Also visit: http://www.ineuro.be/Welcome.html - A must have for every osteopath and health care provider. Simple to use and no unnecessary information. It keeps your knowledge sharp for daily patient care!
Also look for iBooks in the iBook store from Luc Peeters and Grégoire Lason.
This is a BASIC powerpoint focusing on the structures of the hand. Videos and pictures have been included. I trust it assists anyone who uses it. Blessings!
This is a BASIC powerpoint focusing on the structures of the hand. Videos and pictures have been included. I trust it assists anyone who uses it. Blessings!
Dynamic imaging (imaging obtained at rest, during squeezing, straining, and defecation) has a central role in the diagnosis of pelvic floor dysfunction, and it is crucial when choosing a conservative versus a surgical treatment .
Magnetic resonance (MR) imaging has an increasing role in assessing pelvic floor dysfunction because of its multiplanar imaging capability, the intrinsic soft-tissue contrast and the absence of ionizing radiation.
These features are specifically suitable for those patients with multicompartment involvement and for those who have undergone previous repairs.
This pictorial essay shows dynamic MR imaging findings in pelvic floor disorders such as prolapse, obstructed defecation, and fecal incontinence.
The professor David Lopez, PT and DC expose about the theorical basis of manual therapy in Osteopathy for extremities. In a short approach inted demonstrate the differences and similarities with other manual therapy concepts
Pelvic, Hip and Core Stability
From Grégoire Lason and Luc Peeters, The International Academy of Osteopathy, www.osteopathy.eu
Also visit: http://www.osteoapps.eu - A must have for every osteopath and health care provider. Simple to use and no unnecessary information. It keeps your knowledge sharp for daily patient care!
Also look for iBooks in the iBook store from Luc Peeters and Grégoire Lason.
Presentation slides on myofascial release and muscle energy techniques. Our workshop ran from our St John Street Clinic in Manchester on 30th September 2017.
Anterior Cruciate Ligament Injury: Identification of Risk Factors and Prevent...Fernando Farias
Injury to the anterior cruciate ligament (ACL) is common and affects
young individuals, particularly girls, who are active in sports that involve
jumping, pivoting, as well as change of direction. ACL injury is associ-
ated with potential long-term complications including reduction in ac-
tivity levels and osteoarthritis. Multiple intrinsic and extrinsic risk factors
have been identified, which include anatomic variations, neuromuscular
deficits, biomechanical abnormalities, playing environment, and hormonal
status. Multicomponent prevention programs have been shown to be ef-
fective in reducing the incidence of this injury in both girls and boys. Pro-
grams should include a combination of strengthening, stretching, aerobic
conditioning, plyometrics, proprioceptive and balance training, as well as
education and feedback regarding body mechanics and proper landing
pattern. Preventive programs should be implemented at least 6 wk prior to
competition, followed by a maintenance program during the season.
"Median Arcuate Ligament Syndrome - Literature Study and Osteopathic Considerations" from Grégoire Lason and Luc Peeters, The International Academy of Osteopathy, www.osteopathy.eu
Also visit: http://www.ineuro.be/Welcome.html - A must have for every osteopath and health care provider. Simple to use and no unnecessary information. It keeps your knowledge sharp for daily patient care!
Also look for iBooks in the iBook store from Luc Peeters and Grégoire Lason.
Dynamic imaging (imaging obtained at rest, during squeezing, straining, and defecation) has a central role in the diagnosis of pelvic floor dysfunction, and it is crucial when choosing a conservative versus a surgical treatment .
Magnetic resonance (MR) imaging has an increasing role in assessing pelvic floor dysfunction because of its multiplanar imaging capability, the intrinsic soft-tissue contrast and the absence of ionizing radiation.
These features are specifically suitable for those patients with multicompartment involvement and for those who have undergone previous repairs.
This pictorial essay shows dynamic MR imaging findings in pelvic floor disorders such as prolapse, obstructed defecation, and fecal incontinence.
The professor David Lopez, PT and DC expose about the theorical basis of manual therapy in Osteopathy for extremities. In a short approach inted demonstrate the differences and similarities with other manual therapy concepts
Pelvic, Hip and Core Stability
From Grégoire Lason and Luc Peeters, The International Academy of Osteopathy, www.osteopathy.eu
Also visit: http://www.osteoapps.eu - A must have for every osteopath and health care provider. Simple to use and no unnecessary information. It keeps your knowledge sharp for daily patient care!
Also look for iBooks in the iBook store from Luc Peeters and Grégoire Lason.
Presentation slides on myofascial release and muscle energy techniques. Our workshop ran from our St John Street Clinic in Manchester on 30th September 2017.
