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Anatomy, Joint Orientation and
Lumbar Spine
Between Vertebral Bodies
Anterior Longitudinal Ligament
 Supports the vertebral column and discs
 The deep fibres connect adjacent vertebrae
 The superficial fibres extend across several vertebrae
Posterior Longitudinal Ligament
 The deep fibres connect adjacent vertebrae
 The superficial fires extend across several vertebrae
 Fibres only connect to the intervertebral discs and adjacent margins
 The posterior ligament is considerably weaker than the anterior ligament
 The ligament is thicker when over the intervertebral discs
Zygapophyseal Joint
Ligamentum Flavum
 Passes from the laminae of adjacent vertebrae
 Present bilaterally
 Ossification or hypertrophy of this ligament can cause spinal stenosis
Supraspinous Ligament
 Runs across and connects the spinous processes
Interspinous Ligament
 Small ligament that joins adjacent vertebral spines
Lumbosacral Joint
Iliolumbar ligament
 Passes from the transverse process of L5 to the posterior inner lip of the iliac crest
 Can often refer pain anteriorly into the groin and genitals
 Restricts mainly lumbosacral contralateral side flexion
Lateral lumbosacral ligament
 Passes from the transverse process of L5 to the ala of the sacrum
Sacroiliac Joint
Anterior Sacroiliac Ligament
 Broad and flat ligament arising from ala and pelvic surface of the sacrum to the auricular
surface of the ilium
 Limits sacral nutation (sacrum flexion relative to ilium)
Interosseous Sacroiliac Ligament
 Deepest and strongest of all the posterior ligaments
 Fills the gap connecting the tuberosities of the sacrum and ilium
 Prevents distraction forces of the sacroiliac joint
Posterior Sacroiliac Ligament
 Made up of 2 components
1. Short Posterior (Dorsal) Sacroiliac Ligament
 Runs from first and second transverse tubercles of sacrum to tuberosity of the ilium
 Limits sacral nutation
2. Long Posterior (Dorsal) Sacroiliac Ligament
 From the posterior superior iliac spine to the third and fourth transverse tubercles of the
 Limits sacral counternutation
Sacrotuberous Ligament
 From posterior border of ilium between posterior superior and posterior inferior iliac spine,
lower transverse sacral tubercles to the ischial tuberosity
 Lower fibres of ligament merge with biceps femoris
 Posterior surface of ligament gives attachment for gluteus maximus
 Ligament tightens during nutation
 Biceps femoris and gluteus maximus can stabilise SIJ by tightening sacrotuberous ligament
Sacrospinous Ligament
 From lateral margins of sacrum and coccyx to ischial spine
 Merges with gluteus maximus fibres
 Ligament tighten during nutation
Joint Orientation
Lumbar Spine
L1- L5
Superior Articular Facets
 Articulates with inferior articular facet of the superior vertebrae
 Face posteriorly and medially
Inferior Articular Facets
 Articulates with the superior articular facet of inferior vertebrae
 Faces anteriorly and laterally
Lumbosacral Joint
 Inferior aspect of L5 articulates with the superior aspect of the sacrum
 Bones joint like typical vertebrae consisting of zygapophyseal joints and intervertebral discs
 Sacrum is angled posteriorly on L5 vertebrae and intervertebral disc is thicker anteriorly
Sacroiliac Joint
 Crescent shaped
 Face laterally
Crescent shaped
Face medially and posteriorly
Joint Information
Capsular Pattern
The limitation of movement in a defined pattern which usually indicates arthritis. It can indicate
degenerative, inflammatory or traumatic arthritic symptoms. The movements usually take on a
‘hard’ end feel rather than a normal elastic capsular resistance. Involuntary muscle spasm occurs to
protect a painful joint, preventing painful ranges of movement. Ranges of movement that are
underused become limited as the capsule contracts disproportionately. This causes a gross limitation
of certain movements giving rise to a distinct pattern.
End Feel
End feel is the specific sensation felt in the therapist’s hands at the end of range passive movements.
Normal end feels have been divided into three categories
Hard End Feel- bone on bone contact
Soft End Feel- soft tissue on soft tissue contact
Elastic End Feel- passive tension of inert structures around the joint
If an injury has occurred end feels can be divided again into 3 abnormal end feel categories
‘Hard’ End Feel- Involuntary muscle spasm can protect a joint giving a ‘hard’ end feel. A ‘hard’ end
feel can also be the result of capsular resistance. Finally a ‘hard’ end feel can be due to bone on bone
contact in end stage arthritis symptoms where a soft or elastic end feel would normal be detected.
Springy End Feel- usually the result of a mechanical joint displacement or loose body. There is
usually a small restriction in joint range with the joint springing for bouncing back.
