Exam #2 (cont)

Question 0

Where does pain from the QL trigger points radiate?

Answer 0

Groin, lateral aspect of the leg

Question 1

What is the origin, insertion, and action(s) of the quadratus lumborum?

Answer 1

• Origin: 12th rib and TPs of L1-L4
• Insertion: Iliolumbar ligament and posterior iliac crest
• Actions: Stabilizes 12th rib, lateral flexion of lumbar (unilaterally) and extension

Question 2

Give the origin, insertion, and action of the iliopsoas (psoas major) muscle

Answer 2

• Origin: TPs and vertebral bodies of T12-L5
• Insertion: Lesser trochanter
• Action: Flexes thigh, some external rotation, flexes spine on pelvis.

Question 3

What are the referred pain patterns from the iliopsoas?

Answer 3

Lumbar spine and anterior thigh

Question 4

What visceral dysfunction(s) can be confused with iliopsoas spasm/strain?

Answer 4

Kidney stones, ovarian vessel disorder

Question 5

What affect does a shortened iliopsoas muscle have on the lumbar spine and pelvis?

Answer 5

increased LORDOSIS and ANTERIOR pelvic shift

Question 6

During which movement is the iliopsoas stressed?

Answer 6

Flexion

Question 7

What postural observation can be made to identify iliopsoas syndrome?

Answer 7

Flexion at hip and sidebending of lumbar spine to side of most hypertrophied psoas

Question 8

What three tests should be performed to diagnose iliopsoas syndrome, and rule out other pathologies (which?)

Answer 8

1. ) Thomas test (positive)
2. ) Straight leg raise (negative will rule out herniated disc)
3. ) Well leg test (negative will rule out herniated disc)

Question 9

When evaluating iliopsoas syndrome, one should pay particular attention to what vertebral levels?

Answer 9

L1 and L2

Question 10

A full-blown LEFT iliopsoas syndrome will cause:

1. ) A _____ pelvic shift
2. ) Rotation of sacrum on the _____ ______ axis
3. ) Right piriformis spasm
4. ) Pain in the _____ hip down the back of thigh to the knee. This is due to the ________.

Answer 10

1. ) RIGHT pelvic shift
2. ) Rotation of sacrum on the LEFT OBLIQUE AXIS
3. ) ______ piriformis spasm with tender point
4. ) Pain in RIGHT hip, due to SCIATIC NERVE

Question 11

1. ) Where is the key lesion in acute psoas syndrome?

2. ) What type of treatment is contraindicated in acute psoas syndrome?

Answer 11

1. ) Upper-lumbar, approx. L1-L2, sometimes T12/L3

2. ) HVLA

Question 12

What is the origin, insertion, and action of the piriformis?

Answer 12

• Origin: Anterolateral surface of S2-S4 at or near SI joint capsule
• Insertion: Greater trochanter
• External rotation of thigh at the hip, some thigh extension. If hip bent –> abduction of thigh at hip, and internal rotation of thigh.

Question 13

Extensive sitting indicates what pathology?

Answer 13

Piriformis syndrome

Question 14

Sciatica is a _____ rather than a _______

Answer 14

Sciatica is a SET OF SYMPTOMS rather than a DIAGNOSIS

Question 15

Give three observations associated with piriformis syndrome

Answer 15

1. ) Altered, painful gait
2. ) Leg externally rotated
   3) Increased flexion of spine

Question 16

What diagnostic technique is used to differentiate piriformis from disc herniation?

Answer 16

Electromyography (EMG)

Question 17

What technique are recommended in treatment of QL hypertonicity?

Answer 17

Treatment of QL trigger points: 12th rib technique AND passive myofascial release of the QL (both useful during acute stage)

Question 18

Which Type-II somatic dysfunction is common in psoas syndrome?

Answer 18

L5 extended

Question 19

Which OMM techniques are indicated for treatment of ACUTE psoas syndrome?

Answer 19

Passive extension, counterstrain, muscle energy, active and passive myofascial.

Question 20

Define the temporal duration of symptoms in each of the following:

1. ) Acute
2. ) Subacute
3. ) Chronic

Answer 20

Symptoms lasting…

1. ) Acute = < 6 weeks
2. ) Subacute = 6 - 12 weeks
3. ) Chronic = > 3 months

Question 21

What are the seven (7) possible causes of low back pain?

Answer 21

1. ) Mechanical (disc herniation, compression fracture, DDD, etc.)
2. ) Non-mechanical/Viscerogenic (renal disease, IBS, AAA, GI diseases)
3. ) Neoplastic (myeloma, sarcoma, etc.)
4. ) Infection (osteomyelitis)
5. ) Somatic dysfunction (postural compensations)
6. ) Psychosocial (seeking disability or drugs)
7. ) Psychiatric (depression)

Question 22

What etiology are the following complaints typically associated with?

