Archive for June, 2007
Lower back pain| ankle and foot plantar flexion
June 29, 2007 6:51 pmFriday, June 29, 2007
Patients with lower back pain due to L5 and S1 nerve root irritation often complain of calf cramps, especially at night. The strong calf muscles are responsible for you to be able to walk on your toes. These muscles are especially important in the push-off phase of walking on level surfaces as well as on inclines and steps.
To be able to test the strength of the calf muscles, the best way is to have the patient stand on one leg. The patient then lifts the heel off the floor. Normally, there is at least a span of 5" between the surface of the floor and the undersurface of the heel.
When the patient is examined to walk on their toes, one has to assess not just the ability to perform this type of walking but the ability of the patient to raise the heel of the floor by about 4-5".
Similarly, when the patient is instructed to walk on heels, there should at least be a span of 3-3.5 inches between the floor and the undersurface of the big toe joint known as the first metatarso-phalangeal joint.
The muscles that perform plantar flexion of the foot are:
- medial gastrocnemius (L5, S1 through the tibial nerve)
- lateral gastrocnemius (L5, S1 through the tibial nerve)
- soleus (L5, S1 through the tibial nerve)
- tibialis posterior (L5, S1 through the posterior tibial nerve)
- flexor digitorum longus (L5, S1 through the posterior tibial nerve)
- flexor hallucis longus (L5, S1 through the posterior tibial nerve)
- peroneus longus (L5, S1 through the superficial peroneal nerve)
- peroneus brevis (L5, S1 through the superficial peroneal nerve)
© 2007 copyright all rights reserved www.stopmusclepain.com Low back pain| foot plantar flexion
Photograph showing the ankle and foot plantar flexors
Low back pain| ankle and foot dorsiflexion
June 22, 2007 11:32 pmFriday, June 22, 2007
Patients with back pain due to lumbosacral nerve root irritation can have foot and ankle pain with weakness in dorsiflexion of the ankle. Usually, the strength of the dorsiflexor muscles are tested by pressing down on the front of the ankle and toes in order to press the foot in a downward position. The strength of the toes can be individually assessed by giving resistance to the extended toes.
Functionally, it is best to test the ankle dorsiflexor muscles by having the patient stand on one leg. The weight should be placed on the heel in order that the forefoot and toes can be raised up. The span or distance between the floor and the undersurface of the big toe can be measured and compared on both sides.
Ankle and foot dorsiflexor muscles are:
- tibialis anterior (L4, L5)
- extensor digitorum longus (L5, S1)
- extensor hallucis longus (L5, S1)
- extensor digitorum brevis (L5, S1)
All these muscles are supplied by the deep peroneal nerve. The dominant nerve root is L5 root.
© 2007 copyright all rights reserved www.stopmusclepain.com Lower back pain| foot and ankle dorsiflexion
Photograph showing foot and ankle dorsiflexors
Lower back pain | knee flexion| Hamstrings
June 15, 2007 5:54 pmFriday, June 15, 2007
Patients with lower back pain due to lumbosacral nerve root irritation often complain of knee pain. The knee pain may occur with straightening the knee or with bending the knee.
We talked last week about the muscles that straighten the knee and today's topic will be on muscles that bend the knee (knee flexors) . However, if there is pain and spasm in muscles that straighten the knee (knee extensors), knee pain can occur with knee bending due to stretching the tight and shortened knee extensor muscles.
To test the strength of the knee flexor muscles, the patient should be on his stomach and he bends the knee on the tested side. The examiner pushes down on the leg in order to straighten the knee.
The knee flexor muscles are:
- biceps femoris (L5, S1 nerve roots via the sciatic nerve)
- semitendinosus (L5, S1 nerve roots via the sciatic nerve)
- semimembranosus (L5, S1 nerve roots via the sciatic nerve)
© 2007 copyright all rights reserved www.stopmusclepain.com Lower back pain| knee pain| knee flexion
Photograph showing the hamstring muscles (knee flexor) muscles supplied by the L5 and S1 nerve roots.
hamstrings muscles, knee flexion, Lower back pain, lower body topics, nerve root irritation, sciatic nerve
Lower back pain | knee pain| knee extension
June 8, 2007 2:39 pmJune 8, 2007
Patients with lower back pain will often complain of knee pain. The most common roots to be irritated are the L5 and S1 nerve roots which supply many muscles that cross the knee or insert near the knee. Therefore when muscles such as the hamstrings, gluteus maximus, adductor magnus and tensor fascia latae shorten due to spasm, knee pain can often be felt.
Knee pain will be more noticeable on extension (straightening) of the knee or with excessive bending or weight bearing on the knees such as in crawling or kneeling. If the muscles that bend the knee such as the hamstrings go into spasm, knee pain will be felt with knee extension. When the knee extensors such as the tensor fascia latae and the gluteus maximus (through its insertion into the iliotibial tract) shorten due to spasm, knee pain will be felt with knee flexion (bending).
Chief extensors of the knee are the quadriceps (vastus lateralis, vastus medialis, vastus intermedius and rectus femoris) muscles supplied by the femoral nerve (L2, L3, L4).
It is very important that treatments related to problems with knee extension should not be focussed only to treating the quadriceps muscles.
Nerve related muscle pain assessment causing knee pain should include assessment of the movements of the entire spine from the neck to the lower back, hips, knees and ankles.
© 2007 copyright all rights reserved www.stopmusclepain.com Lower back pain| knee pain| knee extension
Photograph showing the quadriceps (knee extensor) muscles supplied by the L2, L3 and L4 nerve roots.
gluteus maximus, hamstrings muscles, knee extension, knee pain, Lower back pain, lower body topics, nerve root irritation, quadriceps
Lower back pain| hip extension
June 1, 2007 1:32 pmJune 1, 2007
Lower back pain caused by S1 nerve root irritation will affect the hip extensor muscles which S1 nerve root so richly supplies.
The hip extensor muscles are best tested by having the patient lie facedown. The patient bends the knee and lifts the knee off the surface of the bed. The examiner can test the strength of the gluteus maximus muscle by pushing down on the buttock and thigh toward the bed while the patient resists the hip from moving down.
If the patient lifts the hip and thigh off the surface of the bed with the knee straight, this movement is primarily performed by the hamstring muscles.
The muscles which perform hip extension are:
- gluteus maximus (inferior gluteal nerve carrying L5, S1 root fibers primarily S1)
- biceps femoris, long head (sciatic nerve carrying L5, S1 root fibers primarily S1)
- semitendinosus (sciatic nerve carrying L5, S1 root fibers primarily L5)
- semimembranosus (sciatic nerve carrying L5, S1 root fibers primarily L5)
© 2007 copyright all rights reserved www.stopmusclepain.com Lower back pain| hip extension
back, gluteus maximus, hamstrings muscles, hip extension, Lower back pain, lower body topics, nerve root irritation
