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Role of the Lumbar Spine:

Role of the Lumbar Spine:. The relation of the spine to somatoautonomic and somatosomatic components have recently been “discovered” by the medical profession. The most important region as it relates to performance, treatment and prevention of soft tissue injuries. Key to performance:.

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Role of the Lumbar Spine:

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  1. Role of the Lumbar Spine: The relation of the spine to somatoautonomic and somatosomatic components have recently been “discovered” by the medical profession The most important region as it relates to performance, treatment and prevention of soft tissue injuries. Dr. Jack Dolbin Session 5

  2. Key to performance: • As it relates to the shoulder • Villanova swimmers 75% • As it relates to Lower Extremity injuries • As it relates to injuries of the upper extremity • As it relates to performance • 2nd most common injury in sports Dr. Jack Dolbin Session 5

  3. Dr. Jack Dolbin Session 5

  4. Running Kinesiology Dr. Jack Dolbin Session 5

  5. Low Back Injuries: • Sprain! Strain • Pars Fractures • Soft Tissue injuries • Disc injuries Dr. Jack Dolbin Session 5

  6. Golf Swing Sequence Dr. Jack Dolbin Session 5

  7. Dr. Jack Dolbin Session 5

  8. Lumbar Sprain • Flexion: Tearing capsular ligaments, Supraspinous Ligament, possible disc injury. • Extension: Compression facet Joint. Possible Pars fracture. Dr. Jack Dolbin Session 5

  9. Examination • Observation • Inspection: A • Palpation: T • Range of Motion: R • Provocative Tests • Neurology • Imaging Dr. Jack Dolbin Session 5

  10. Diagnostic Tests • Kemps • Adams • Sitting Bechterew • SLR • Braggards • SotoHall • Golthwaits Dr. Jack Dolbin Session 5

  11. Diagnostic Tests • Stork Test • Gaenslens • Obers • Thomas • Yeomans • Nachlas • Elys Dr. Jack Dolbin Session 5

  12. Neurology • Lower extremity neurology • DTR’s • Manual Muscle tests • Pin Wheel • Vascular: Dorsal pedis/Tibial • Pathological Reflexes Dr. Jack Dolbin Session 5

  13. Treatment • If within 24-48 hours deal with the acute tissue response • A. Ice, lazer,HVG, Kinesiotaping. Cyriax • After 48 hours: Cyriax Cross Fiber, Muscle energy, Impulse Adjusting. • Modalities to promote circulation, midrange exercise..Adjustments to fixated joints. Dr. Jack Dolbin Session 5

  14. Pars Injuries • Active Spondylo: • Inactive Spondylo: • Pending Spondylo: • Chapter 5: Dr Terry Yochum • Illustration: Steven Soffer MD. FICS Dr. Jack Dolbin Session 5

  15. Epidemiology • Gymnasts: Female Adolescent • Long Jumpers, Triple Jumpers. • Weight Lifters • Female volleyball, basketball • Athletes that do repetitive hyperextension activities. Dr. Jack Dolbin Session 5

  16. History of repetitive hyperextension activities or extreme vertical stress. • Positive Stork • Positive Kemps. Dr. Jack Dolbin Session 5

  17. Holding our Breath Dr. Jack Dolbin Session 5

  18. Cruising Dr. Jack Dolbin Session 5

  19. Pars Fracture MRI Dr. Jack Dolbin Session 5

  20. Radiological Evidence of pars Defect Dr. Jack Dolbin Session 5

  21. Spondylolysis • There has never been a baby born with a pars defect. • Stress fracture: Dr. Jack Dolbin Session 5

  22. Pars defect Axial View Dr. Jack Dolbin Session 5

  23. Bilateral Pars Defect Dr. Jack Dolbin Session 5

  24. Scotty Dog Dr. Jack Dolbin Session 5

  25. Active Spondylo Dr. Jack Dolbin Session 5

  26. Active or Pending Dr. Jack Dolbin Session 5

  27. Treatment • HF 27 US .02 w/cm2 15 min. • Laser/light 360 seconds • Boston overlap: Minimum 2 months redo spec bone scan or MRI • Once FX is healed: CMT, RMT, progressive resistance exercises as per Wolfes Law. Dr. Jack Dolbin Session 5

  28. Rehab Dr. Jack Dolbin Session 5

  29. Rehab Dr. Jack Dolbin Session 5

  30. Rehab Dr. Jack Dolbin Session 5

  31. Rehab Dr. Jack Dolbin Session 5

  32. Rehab Dr. Jack Dolbin Session 5

  33. Rehab Dr. Jack Dolbin Session 5

  34. Rehab Dr. Jack Dolbin Session 5

  35. Rehab Dr. Jack Dolbin Session 5

  36. Rehab Dr. Jack Dolbin Session 5

  37. Rehab Dr. Jack Dolbin Session 5

  38. Rehab Dr. Jack Dolbin Session 5

  39. Rehab Dr. Jack Dolbin Session 5

  40. Rehab Dr. Jack Dolbin Session 5

  41. Rehab Dr. Jack Dolbin Session 5

  42. Rehab Dr. Jack Dolbin Session 5

  43. The Sacroiliac Joint • Normal function as it relates to performance • Dysfunction as it relates to injury • A. IT Band • B. Patellofemoral syndrome • C. Medial Shear at knee • D. Hamstring Injuries • F. Pronation Dr. Jack Dolbin Session 5

  44. Normal SI Structure/Function • Sits at a 55 degree angle to the sagital plane and 30 degree to the frontal plane • Nutates in both the saggital and frontal plane • Shearing forces ie: long jumping, rebounding can subluxate the sacrum on the ilium spraining the iliolumbar and sacroiliac ligaments. Dr. Jack Dolbin Session 5

  45. Findings • History of shearing force or lifting and twisting • Palpatory exam: Iliolumbar, lumbosacral and sacroiliac ligament • Gaenslens Test • Yeomans • Nachlas Dr. Jack Dolbin Session 5

  46. AP SI Joints Dr. Jack Dolbin Session 5

  47. Anterior Inferior Sacrum Dr. Jack Dolbin Session 5

  48. SI ( continued ) • Injury involves the quad femoris muscle • Magines Syndrome. Marc Heller DC • Very prominent in the female athlete • Usually involves 5th lumbar facet • Iliopsoas Muscle Dr. Jack Dolbin Session 5

  49. Pyriformis Dr. Jack Dolbin Session 5

  50. Pyriformis Dr. Jack Dolbin Session 5

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