1. ) Pain worse when sitting
2. ) Pain relieved with forward flexion
3. ) Radiation below the knee

Answer 22

1. ) Disc herniation
2. ) Spinal stenosis
3. ) Sciatica

Question 23

List which structures correspond with the following sympathetic levels:

1. ) T1-T4
2. ) T1-T6
3. ) T5-T9 (right and left)
4. ) T10-T11
5. ) T12-L2

Answer 23

1. ) Sympathetics to head and neck
2. ) Heart and lungs
3. ) Upper abdominal viscera (celiac plexus) –> Right: Liver, gallbladder, duodenum, head of pancreas. Left: Stomach, spleen, tail of pancreas.
4. ) Superior mesenteric plexus: Remainder of small intestine, kidneys (R&L), upper part of the ureters (R&L), gonads (ovaries and testes) – RIGHT: Appendix, cecum, ascending to mid-transverse colon.
5. ) Inferior mesenteric plexus: Colon from mid-transverse to rectum and pelvic organs (bladder, uterus, prostate).

Question 24

Herniation at disc X affects nerve root ________. Why?

Answer 24

Affects nerve root X+1, because nerve root X will have already exited the foramina and will be unaffected.

Question 25

Give a description of the following: 1. ) Sacralization 2. ) Lumbarization

Answer 25

1. ) 5th lumbar fused with S1 | 2. ) S1 independent of rest of sacrum

Question 26

1. ) Describe spondylolisthesis 2. ) On which diagnostic imaging tests is it best seen (2)? 3. ) What is a typical compensatory symptom?

Answer 26

1. ) Forward slippage of a vertebral body on the one BELOW 2. ) Lateral X-ray, MRI 3. ) Pelvic rotation and tight hamstrings

Question 27

1. ) What is spinal stenosis? | 2. ) What are three relieving postures for patients with spinal stenosis?

Answer 27

1. ) Narrowing of the spinal canal, i.e. vertebral canal narrowing that compresses nerve roots, thus causing ischemia. 2. ) a. ) Flexion b. ) Sitting c. ) Bringing knees to chest

Question 28

What types of exercises would be useful in treating spinal stenosis?

Answer 28

Exercises that tilt the pelvis and flatten or decrease lordosis, and initiate lumbar kyphosis.

Question 29

Patients with what TWO conditions are more prone to compression fractures?

Answer 29

Hypocalcemia or osteoporosis

Question 30

Where are the weak portions of the lumbar spine?

Answer 30

"Weak" spot on the ANTERIOR PORTION.

Question 31

What are symptoms of Cauda Equina Syndrome (3)?

Answer 31

1. ) Progressive low back pain 2. ) Sphincter (anal/urinary) weakness 3. ) Ascending paralysis of lower extremities

Question 32

1. ) What is Meralgia Paresthetica? | 2. ) Describe its pain pattern.

Answer 32

1. ) A compression of lateral cutaneous nerve of the thigh. | 2. ) It causes pain to the lateral anterior aspect of the thigh.

Question 33

Which nerve root is associated with the following, and how would you test: 1. ) Great toe extension, dorsal foot sensation 2. ) Foot inversion, patellar reflex, medial foot sensation 3. ) Foot eversion, Achilles reflex, lateral foot sensation

Answer 33

1. ) L5 --> Walk on heels, ABduct hip 2. ) L4 --> Walk on heels with foot inverted 3. ) S1 --> Walk on toes

Question 34

Osteoarthritis of the hip joint is characterized by decreases in what TWO ranges of motion?

Answer 34

1. ) Decreased extension | 2. ) Decreased internal rotation

Question 35

The innominate bone can rotate around a ______ axis, its direction of rotation is named for the direction that the _____ moves.

Answer 35

- Transverse | - Superior iliac crest

Question 36

A posteriorly rotated innominate will make the ipsilateral leg functionally ________. Anteriorly rotated?

Answer 36

Posterior rotation = functionally SHORTER | Anterior rotation = functionally LONGER

Question 37

1. ) If a patient has level iliac crests and significant anterior rotation of right innominate, which came first: Short right leg or rotated innominate? 2. ) What, if any, compensation will occur in the contralateral innominate bone?

Answer 37

1. ) Right short leg came first (likely) | 2. ) Contralateral innominate will rotate POSTERIORLY to compensate

Question 38

An anterior innominate rotation on the LOW PELVIC side suggests what about a leg length discrepancy?

Answer 38

It suggests that the anteriorly rotated innominate is compensating (by functionally lengthening) for an ANATOMICALLY SHORTENED LEG. *While a POSTERIOR ROTATION on the CONTRALATERAL side suggests compensation (functionally shortening) for the shortened right side*

Question 39

If iliac crests are unlevel and the innominate on the lower side is POSTERIORLY rotated, what does this suggest?

Answer 39

That the innominate rotation is causing the pelvic unleveling, and thus a functionally shorter leg. While the opposite side rotated anteriorly is causing a functionally longer leg.

Question 40

The _____ is the key muscle in stabilizing the spine in a side-to-side direction

Answer 40

QL