The Vollowitz 4
The Fritz Treatment
Back to (Bony) Anatomy
Holding It Together
Disc-isions, Disc-isions
Weird Flex But Okay
Getting on my nerves
The -Tomes
Miscellaneous
100
What are the 4 Classifications according to the common patterns of symptom behavior?
Position Sensitivity, Weight Bearing Sensitivity, Constrained Posture Sensitivity, Pressure Sensitivity
100
What are the LBP classifications based on intervention strategies?
Manipulation, Stabilization, Specific Exercise, Traction
100
How many vertebrae are there in the entire vertebral column?
33 (7 C, 12 T, 5 L, 5 S, 4 Co)
100
What ligament in the vertebral column limits extension?
Anterior Longitudinal Ligament (ALL)
100
Which area(s) of the spine has the greatest amount of mobility?
Cervical and Lumbar Spines
100
What is the name of the structure formed by the Internal Oblique, External Oblique, and Transversus Abdominis?
Rectus Sheath
100
Which areas do the lumbar spine refer symptoms to? (Name 2)
- Abdomen
- Lower T Spine
- SI Region
- Entire LE (hip/knee/ankle/foot)
100
What myotome corresponds to hip flexion?
L2
100
What innervates the muscles of the back?
Dorsal Rami
200
Name the condition that is consistently aggravated by specific postures/positions while also being relieved by other postures/positions?
Position Sensitivity
200
A patient presents with an "instability catch" or aberrant movement during lumbar ROM; which of the Fritz classifications would you be tempted to identify her as?
Stabilization
200
Name the primary curves of the vertebral column
Thoracic and Sacral
200
Identify This Structure
Iliolumbar Ligaments (resists flexion, extension, axial rotation, and lateral bending of L5 on S1)
200
Which part of the disc has the highest percentage of proteoglycans?
Nucleus Pulposus (due to necessity of resisting compressive loads)
200
Name the erector spinae muscles from most medial to most lateral
Spinalis, Longissimus, Iliocostalis
200
What DTR Grades can be considered normal?
1+, 2+, 3+
200
In general, what dermatomes correspond to the anterior/ventral LE?
L1 - L5
200
What ligaments create the greater and lesser sciatic notches?
Sacrotuberous Ligament, Sacrospinous Liagment
300
A patient arrives in the clinic complaining of low back pain, as you examine the patient's bony alignments via palpation of the pelvic girdle landmarks you notice the patient cringing away from your touch; which Vollowitz 4 does this indicate?
Pressure Sensitivity
300
You suspect a nerve root compression based on signs and symptoms presented and discover that no movements centralize the symptoms; what classification is indicated?
Traction
300
What makes up the mobile segment (the smallest unit in the spine)
2 Adjacent Vertebrae, Intervening Intervertebral Disc, All Soft Tissue that Secure them Together
300
This ligament limits forward flexion and reinforces the posterior portion of the annulus fibrosus, it is narrow in the Lumbar Spine
Posterior Longitudinal Ligament (PLL)
300
What are the 2 functions of the intervertebral discs?
1. Separate 2 Vertebral Bodies (also acceptable: increase available motion)
2. Transmit Loads (from 1 vertebral to the next)
300
What is the function of the multifidus?
Rotation (to opposite side)
300
What are the two most important nerves in the Lumbar Plexus?
Femoral Nerve (muscular innervation of anterior thigh)
Obturator Nerve (muscular innervation of medial thigh)
300
What dermatome corresponds with the heels and medial calf?
S1
300
What do the mesoderm, ectoderm, and endoderm give rise to? (partial credit available)
Mesoderm: MSK (+ Circulatory System + Dermis)
Ectoderm: NS (+ Epidermis)
Endoderm: GI (+ Lining of Organs)
400
These types of patients experiences an increase in symptoms at night, when waking up, during driving, and standing
Constrained Posture Sensitivity
400
Name 2 of the characteristics that fall in the Manipulation Criteria?
