Spinal Abnormalities

Question 1

Plumb line surface landmarks

Answer 1

• Ear lobe
• Shoulder joint
• Midway of the trunk
• Greater trochanter
• slightly ant to knee joint
• slightly ant to ankle joint

Question 2

What are the structural changes in exagerrated lumbar lordosis

Answer 2

• Lordosis
• ANterior pelvic tilt
• hip flexion

Question 3

What are the structural changes in sway back

Answer 3

• Pelvis shifted forward in relation to thorax
• Increased lumbar lordosis
• Thoracic kyphosis
• hip extension

Question 4

What muscles are short and strong in sway back

Answer 4

Hamstrings

Upper fibers of IO

Question 5

What muscles are strong but not short in sway back

Answer 5

lumbar erector spinae

Question 6

What muscles are long and weak in sway back

Answer 6

• One joint hip flexors
• External oblique
• Upper back extensors
• Need flexors

Question 7

What are potential sources of dysfunction in sway back

Answer 7

• Stretch iliofemoral lig
• hip joint dysfunction
• Lumbar lordosis/thoracic kyphosis/HFP

Question 8

What are the structural changes in Flat back

Answer 8

Decreased lumbar lordosis + posterior pelvic tilt

Question 9

What muscles are short and strong in flat back

Answer 9

Hamstrings and often abdominals

Question 10

What muscles are long and weak in flat back

Answer 10

one joint hip flexors

Question 11

Possible causes of flat back?

Answer 11

Poor postural habit, poor ergonomics

Question 12

Possible sources of dysfunction for flat back

Answer 12

• short abdominals/hip extensors
• long and weak lumbar extensors
• loss of normal lumbar curve (reduced capacity for shock absorption)
• stretched PLL and lumbar erectors, compressed anterior disc
• altered respiration

Question 13

What muscles are short and strong in HFP

Answer 13

Lev scap
SCM
Scalenes
Suboccipitals

Question 14

What muscles are long and weak in HFP

Answer 14

• Deep neck flexors

- Erector spinae

Question 15

Types of scoliosis

Answer 15

• idiopathic
• Congenital - vertebral deformities
• neuromuscular - second to other conditions

Question 16

Scoliosis S&S

Answer 16

• Decreased nerve conduction - myo, demas, reflexes

- Decreased nerve mobility - SLR, slump

Question 17

Scoliosis Ax

Answer 17

• Forward bend test
• muscle imbalance
• Decreased proprioception

Question 18

Scoliosis Rx

Answer 18

• Posture
• Stretch and strengthen
• CV training (decreases pain)
• If severe - bracing + surgery

Question 19

Postural back pain caused by ____

Answer 19

tissue creep

Question 20

Postural dysfunction S&S

Answer 20

i. pain increases w/ sitting or prolonged postures
ii. poor posture/ergonomic set up
iii. pain not specifically caused by FLEX or EXT
iv. NO neurological s/s
v. better in AM, worse as the day goes on
vi. associated w/ decreased fitness

Question 21

Postural dysfunction Rx

Answer 21

Correct!!!
	posture and ergonomics
	muscle imbalances
	fitness issues
	spinal supports (obus forme)
	education on posture + rest/activity/breaks

Question 22

What are the general risk factors for MSK Injury due to workplace ergonomics

Answer 22

• Repetitive, labor intensive work
• Young ( < 30 yrs)
• First 5 years of practice
• Responding to unexpected movement
• Failure to take rest breaks
• Inadequate training re: injury prevention

Question 23

What are the WorkSafe BC Ergonomic recommendations

Answer 23

o Forearms horizontal, elbows at 90° (or slightly greater) with shoulders/upper arms relaxed
o Wrists neutral (straight) with hands on keyboard or mouse
o Head upright over shoulders, eyes looking slightly downward (~30° with screen 64-75 cm from the floor)
 Top of line of text should be at eye level
 Arms length between your eyes and the screen
o Backrest supporting lower back, pelvis, and the natural curve of your spine (90-110° tilt, minimum 45 cm tall)
o Thighs resting horizontally with a 90-110° angle at the hips (seat height 38-51 cm)
o Feet fully supported by the floor or a footrest with an adjustable slope (10-20°)

Question 24

What are the two components of a disc? Which has pain fibers?

Answer 24

Nucleus pulposis (inner) 
Annulus  fibrosis (outer) 

Annulus has pain fibers

Question 25

What is the healing time for a disc lesion

Answer 25

3 months for ligaments to heal

Question 26

Disc lesion S&S

Answer 26

- Central back pain +/- leg pain - +/- lateral shift (name relative to shoulders) - loss of normal lordosis - flat back - muscle supporting EXT

Question 27

Disc lesions Rx

Answer 27

```  centralize pain, radiate  correct shift  support lordosis  posture education  avoid flexion postures with time  traction (gentle!)  correct: muscle balance, posture, ergonomics ```

Question 28

Stenosis - Causes:

Answer 28

Swelling Disc Osteophyte Bony change

Question 29

Stenosis - S&S:

Answer 29

- Bilateral radiation: legs/feet | - X-ray changes: bony hypertrophy, DDD, spurs

Question 30

Stenosis - Rx:

Answer 30

 posture avoidance, correct muscle imbalances (core, hamstrings)

Question 31

Spondylolisthesis S&S:

Answer 31

- central low back pain +/- referred pain - weak abdominal muscles - +/- tight hamstrings - Agg: Ext - Ease: Flex

Question 32

Spondylolisthesis Rx:

Answer 32

- address lower quadrant muscle imbalance - abdominal strengthening - biomechanical counseling - avoid HYPEREXT activities