Empty End Feel- usually associated with serious pathology or a highly irritable injury. Therapist is
unable to test end of range as patient’s halts the movement with voluntary muscle spasm
Resting Position
This is the position in which the joint is under the least amount of stress. This allows joint play to be
assessed easily. This position results in decreased contact areas for the joint surface providing
proper joint lubrication and allows complete arthrokinematics at the joint.
Close Packed Position
In this position the joint is under maximal tension and the joint surface is fully congruent. This
position is often painful for a joint that is swollen.
Arthrokinematics- Lumbar Spine
Capsular Pattern
Resting Position
Close Packed
End Feel
Sidebending and Rotation, then Extension
Midway between flexion and extension
Full Extension
 Flexion- ELASTIC -STRETCHING of posterior ligaments, posterior annulus
of disc and zygapophyseal joints. PASSIVE TENSION of posterior lumbar
 Extension- ELASTIC – STRETCHING of anterior annulus of disc,
zygapophyseal joint capsules and anterior lumbar musculature. HARD IMPACT of spinous processes and zygapophyseal joints
 Lateral flexion- ELASTIC – STRETCHING of contralateral intertransverse
ligaments, lateral annulus of disc, contralateral lumbar musculature. HARD
– IMPACT of ipsilateral zygapophyseal joints
 Rotation- ELASTIC – STRETCHING of contralateral intertransverse
ligaments, lateral annulus of disc, contralateral lumbar musculature. HARD
– IMPACT of ipsilateral zygapophyseal joints
 Flexion- upper vertebrae rolls anteriorly and glides anteriorly
 Extension- upper vertebrae rolls posteriorly and glides posteriorly
 Lateral flexion- ipsilateral inferior articular surface of superior vertebrae
glides posteriorly and inferiorly
 Rotation- minimal movement especially in a position of extension
Sacroiliac Joint
Capsular Pattern
Resting Position
Close Packed
Sacroiliac Joint
Pain when joints are stressed
End Feel
 Unknown
 See Below
Sacroiliac Joint Movement
Lots of variations and discrepancies exist
Generally accepted that there is nutation and counter nutation
 Flexion position of the sacrum relative to the ilium
 This increases lumbar lordosis
 Close packed and stable position of the SIJ
 More commonly adopted during weight bearing positions
Counter Nutation
 Extended position of the sacrum relative to the ilium
 Decreases lumbar lordosis
 Unstable position of the SIJ
 More common in non-weight bearing positions such as lying supine
 Pain when lying supine in SIJ can be change by flexing the knees and hips, as this causes
nutation of the SIJ making it more stable
Sacroiliac Movement during Lumbar Spine Movement
Lumbar Spine Flexion
 During lumbar flexion the sacrum initially move into a position of nutation
 As tension in the posterior structures of the lumbar spine increases the pelvis is rotated
anteriorly, causing counter nutation of the sacrum
 The sooner counter nutation occurs the more unstable the SIJ becomes increasing the risk of
Lumbar Spine Extension
 During lumbar extension the sacrum moves into a position of nutation
Active Straight Leg Raise
 As the leg is raised the sacrum should rotate anteriorly to the ilium into a position of
nutation and become stable
 In those who experience pain with the active straight leg raise, including those with pelvic
girdle pain during and after pregnancy, the ilium may rotate anteriorly relative to the sacrum
(counter nutation) creating instability and pain
 Pain during active straight leg raise may also be caused due to excess lumbar rotation or
Coupling refers to a movement at a joint that occurs in combination with a different movement
around a separate axis. Coupling occurs at all joints throughout the spinal column.
Coupling can be categorised into 3, depending on ‘Fryette’s Law’
Law 1 – Neutral side bending produces rotation to the other side.
Law 2- Non Neutral rotation and side bending go to the same side
Law 3- Introducing motion in one vertebral joint in one plane automatically reduces its mobility in
the other two planes
Coupling - Lumbar Spine
There is variation into the coupling motions available at the lumbar spine. The information
given below should be used as a guide only
Flexion of the lumbar spine- Rotation and lateral flexion occur to the same side (Type 2)
Neutral or extension of the lumbar spine- Rotation and lateral flexion occur to opposite sides (Type
Spinal Locking
Spinal locking is necessary when performing long-level high-velocity low-amplitude (HVLA) thrusts.
In order to do this the spine must be placed in a position opposite to its normal coupling behaviour.
Spinal Locking- Lumbar Spine
Flexion of the lumbar spine- Locking is achieved with lumbar rotation and side bending to opposite
Neutral or extension of the lumbar spine- Locking is achieved with lumbar rotation and side bending
to the same side