Romans 10:9 New International Version (NIV) 9 If you declare with your mouth, “Jesus is Lord,” and believe in your heart that God raised him from the dead, you. Schafer, DC, Ph. D, FICC's best- selling book: “Symptomatology and Differential Diagnosis”. The following materials are provided as a service to our profession. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress. We are an Amazon Associate. We make a small commission on every purchase you make. Help us support chiropractic research with your purchase. Schafer's books are now available on CDs, with all proceeds being donated to chiropractic research. Please review the complete list of available books. Largo di Torre Argentina is a square in Rome, Italy, that hosts four Republican Roman temples, and the remains of Pompey's Theatre. It is located in the ancient. Via Sacra, Rom: Se 241 anmeldelser, artikler og 308 billeder fra Via Sacra, nr.96 p The origins of the Torre Argentina Cat Sanctuary combine a colorful array of ancient Roman history, international cooperation and even a bit of Hollywood! Brunnstrom's Clinical Kinesiology, 5th ed. Extension is controlled by stretching of the anterior longitudinal ligament and rectus abdominis, relaxation of the posterior ligaments, and contraction of the spinal extensor muscles. Loss of lumbar extension is usually the result of poor sitting posture and/or inadequate extension mobilization following injury in which shortened scar tissue prevents a full range of extension. Reduced extension. If a person must work habitually in a prolonged forward flexed position, periodic lumbar extension will relieve the stress of the posterior anulus and tend to shift a loose nucleus pulposus anteriorly; ie, away from the spinal cord and IVF. Many manual workers do this maneuver automatically. About 7. 5% of all spinal flexion below the neck occurs in the lumbar spine, and about 7. Any muscle with vertical or oblique fibers that connects the thorax with the pelvis assists in flexion of the trunk. The major actions involved are bilateral activity of the rectus abdominis, external and internal oblique, and psoas major. During lower back flexion or extension, there is far less vertebral gliding than seen in other areas of the spine during A- P motion. Widening of the anterior disc on extension or of the posterior disc on flexion does not occur until movement nears its full range of motion. Even then, it is much less than that seen in other areas of the spine. The anterior longitudinal ligaments relax during lumbar flexion, and the supraspinal and interspinal ligaments stretch. To measure flexion, the standing patient flexes forward and attempts to touch the floor with his fingertips. Then the floor- fingertip distance is measured. Such flexion in the adult will not normally result in a kyphosis of the lumbar area as flexion does in the cervical area. While a number of disorders result in decreased flexion, paraspinal muscle spasm is the primary cause. All trunk flexors and extensors can produce lateral flexion when acting unilaterally. The major muscles involved are the rectus abdominis, external and internal obliques, erector spinae, semispinalis thoracis, latissimus dorsi, deep posterior spinal muscles, quadratus lumborum, and psoas. Rotation to the same side is produced by the internal oblique and erector spinae. While lumbar motion is potentially greater than that of the thoracic spine because of the lack of rib restriction, the angle of facet facing and the heavy ligaments check the range of rotary motion. Although great curves in the lumbar area are commonly seen, most of the apparent rotation seen is from distortion of the lumbar spine's base, tipping, and the lumbar lordosis viewed out of its normal plane. Trunk Motion. Joint Motion. Prime Movers and Accessories. Extension. Iliocostalis lumborum. Iliocostalis thoracis. Interspinalis*Intertransversari*Longissimus thoracis. Multifidi*Quadratus lumborum*Rotators*Semispinalis*Spinalis thoracis. Flexion with rotation. External obliqueabdominis. Internal oblique abdominis. Forward flexion. External oblique abdominis*Internal oblique abdominis*Psoas major*Rectus abdominis. Lateral flexion. Erector spinae group. External oblique abdominis. Internal oblique abdominis. Latissimus dorsi. Psoas major. Quadratus lumborum. Rectus abdominis. Semispinalis thoracis. Transversospinalis group. Rotation. Erector spinae. External oblique abdominis. Internal oblique abdominis. Intertransversari*Psoas major*Quadratus lumborum*Rotators*Semispinalis*Accessories. THORACOLUMBAR TRANSITIONAL AREA MOTIONBecause of the restriction of normal movements in the thoracic spine and the relatively mobile lumbar spine below, the intervening thoracolumbar area must achieve a degree of hypermobility in all three body planes. Thus, as is true to some extent in all spinal transitional areas, the thoracolumbar junction is more prone to stress from both above and below because of its unusual design. The articulating facets of the transitional vertebra resemble thoracic facets and are designed for rotation and lateral flexion, even though these motions are restricted somewhat by the free ribs. While the stiff thoracic spine tends to move as a whole, most rotation takes place in the lower segments that are not restricted by the