back bent and knees straight 5%
15%
25%
40%
40-50%
73%
150%
169%

16. Range of Motion Flexion Extension Lateral Flexion Rotation 40-60 20-35
15-20
3-18

17. Myotomes L2 L3 L4 L5 S1 S2 Hip Flexion Knee Extension
Ankle Dorsiflexion
Great Toe Extension
Ankle Eversion
Knee Flexion

18. Dermatomes L2 Mid-Anterior Thigh L3 Medial Knee L4 Medial Ankle L5
Dorsal Ankle
Lateral Ankle
Posterior Thigh

19. Reflex
L3-L4 Patella
S1 Achilles Tendon

20. Special Tests

21. Straight Leg Raise
lie supine, lift leg by supporting foot, knee straight
If experience pain, lower leg and dorsiflex foot
If pain is induced, (+)tight hamstrings

22. Well straight leg raise
raise uninvolved leg
(+) If pain, possible herniated disc

23. Hoovers test lie supine and place heels into hands
have patient lift leg
opposite heel should drop in hand
(+) inability to lift the leg may reflect a neuromuscular weakness or to determine malingering

24. Kernig Test lie supine with hands cupped behind head
lift leg to no more then 90 degrees flexion of hip and knee, flex head to chest
Positive finding – pain with stretched spinal cord, nerve root impingement

25. Valsalva Maneuver Subject should be seated
Take a deep breath and hold while bearing down as if having a bowel movement
(+) increased pain due to intrathecal pressure, possible herniated disc, tumor, lesion.

26. Stork Standing Test stand on involved leg and lean back
(+) pain on ipsilateral leg standing causes most pain with ipsilateral fractures

27. Babinski Test draw line up plantar surface of foot
calcaneus to forefoot; toes spread
(+) no movement of the toes indicative of a central nervous disorder

28. Bowstring Test Subject is supine
Passively perform a straight leg raise on the involved side, if pain is experienced, flex the subject’s knee to 20 degrees in attempt to reduce pain.
Then apply pressure in the popliteal area in attempt to reproduce the radicular pain
(+) painful radicular reproduction following popliteal compression indicates tension on the sciatic nerve

29. Slump Test
Subject sits in chair or at the end of the table, hands behind their back
Slump over having shoulders relaxed
Actively flex chin to chest
Passively extend knee
And return to normal
(+) if symptoms are increased in the slumped position and decreased as the subject moves neck out of flexion