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Transcript
Muscular Anatomy
Lumbar Spine
Multifidus
Origin
Back of sacrum, fascia covering erector
spinae, mammillary processes of lumbar
vertebrae, transverse processes of thoracic
vertebrae and articular processes of the
lower 4 or 5 cervical vertebrae
Spines of all vertebrae from L5 to Axis
Insertion
Action
Nerve Supply
Extension, rotation and side flexion. Acts as
extensible ligaments – stabilising vertebral
column on movement by changing length
Posterior primary rami od adjacent spinal
nerves.
N/A
Palpation
Transverse processes of T6 – T10
Semispinalis Thoracic
Origin
Spinous Processes of C6 – T2
Insertion
Action
Nerve Supply
Both sides acting together causes thoracic
extension. One side causes contralateral
rotation
Posterior Primary Rami of the adjacent
spinal nerves
N/A
Palpation
Iliolumbar ligament and adjacent iliac crest
Quadratus Lumborum
Origin
Insertion
Action
Nerve Supply
Palpation
Medial half of the lower border of the 12th
rib and anterior tubercles of the transverse
processes of all lumbar vertebrae
Ipsilateral Side flexion. Lumbar extension.
Fixes 12th rib on deep inspiration to give a
fixed origin for the diaphragm. Prevent the
pelvis dropping on the none weight bearing
side during single leg stance
Anterior Primary Rami of the Subcostal
nerve and the upper three or 4 lumbar
nerves (T12, L1, L2, L3 and L4)
Model side lying on uninvolved side. Raise
the arm above the head to elevate the rib
cage, and drop the knee of the involved side
behind the other knee onto the table.
Palpate the space between the between the
iliac crest and 12th rib.
Intertransversarii
Origin
Adjacent transverse processes of the lumbar
vertebrae
Insertion
Adjacent transverse processes of the lumbar
vertebrae
Action
Stabilising adjacent vertebral segments and
can produce Ipsilateral side flexion
Nerve Supply
Lateral Slips – Anterior primary rami of
adjacent spinal nerves. Medial slips –
Posterior primary rami of adjacent nerves
Palpation
N/A
Rotatores
Origin
Adjacent to the transverse process
Insertion
Lamina of the vertebrae above
Action
Extension and lateral side flexion. Can cause
rotation in thoracic region only. Along with
Multifidus, act as extensible ligaments
Nerve Supply
Adjacent Posterior Primary Rami nerves
N/A
Palpation
Interspinalis
Origin
Spinous process below
Insertion
Spinous process above
Action
Extensible ligaments primarily. Can produce
extension of the lumbar spine
Nerve Supply
Adjacent posterior primary rami nerves
Palpation
N/A
Erector Spinae
Origin
Insertion
Action
Erector Spinae originates from a thick, flat tendon
which attaches around the origin of Multifidus in
a ‘ U ‘shaped line. It consists of a 3 muscles
(Illiocostalis, Longissimus and Spinalis) and has
multiple origins.
Iliocostalis: Inferior borders of the lower 6 ribs
near their angles. Longissimus :Transverse
processes of all thoracic vertebra and lower ten
ribs. Spinalis: Spinous Processes of T1-T6.
Bilateral contraction causes trunk extension.
Unilateral contraction causes ipsilateral side
flexion and ipsilateral rotation. Controls flexion
of the trunk. Lumbar region works when one
legged standing or walking to prevent pelvic
drop on NWB side
Nerve Supply
Adjacent posterior primary rami nerves
Palpation
The three columns can be seen and felt lateral to
the Spinous Processes of the lumbar, thoracic and
cervical vertebrae. Can be identified easily in
prone if the client extends the head and trunk.
Rectus Abdominis
Origin
Symphysis pubis and pubic crest
Insertion
Anterior surface of xiphoid process and
costal cartilages of the 5th 6th and 7th ribs
Lumbar flexion, Posterior pelvic tilting
Action
Nerve Supply
Anterior primary rami of T6/7-T12
Palpation
Vertically and centrally on the abdomen
with resisted trunk flexion
External Oblique
Origin
Outer borders of the lower 8 ribs and costal
cartilages
Insertion
Outer lip of the anterior two thirds of the
iliac crest, line alba, and forms the inguinal
ligament
Action
Flexion, contralateral rotation and
ipsilateral side flexion. Posterior pelvic tilt.
Nerve Supply
Anterior primary rami of T7-T12nerves
Palpation
Flat hand over the lower lateral aspect of
the ribs with resisted flexion and combined
rotation
Internal Oblique
Origin
Insertion
Action
Lateral two thirds of inguinal ligament,
anterior two thirds of intermediate line of
iliac crest, thoracolumbar fascia
Inferior borders of lower 4 ribs, abdominal
aponeurosis to linea alba
Flexion, ipsilateral rotation and ipsilateral
side flexion. Posterior Pelvic tilt
Anterior primary rami of T7-L1 nerves
Nerve Supply
Palpation
Flat hand placed over the lower abdomen
just above the anterior half of the iliac crest.
