Ed Bezkor DPT, OCS, MTC

Orthopedic Neurologic Evaluation 2

Week 9

GoalsGoals

• 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

Intervertebral DiscIntervertebral Disc

•Annulus fibrosus

•Nucleus polposus

Intervertebral DiscIntervertebral Disc

•Allows movement

•Provides shock absorption

Method of InjuryMethod of Injury

•Posterior annular fibers are less and thinner

•Posterior longitudinal ligament is weaker and narrower than anterior longitudinal ligament

Disc InjuryDisc Injury

Spinal StenosisSpinal Stenosis

Stenosis vs HerniationStenosis vs Herniation

Lumbar Contractile TissueLumbar Contractile Tissue

• Extensors– 3 layer – superficial to

deep• Erector Spinae

• Multifidus

• Intrinsics

• Flexors– Ilio Psoas

• Iliacus

• Psoas Major

• Psoas Minor

– Rectus Abdominus

NeuroanatomyNeuroanatomy

• Lumbosacral Plexus L4-S3

– Sciatic Nerve

• Nerve made of Lumbar and sacral plexus

• The Plexus

• L-4 to S-3

SciaticaSciatica

– 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

NeuroanatomyNeuroanatomy

• Lumbar Plexus L1-4

– Lateral Femoral Cutaneous

– Femoral Nerve

OsteoporosisOsteoporosis

• Factors

– Age

– Poor nutrition

– Lifestyle

• Lack of activity

• Lack of resistance weight bearing exercise

AssessmentAssessment

•Posture

•AROM

•PIVM

•Special Tests

Fear-Avoidance Beliefs QuestionnaireFear-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

The End The End