Lumbar spine has many muscles -
superficial to deep.
The erector spinae muscles, medial to lateral
include the spinalis, longissimus and iliocostalis.
You have the multifidus and rotator
ones that are deeper
which contol more fine motor
motion in the lumbar spine.
And then you could have any
spasm in this region.
Tightness of these muscles can lead to
back pain, could cause asymmetries,
can cause more of a side bending
to one side to the other
can lead to and contribute to type I
The quadratus lumborum is an important
muscle that attaches to the 12th rib
along the vertebral column in the
lumbar spine and then to iliac crest.
Because of it's attachment to the 12th
rib, it actually helps to fix the 12th rib
and stabilize the postural aspect
of the diaphragm with breating.
If the quadratus is spasmed, that could
potentially cause a side bending to that side.
It could also lead to low back pain.
A spasm of the quadratus lumborum could
also cause a dysfunction of the 12th rib
which then could result in
issues with the diaphragm.
The lumbar spine also has considerations
with the abdominal muscles.
The abdominal muscles helps to
make the cylinder around our core.
And so, our abdominal muscles help
to support our abdominal organs
and pelvic organs from falling forward.
Falling forward of the organs is
also called ptosis.
So, the rectus abdominis, external
and internal obliques, the transversalis
all work together to try to keep this core
tight, the cylinder that wraps around the spine.
If you do have weakness or ptosis you could lead
to decreased stability, increased lumbar lordosis
and have more issues with back problems, back
pain and joint degenerations in the lumbar spine.
The iliopsoas muscles are important muscle
to consider when looking at lower back pain.
The iliopsoas is composed of
two different muscles.
The psoas muscle which originates from L1 to
L5 along the anterior portion of the bodies
and then comes down and attaches to
the lesser trochanter in the femur.
And the iliacus which originates
along the pelvis
and comes down and also inserts
along the psoas tendon.
So these 2 combined, help to flex the hip
and what happens with prolonged sitting
or if you're stuck in a crouched,
crawling position for a long time,
these muscles could become hypertonic,
they could become shortened.
And when you have a sudden stretch
like getting up too quickly,
these muscles could contract,
forcing you to flex forward.
And so, clinically if you see a patient that
is spasmed on one side and flexed forward,
having a little bit of like a limping gait,
unable to straigten up fully
what they say that when they try to lay
down flat that their back hurts more,
this would point more to a potential
Where the psoas muscle is
contracted and irritated.
Another consideration sometimes with kidney
stones, the passing of the kidney stones,
stone passing through the
ureter, if there's ureter irritation
because of the proximity of the kidney
and the ureters to the psoas muscle,
sometimes you could have that reflex spasm
due to the inflammation in the region.
Range of motion assessment in the lumbar spine
is really combined thoracolumbar spine.
It's hard to isolate only motion
at the lumbar spine only.
So, if we ask our patient to flex forward, that would
be forward flexion of the thoracolumbar spine
and you're measuring here
the amount of forward flexion
with a straight line drawn through
the lumbar spine.
So here, you could see that it
flexes forward at about 80 degrees.
We're not accounting for the additional
flexion of the thoracic spine here.
Extension would be about 30 degrees.
Again, drawing a line straight through
the bodies of the lumbar spine.
And flexion and extension occurs
along the saggital plane.
In the coronal plane, you could have
lateral bending or side bending.
And in the lumbar spine,
you limit it to about 35 degrees.
Remember, the facets are oriented more vertically
so it decreases the amount of lateral
flexion that you could have.
Thoracolumbar rotation is about
45 degrees on a transverse plane.