lumbarisation.pptx
- 1. Lumbarisation /Sacralization Dr.Simranjeet Kaur (Pt) Assistant Professor MMIPR,MM(DU)
- 2. Lumbarisation • Lumbarisation is an anomaly in the spine. • It is defined by the nonfusion of the first and second segments of the sacrum • The lumbar spine subsequently appears to have six vertebrae or segments, not five. This sixth lumbar vertebra is known as a transitional vertebra. Conversely the sacrum appears to have only four segments instead of its designated five segments..
- 3. • Lumbosacral transitional vertebrae consist of the process of the last lumbar vertebra fusing with the first sacral segment. While only around 10 percent of adults have a spinal abnormality due to genetics, a sixth lumbar vertebra is one of the more common abnormalities
- 4. • Lumbarisation is where the uppermost segment of the sacrum is not fused. Rather it is free to move and participates, along with the neighbouring lumbar vertebrae in spinal activity. The first sacral segment is said to be lumbarised.
- 7. Sacralization • is often described as having one fewer vertebra because the bottom lumbar segment (L5) is fused to the pelvis. It can either being fused to the sacrum below, or to the ilium at the side (the large ear-shaped bones of the pelvis) or both. • Sacralisation with the sacrum can be termed central sacralisation, whereas to the sides it can be either uni- or bi-lateral transverse sacralisation. Being fused or semi-fused the L5 segment has more in common with its sacral neighbours than its (mobile) lumbar ones, hence it is said to be sacralised.
- 8. • With central sacralisation the vertebra may be solidly fused or there may be a slight degree of movement through the presence of a vestigeal L5 disc. It is well possible to get to advanced years being completely unaware that you have one less vertebra. Problems may only come to the fore when fitness levels diminish, particularly the strength of the abdominal muscles.
- 9. Types • Fully sacralised joint (that is fully fused) is usually pain-free but causes symptoms elsewhere at other joints - centrally at the level above and contra-laterally at both the same level and higher levels throughout the lumbar spine. This is described more fully below. • Partially sacralised joint (with a some degree of movement) is more likely to develop symptoms. also called Bertolotti's syndrome
- 10. Bertolotti's syndrome • It is a pseudo arthrosis • when a transverse process of L5 nudges permanently up against the bone of the pelvis. The pain of BS is typically one-sided and felt where there is a 'bony hardness' at the top of the back of the pelvis.
- 11. • more complex one-sided disturbance of the biomechanics through the base of the spine. • Leg length discrepancy may be implicated in bringing symptoms of partial sacralisation to the fore.
- 12. Full- fusion unilateral sacralisation • bottom lumbar segment has several knock-on effects. The first is excessive movement strain of the pseudarthrosis on the contralateral side. One treatment option is to surgically fuse the pseaudarthrosis although conservative mobilising and self-treatment techniques to make the false joint work better should be tried exhaustively first.
- 13. A fused unilateral sacralisation throws movement strain to the contralateral joint at the same level Unilateral fused sacralisation causes contralateral/cephalad movement strain at higher lumbar levels.
- 14. Full fusion bilateral sacralisation • commonly causes degenerative breakdown of the L4 disc above, related to the altered centre of gravity of the base of the spine. With the L5 fused to the sacrum, the seat of spinal movement is raised. L4 - the 'new' spinal base - lacks the secure shoring afforded L5 and this can lead overuse syndrome and developmental instability of the L4 segment.
- 15. Causes • Generally patients experience LBP and there are some points which enhance their symptoms • Poor sitting posture that places stress on the affected joints • Twisting movements that can irritate nerve roots • Lifting heavy loads incorrectly • Sitting for prolonged periods • Low levels of physical activity
- 16. Symptoms • Lower back pain along with buttock pain • Inflammation • swelling • stiffness of back • Limited ipsilateral (same side of the body) flexion • Reduced mobility • Muscle spasms • Decreased coordination and flexibility • increased risk of injury • Sciatica or radicular pain patterns • Chronic back pain in adolescents
- 17. Treatment • Depends on the nature of the anomaly and the lumbarized sacral bone . • Anti-inflammatory drugs, muscle relaxants for back pain, swelling, inflammation. • Injections and steroid treatment • Surgical treatment may be considered for cases requiring correction
- 18. Physiotherapy • Improving the spine's supporting muscles • Relieving strain on the discs and facet joints • Reducing rigidity and enhancing mobility • Increasing blood flow helps provide nutrients more evenly throughout the body, notably to the spinal discs • Endorphin release, which has the ability to reduce pain. Endorphin release on a regular basis might lessen the need for painkillers. Another benefit of endorphins is the reduction of depressive symptoms, which are a typical side effect of chronic pain.lowering the frequency of back or neck pain attacks and the intensity of the pain when they do occur
- 19. • Endorphins are chemical messengers in body, released by both CNS and pituitary gland. • Some studies suggests that endorphins play an important part in body’s ability to manage pain • Generally release during Exercise
- 20. LBP • Stretching exercise • Back Flexion Stretch • Knee to Chest Stretch • Kneeling Lunge Stretch • Piriformis Muscle Stretch • Hamstring stretch
- 21. Strengthening exercise for Lumbarization Strengthening exercises focus on the core muscles, including the abdominal, gluteus, and hip muscles, in addition to muscles surrounding the spine. All of the core muscles are essential in supporting and minimizing strain on the spine Transverse Abdominis Muscle Strengthening (Abdominal Exercise)
- 22. • Gluteus Maximums Muscle Strengthening (Buttock Exercise) • Gluteus Medius Muscle Strengthening (Hip Abductor Exercise)
- 23. Others… • Pilates • Yoga • Tai chi • Weight lifting and training • Resistance bands • Base ball • Exercise ball
- 24. Lumbar stabilization exercises • From static (lying) to dynamic (standing or jumping) • From resisting gravity to resisting additional outside force • From predictable to unpredictable movements • From individual components of a movement to the complete range of motion in a movement
- 25. Mobility exercise for lumbar spine: • Low back Rotation • Pelvic tilt exercise