- No symptoms distal to the knee
- Recent onset of symptoms (< 16 days)- Low FABQ score (< 19)
- Hypomobility of the lumbar spine
- Hip IR ROM > 35 degrees for at least 1 hip
400
All of the highlighted structures can be identified as the...
Neural Arch
400
Identify the ligament(s) that limit lateral flexion
Intertransverse Ligaments (also acceptable: Alar Ligaments)
400
What determines the amount of motion at the intervertebral disc?
Ratio between Disc Thickness and Vertebral Body Height
400
What muscle creates lateral trunk flexion or "hip-hiking" when contracted unilaterally and lumbar extension when contracted bilaterally?
Quadratus Lumborum
400
What levels of the vertebral column do the Lumbar Plexus and Sacral Plexus nerves emerge from? (Partial credit available
Lumbar: L2 - L4
Sacral: L4 - S4
400
What myotome corresponds with plantar flexion/eversion?
S1
400
This term refers to a sensation that feels like a narrow band of sharp pain following a nerve path that can be accompanied by sensory or motor symptoms
Radicular
500
These types of patients change position very often during load bearing activities and will frequently shift from one end range lumbar position to another (with very little relief)
Weight Bearing Sensitivity
500
Patients with an Extension Specific Exercise Classification have what criteria? (Name at least 1)
- Directional preference for extension
- Symptoms centralize w extension
- Symptoms peripheralize w flexion- Symptoms distal to buttock
500
Vertebrae in the lumbar spine are most restricted in what motions?
Rotation
500
What are the first 2 ligaments to be damaged by excessive flexion?
Interspinous Ligament, Supraspinous Ligament
500
Name the 4 levels of herniations (bonus points for descriptions!)
Protrusion
Prolapse
Extrusion (where annular fibers are disrupted)
Sequestration
500
The pelvic diaphragm muscles are innervated by...
Branches of Sacral Plexus
500
Describe the following terms with one word:
- Neurapraxia
- Axonotmesis
- Neurotmesis
Neurapraxia: compression
Axonotmesis: stretch
Neurotmesis: severance
500
What myotome corresponds with dorsiflexion/inversion?
L4
500
When a patient forward bends, what combination of side bending and rotation will result in the greatest amount of movement
Side bending and Rotation in same direction
600
In a patient with Position Sensitivity, you notice that they tend to display passive positioning behaviors with less acute thigh - torso angles (i.e. standing is preferable to seating, sleeping supine is preferred to prone). What type of position bias might this patient have?
Extension Bias
600
Postpartum patients tend to fall under what classification?
Stabilization
600
What specializes the Lumbar vertebrae? (Name at least 1 characteristic)
- Large vertebral body
- Short and thick pedicles- Short and broad laminae
- Long slender TP
- Thick broad SP- Triangular shaped vertebral forament
600
This ligament resists forward flexion by resisting the separation of the laminae, it is strongest/thickest in the L Spine; its name comes from the slight yellow color this ligament usually has.
Ligamentum Flavum
600
In the IV discs, the collagen fibers of the annulus fibrosus are arranged in sheets/lamellae, these are arranged in concentric rings that surround the nucleus and are oriented in opposite directons by about 120 degrees to each other. What is the advantage from this?
Allows tensile force resistance in nearly all directions
600
Name the all muscles that contribute to increasing intra-abdominal pressure and forced expiration?
External Oblique, Internal Oblique, Transversus Abdominus, Rectus Abdominus
600
This refers to degeneration of an axon that occurs distal to the site of damage, wherein the myelin and distal axon are phagocytized
Wallerian Degeneration
600
What myotome corresponds with great toe extension?
L5
600
What 2 major conclusions can be drawn about the patient's pain from the Movement Diagram above?
Patient is in Constant Pain at rest
Pain in the Limiting factor (Pain Dominant)