1. Muscular Anatomy Lumbar Spine

2. Multifidus Origin Back of sacrum, fascia covering erector spinae, mammillary processes of lumbar vertebrae, transverse processes of thoracic vertebrae and articular processes of the lower 4 or 5 cervical vertebrae Insertion Spines of all vertebrae from L5 to Axis Action Extension, rotation and side flexion. Acts as extensible ligaments – stabilising vertebral column on movement by changing length Nerve Supply Posterior primary rami od adjacent spinal nerves. Palpation N/A

3. Semispinalis Thoracic Origin Transverse processes of T6 – T10 Insertion Spinous Processes of C6 – T2 Action Both sides acting together causes thoracic extension. One side causes contralateral rotation Nerve Supply Posterior Primary Rami of the adjacent spinal nerves Palpation N/A

4. Quadratus Lumborum Origin Iliolumbar ligament and adjacent iliac crest Insertion Medial half of the lower border of the 12th rib and anterior tubercles of the transverse processes of all lumbar vertebrae Action Ipsilateral Side flexion. Lumbar extension. Fixes 12th rib on deep inspiration to give a fixed origin for the diaphragm. Prevent the pelvis dropping on the none weight bearing side during single leg stance Nerve Supply Anterior Primary Rami of the Subcostal nerve and the upper three or 4 lumbar nerves (T12, L1, L2, L3 and L4) Palpation Model side lying on uninvolved side. Raise the arm above the head to elevate the rib cage, and drop the knee of the involved side behind the other knee onto the table. Palpate the space between the between the iliac crest and 12th rib.

5. Intertransversarii Origin Adjacent transverse processes of the lumbar vertebrae Insertion Adjacent transverse processes of the lumbar vertebrae Action Stabilising adjacent vertebral segments and can produce Ipsilateral side flexion Nerve Supply Lateral Slips – Anterior primary rami of adjacent spinal nerves. Medial slips – Posterior primary rami of adjacent nerves Palpation N/A

6. Rotatores Origin Adjacent to the transverse process Insertion Lamina of the vertebrae above Action Extension and lateral side flexion. Can cause rotation in thoracic region only. Along with Multifidus, act as extensible ligaments Nerve Supply Adjacent Posterior Primary Rami nerves Palpation N/A

7. Interspinalis Origin Spinous process below Insertion Spinous process above Action Extensible ligaments primarily. Can produce extension of the lumbar spine Nerve Supply Adjacent posterior primary rami nerves Palpation N/A

8. Erector Spinae Origin Erector Spinae originates from a thick, flat tendon which attaches around the origin of Multifidus in a ‘ U ‘shaped line. It consists of a 3 muscles (Illiocostalis, Longissimus and Spinalis) and has multiple origins. Insertion Iliocostalis: Inferior borders of the lower 6 ribs near their angles. Longissimus :Transverse processes of all thoracic vertebra and lower ten ribs. Spinalis: Spinous Processes of T1-T6. Action Bilateral contraction causes trunk extension. Unilateral contraction causes ipsilateral side flexion and ipsilateral rotation. Controls flexion of the trunk. Lumbar region works when one legged standing or walking to prevent pelvic drop on NWB side Nerve Supply Adjacent posterior primary rami nerves Palpation The three columns can be seen and felt lateral to the Spinous Processes of the lumbar, thoracic and cervical vertebrae. Can be identified easily in prone if the client extends the head and trunk.

9. Rectus Abdominis Origin Symphysis pubis and pubic crest Insertion Anterior surface of xiphoid process and costal cartilages of the 5th 6th and 7th ribs Action Lumbar flexion, Posterior pelvic tilting Nerve Supply Anterior primary rami of T6/7-T12 Palpation Vertically and centrally on the abdomen with resisted trunk flexion

10. External Oblique Origin Outer borders of the lower 8 ribs and costal cartilages Insertion Outer lip of the anterior two thirds of the iliac crest, line alba, and forms the inguinal ligament Action Flexion, contralateral rotation and ipsilateral side flexion. Posterior pelvic tilt. Nerve Supply Anterior primary rami of T7-T12nerves Palpation Flat hand over the lower lateral aspect of the ribs with resisted flexion and combined rotation