With resisted flexion and combined rotation
Psoas Major
Origin
Adjacent margins of the bodies of the
vertebra and discs and anterior medial
transverse processes from the body of T12
to the body of L5
Insertion
Tip and posterior aspect of lesser trochanter
of the femur
Action
Flexion of the hip and lumbar spine
Nerve Supply
Anterior rami of L1-L3/4
Palpation
Model supine with hip and knee flexion,
feet resting on table. Therapist places
fingers 2 inches lateral to umbilicus on
lateral edge of rectus abdominis. Pressure
is applied towards to spinal column. Model
can perform hip flexion to confirm
palpation.
Transversus Abdominis
Origin
Anterior iliac crest, lateral half of the
inguinal ligament, thoracolumbar fascia and
cartilages of ribs 6-12
Insertion
Abdominal aponeurosis to linea alba,
xiphoid process and pubic symphysis
Action
Supports abdominal wall, aids forced
expiration and raising intra-abdominal
pressure. Conjoint tendon supports post
wall of inguinal canal
Nerve Supply
7-12 intercostal, iliohyogastric and
ilioinguinal nerves
Palpation
Place fingers just medial and inferior to
anterior inferior iliac spine and ask the
model to draw ASIS together
Psoas Minor
Origin
Sides of the bodies of T12 and L1 and
intervertebral disc
Insertion
Iliopubic eminence and iliac fascia
Action
Weak flexor of the lumbar spine
Nerve Supply
Anterior primary ramus of L1
Palpation
N/A
Iliacus
Origin
Upper and posterior two thirds of the iliac
fossa, ala of the sacrum and anterior
sacroiliac ligament
Insertion
Lesser trochanter of the femur. A few fibres
attach to the hip joint capsule
Action
Hip Flexion. When the origin and insertion
are reversed so the lower point is fixed
iliacus is a lumbar flexor and anteriorly tilts
the pelvis
Nerve Supply
Femoral nerve
Palpation
Anterior aspect of ilium just medial to the
ASIS
Latissimus Dorsi
Origin
Spinous processes of lower six thoracic and
all lumbar and sacral vertebrae,
supraspinous and interspinous ligaments,
outer lip of iliac crest, outer surfaces of
lower 3 or 4 ribs and inferior angle of the
scapula
Insertion
Intertubercular sulcus of humerus
Action
Extends, abducts and medially rotates
shoulder
Nerve Supply
Thoracodorsal nerve and the posterior cord
of the brachial plexus
Palpation
Model seated with hands at their sides.
Place palpating hand on posterior axillary
fold and ask the model to push down on the
table with both hands, attempting to
elevate the pelvis and trunk off the table.
Feel for the contraction of the
latissimusdorsi
Gluteus Maximus
Origin
Insertion
Posterior gluteal line of the ilium, tendon of
sacrospinalis, dorsal surface of the sacrum,
coccyx and sacrotuberous ligament
Gluteal tuberosity of the femur and
iliotibial tract of fascia lata
Action
Extension of the femur, lateral stabilisation
of the hip. Inferior fibres can assist with
adduction and external rotation of the
femur. Superior fibres can assist with
abduction and internal rotation of the
femur.
Nerve Supply
Inferior Gluteal Nerve (L5-S2)
Palpation
Prone lying with one knee joint flexed to
90 . Apply max resistance to posterior
surface of thigh and ask for hip extension.
Gluteus Medius
Origin
Insertion
Outer surface of the ilium from the iliac
crest and posterior gluteal line
Superolateral surface of the greater
trochanter
Action
Abduction of the hip. Anterior fibres assist
with femoral internal rotation. Posterior
fibres assist with external rotation. Stabilise
the pelvis on the femur during single leg
stance
Nerve Supply
Superior Gluteal Nerve L4-L5, S1
Palpation
Model side lying. Place hand between the
iliac crest and greater trochanter of the
femur. Ask model to abduct the femur
Piriformis
Origin
Insertion
Anterior surface of the sacrum between
and lateral to anterior sacral foramen,
capsule of sacroiliac articulation, margin of
the greater sciatic foramen and
sacrotuberous ligament
Superior border of the greater trochanter
of the femur
Action
Extension and external rotation of the hip
in hip extension or neutral. Internal
rotation and abduction in 90° of hip flexion
Nerve Supply
Sacral plexus, L5, S1, S2
Palpation
Model in side lying on uninvolved side with
hip flexed to 90°. Palpate in a line from the
greater trochanter to the palpable border
of the sacrum