rib cage. The effect is a mechanical accommodation of the lumbar spine above assuming a posterior rotation on the side of the unilateral sacral anteroinferiority. It also tends to assume an anteroflexed position, thus producing the three- dimensional movements of the lumbar spine. In view of the intricacy of the lumbosacral junction, anomalies (eg, asymmetrical facets) have a strong influence on predictable movements in this area. Because of its deep position below the iliac crests and the strong strapping by the iliolumbar ligaments and spinal extensors, L5 is only as movable as the sacral base will allow. Thus, when lipping of or spurs at the inferior L5 body are seen, a history of instability can be presumed. Because the sacrum does not have distinct articular planes but moves within the pelvic ring, its motion is multidirectional for 1–3 mm rather than in restricted directions. This multidirectional motion is especially passive in the non- weight- bearing positions and affected above from lumbar forces and/or laterally and below from iliac- ischial forces. However, Wyke and others report that they are. We can suspect that fibrotic changes following the granulation tissue of irritation, especially in the lumbosacral region, frequently fix the sleeve at one or more points. This would contribute to traction on the sheath and its contents during movements such as exhibited in a supine straight- leg- raising test. Such abnormal attachments increase in strength with repetitive trauma, aging, and other degenerative changes. The major nerves of the lumbosacral plexus and their function are given in Table 1. There are about twice as many sensory fibers than motor fibers in the lumbar roots. When the anterior root is irritated, pain is felt in the muscles supplied and often becomes self- perpetuating from the focal spasm produced. In posterior root irritation, pain can be felt in the dermatome, myotome, sclerotome, and possibly in the viscerotome. The nerve root in the lumbar spine runs anterior and superior to the facets. It is often compressed in the IVF by a subluxated articular facet and less often by a herniated disc or a spur from the posterior aspect of the vertebral body. These disorders can be made worse by spinal stenosis, which narrows the vertebral canal and possibly the tunnels in which the nerve roots exit. Segmental Innervation of the Lumbosacral Spine. Segment. Major Muscles Supplied. L1- 2. Cremaster. L1- 5. Iliopsoas. L2- 3. Sartorius, pectineus, abductor longus. L2- 4. Quadriceps, gracilis, adductor brevis. L3- 4. Obturator externus, adductor magnus and minimus. L4- 5. Tibialis anticus. L4- S1. Semimembranosus, semitendinosus, extensor hallucis longus, popliteus, plantaris, extensor digitorum longus, extensor hallucis brevis, gluteus medius and minimus, quadratus. L5- S1. Peroneus longus and brevis, tibialis posticus, flexor digiti brevis, abductor hallucis. L5- S2. Gluteus maximus, obturator internus, biceps femoris, soleus, gastrocnemius, flexor hallucis longus. S1- 2. Lumbricales, piriformis, abductor digiti, flexor digiti, opponens, quadratus plantae, interossei. S2- 4. Levator ani, bulbocavernosus, ischiocavernosus. S4- 5. Sphincter vesicae. S5- Cx. 1Sphincter ani, coccygeus Segment. Skin- Reflexes. L1- 2. Cremasteric. L4- S1. Gluteal. S1- 2. Plantar. S5- Cx. 1Anal Segment. Tendon Reflexes. L2- 4. Patellar. L5- S2. Achilles. Table 1. Nerve Function of the Lumbosacral Plexus. Nerve. Function. Femoral. Sensory to skin over anterior and medial thigh, knee, leg, dorsum of foot to base of 1st metatarsal. Motor to iliacus, pectineus, sartorius, quadriceps femoris. Genitofemoral. Sensory to skin over scrotum, upper anterior thigh area. Motor to levator ani, coccygeus, sphincter ani externus, transversus perinei superficialis, profundus, bulbocavernosus, ischiocavernosus, sphincter urethrae membranacae. Sciatic. Sensory to skin over posterolateral aspect of leg and lateral foot; heel; over upper third of lateral aspect of leg below knee; over anterolateral aspect of leg and dorsum of foot and toes; medial aspect of sole, great toe, 2nd to 4th toes; lateral aspect of sole, 4th and 5th toes; on dorsum of foot between great toe and 2nd toe. Motor to hamstrings, adductor magnus, gastrocnemius, plantaris, soleus, popliteus, tibialis anterior and posterior, flexor and extensor digitorum longus and brevis; peroneus longus, brevis, and tertius; abductor and adductor hallucis, flexor hallucis brevis, extensor hallucis longus, quadratus plantae, abductor digiti quinti brevis, all interossei, and 1st through 4th lumbricals. Superior gluteal. Motor to gluteus minimus and medius, tensor fascia lata. This reflex is also initiated when a gloved finger is inserted into the rectum such as during a prostate examination. This normal reflex is absent in tabes dorsalis and lesions of the cauda equina or conus medullaris. Bladder and Rectal Reflexes. Normal sphincter regulation of the bladder and rectum is under the control of the pelvic autonomic nerves. If the motor fibers to these sphincters are impaired, incontinency is the result. If the sensory fibers are impaired, distention and dribbling result because the urge to defecate or urinate has been diminished (eg, tabes dorsalis).
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