1. LUMBAR SPINE

2. Bony Anatomy Made of two parts - vertebral body and vertebral arch
Pedicles – attach body to arch
Vertebral foramen – space where spinal nerves exit
Articular process (facets) – junction of pedicle and laminae
Pars interarticularis – area between facets

3. Transverse process – attachment site for muscles
Spinous process – attachment site for muscles and ligaments

5. Vertebral Ligaments Anterior longitudinal Posterior longitudinal
extends anterior region of spine
thin in cervical and thickens as it
moves inferior
strongly attaches to periosteum
Posterior longitudinal
extends skull to sacrum
widest in cervical region
loosely attaches to vertebral bodies

7. 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

14. Extrusion

15. 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%

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

18. Lower Quarter Exam

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

20. Dermatomes L4 L5 S1
Medial Ankle
Dorsal Ankle
Lateral Ankle

21. Reflex
L3-L4 Patella
S1 Achilles Tendon

22. Special Tests

23. 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

24. Well straight leg raise
raise uninvolved leg
If pain, herniated disc

25. Hoovers test lie supine and place heels into hands
have patient lift leg
opposite heel should drop in hand
determine malingering

26. Kernig Test lie supine lift leg and flex head to chest
Positive finding – pain with stretched spinal cord

27. Valsalva Maneuver
increase intrathecal pressure by having a bowel movement

28. Stork Standing Test
stand on involved leg and lean back

29. Babinski Test draw line up plantar surface of foot
calcaneus to forefoot; toes spread

30. Bowstring Test
Straight leg test with knee bent

31. Slump Test
sit in chair
stretch involved leg out and slump over