11. Internal Oblique Origin Lateral two thirds of inguinal ligament, anterior two thirds of intermediate line of iliac crest, thoracolumbar fascia Insertion Inferior borders of lower 4 ribs, abdominal aponeurosis to linea alba Action Flexion, ipsilateral rotation and ipsilateral side flexion. Posterior Pelvic tilt Nerve Supply Anterior primary rami of T7-L1 nerves Palpation Flat hand placed over the lower abdomen just above the anterior half of the iliac crest. With resisted flexion and combined rotation

12. Psoas Major Origin Adjacent margins of the bodies of the vertebra and discs and anterior medial transverse processes from the body of T12 to the body of L5 Insertion Tip and posterior aspect of lesser trochanter of the femur Action Flexion of the hip and lumbar spine Nerve Supply Anterior rami of L1-L3/4 Palpation Model supine with hip and knee flexion, feet resting on table. Therapist places fingers 2 inches lateral to umbilicus on lateral edge of rectus abdominis. Pressure is applied towards to spinal column. Model can perform hip flexion to confirm palpation.

13. Transversus Abdominis Origin Anterior iliac crest, lateral half of the inguinal ligament, thoracolumbar fascia and cartilages of ribs 6-12 Insertion Abdominal aponeurosis to linea alba, xiphoid process and pubic symphysis Action Supports abdominal wall, aids forced expiration and raising intra-abdominal pressure. Conjoint tendon supports post wall of inguinal canal Nerve Supply 7-12 intercostal, iliohyogastric and ilioinguinal nerves Palpation Place fingers just medial and inferior to anterior inferior iliac spine and ask the model to draw ASIS together

14. Psoas Minor Origin Sides of the bodies of T12 and L1 and intervertebral disc Insertion Iliopubic eminence and iliac fascia Action Weak flexor of the lumbar spine Nerve Supply Anterior primary ramus of L1 Palpation N/A

15. Iliacus Origin Upper and posterior two thirds of the iliac fossa, ala of the sacrum and anterior sacroiliac ligament Insertion Lesser trochanter of the femur. A few fibres attach to the hip joint capsule Action Hip Flexion. When the origin and insertion are reversed so the lower point is fixed iliacus is a lumbar flexor and anteriorly tilts the pelvis Nerve Supply Femoral nerve Palpation Anterior aspect of ilium just medial to the ASIS

16. Latissimus Dorsi Origin Spinous processes of lower six thoracic and all lumbar and sacral vertebrae, supraspinous and interspinous ligaments, outer lip of iliac crest, outer surfaces of lower 3 or 4 ribs and inferior angle of the scapula Insertion Intertubercular sulcus of humerus Action Extends, abducts and medially rotates shoulder Nerve Supply Thoracodorsal nerve and the posterior cord of the brachial plexus Palpation Model seated with hands at their sides. Place palpating hand on posterior axillary fold and ask the model to push down on the table with both hands, attempting to elevate the pelvis and trunk off the table. Feel for the contraction of the latissimusdorsi

17. Gluteus Maximus Origin Posterior gluteal line of the ilium, tendon of sacrospinalis, dorsal surface of the sacrum, coccyx and sacrotuberous ligament Insertion Gluteal tuberosity of the femur and iliotibial tract of fascia lata Action Extension of the femur, lateral stabilisation of the hip. Inferior fibres can assist with adduction and external rotation of the femur. Superior fibres can assist with abduction and internal rotation of the femur. Nerve Supply Inferior Gluteal Nerve (L5-S2) Palpation Prone lying with one knee joint flexed to 90 . Apply max resistance to posterior surface of thigh and ask for hip extension.

18. Gluteus Medius Origin Outer surface of the ilium from the iliac crest and posterior gluteal line Insertion Superolateral surface of the greater trochanter Action Abduction of the hip. Anterior fibres assist with femoral internal rotation. Posterior fibres assist with external rotation. Stabilise the pelvis on the femur during single leg stance Nerve Supply Superior Gluteal Nerve L4-L5, S1 Palpation Model side lying. Place hand between the iliac crest and greater trochanter of the femur. Ask model to abduct the femur

19. Piriformis Origin Anterior surface of the sacrum between and lateral to anterior sacral foramen, capsule of sacroiliac articulation, margin of the greater sciatic foramen and sacrotuberous ligament Insertion Superior border of the greater trochanter of the femur Action Extension and external rotation of the hip in hip extension or neutral. Internal rotation and abduction in 90° of hip flexion Nerve Supply Sacral plexus, L5, S1, S2 Palpation Model in side lying on uninvolved side with hip flexed to 90°. Palpate in a line from the greater trochanter to the palpable border of the sacrum