1. Orthopedic Neurologic Evaluation 2
Week 9
Lumbar
spine
Ed Bezkor DPT, OCS, MTC

2. Goals Understanding of lumbar spine anatomy and patho- anatomy
Perform lumbar spine Active Range of Motion (AROM) with/without overpressure
Assess Passive Intervertebral Motion (PIVM) of lumbar spine
Perform lumbar spine special tests

3. Intervertebral Disc
Annulus fibrosus
Nucleus polposus

4. Intervertebral Disc
Allows movement
Provides shock absorption

5. Method of Injury Posterior annular fibers are less and thinner
Posterior longitudinal ligament is weaker and narrower than anterior longitudinal ligament

7. Disc Injury

8. Spinal Stenosis

9. Stenosis vs Herniation
Movement preference

10. Lumbar Contractile Tissue
Extensors
3 layer – superficial to deep
Erector Spinae
Multifidus
Intrinsics
Flexors
Ilio Psoas
Iliacus
Psoas Major
Psoas Minor
Rectus Abdominus

11. T12-L5

12. Neuroanatomy Lumbosacral Plexus L4-S3 Sciatic Nerve
Nerve made of Lumbar and sacral plexus
The Plexus
L-4 to S-3

13. Sciatica Pain and paresthesia into buttock post. thigh and lower leg
Compression on sciatic nerve
11% of people, the peroneal nerve splits from tibial nerve and goes through the piriformis
Piriformis Syndrome
85% sciatic nerve passes posterior to external rotators

14. Neuroanatomy Lumbar Plexus L1-4 Lateral Femoral Cutaneous
Femoral Nerve

15. Osteoporosis Factors Age Poor nutrition Lifestyle Lack of activity
Lack of resistance weight bearing exercise

16. Assessment
Posture
AROM
PIVM
Special Tests

17. Fear-Avoidance Beliefs Questionnaire
Patients beliefs on how physical activity and work affect their low back pain
Specific fear-avoidance beliefs about work are strongly related to work loss due to low back pain

19. The End