Anterior Cruciate Ligament Injury: Identification of Risk Factors and Prevent...Fernando Farias
Injury to the anterior cruciate ligament (ACL) is common and affects
young individuals, particularly girls, who are active in sports that involve
jumping, pivoting, as well as change of direction. ACL injury is associ-
ated with potential long-term complications including reduction in ac-
tivity levels and osteoarthritis. Multiple intrinsic and extrinsic risk factors
have been identified, which include anatomic variations, neuromuscular
deficits, biomechanical abnormalities, playing environment, and hormonal
status. Multicomponent prevention programs have been shown to be ef-
fective in reducing the incidence of this injury in both girls and boys. Pro-
grams should include a combination of strengthening, stretching, aerobic
conditioning, plyometrics, proprioceptive and balance training, as well as
education and feedback regarding body mechanics and proper landing
pattern. Preventive programs should be implemented at least 6 wk prior to
competition, followed by a maintenance program during the season.
"Median Arcuate Ligament Syndrome - Literature Study and Osteopathic Considerations" from Grégoire Lason and Luc Peeters, The International Academy of Osteopathy, www.osteopathy.eu
Also visit: http://www.ineuro.be/Welcome.html - A must have for every osteopath and health care provider. Simple to use and no unnecessary information. It keeps your knowledge sharp for daily patient care!
Also look for iBooks in the iBook store from Luc Peeters and Grégoire Lason.
Common Referred Pain Patterns – Low Back
Document by Luc Peeters, MSc.Ost. and Grégoire Lason, MSc.Ost.
Joint principals of the International Academy of Osteopathy (I.A.O.)
More information at www.osteopathy.eu
Preventive Paediatric Osteopathy
Document by Luc Peeters, MSc.Ost. and Grégoire Lason, MSc.Ost.
Joint principals of the International Academy of Osteopathy (I.A.O.)
More information at www.osteopathy.eu
Vertebral Artery Pathology
Document by Luc Peeters, MSc.Ost. and Grégoire Lason, MSc.Ost.
Joint principals of the International Academy of Osteopathy (I.A.O.)
More information at www.osteopathy.eu
The Vertebral Artery Test
Luc Peeters, MSc.Ost. & Grégoire Lason, MSc.Ost.
The International Academy of Osteopathy
http://www.osteopathie.eu/en
http://www.osteopathie.eu/en/publications
info@osteopathy.eu
Why do clever osteopaths believe stupid things?
The International Academy of Osteopathy
http://www.osteopathie.eu/en
http://www.osteopathie.eu/en/publications
info@osteopathy.eu
Sacroiliac(SI) Joint Dysfunction,Evaluation and Treatment Dr.Md.Monsur Rahman
Dr.MD.Monsur Rahman,PT
MPT-Musculoskeletal Disorders
Maharishi Markandeshwar Institute Of Physiotherapy And Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana - Ambala,133-207 (Haryana)
The quadriceps femoris is traditionally described as a muscle group com-
posed of the rectus femoris and the three vasti. However, clinical experience
and investigations of anatomical specimens are not consistent with the text-
book description. We have found a second tensor-like muscle between the
vastus lateralis (VL) and the vastus intermedius (VI), hereafter named the
tensor VI (TVI). The aim of this study was to clarify whether this intervening
muscle was a variation of the VL or the VI, or a separate head of the exten-
sor apparatus. Twenty-six cadaveric lower limbs were investigated...
Morphohistometric study of the ligamentum flavum in cervical,thoracic and lum...Prof. Hesham N. Mustafa
ABSTRACT Anatomic characterization and fine structure of the human ligamentum flavum (LF), especially at different spinal levels, represent an attractive focus for the scientific and surgical application. Descrip-tive anatomical and structural study of LF at the cervical, thoracic and lumbar levels of the vertebral column in human cadavers is carried out here. The aim of the work is to clarify the anatomical features and fine structural differences in the human LF at different vertebral levels (cervical, thoracic and lumbar). Specimens of vertebral column were ob-tained from 34 human preserved cadavers. Their average age ranged between 56 and 69 years. Morphometric parameters including height, width and thickness of the ligament flavum at the mid-levels of cervical, thoracic and lumbar regions were measured. Sections obtained from different levels were stained with different stains. Morpho-metric measurements involved the relative elastic area, relative collagen area, elastic area% and collagen area% were measured.The results of the height, width and thickness of the LF at different spinal levels showed gradual increase in their mean values respectively. The LF midline gaps were found in the cervical, thoracic and lumbar regions. The morphometrical measure-ments showed that the average elastic area was highest in the cervical region and lowest in the tho-racic region. In the lumbar region, the percentages of both elastic area and the collagen area were nearly the same. The characterization of morpho-logical and histological aspects of the LF at differ-ent spinal levels will be of great importance for ap-plications in spinal surgery, biomechanical and physical rehabilitation of vertebral column.Keywords: Ligamentum Flavum – Spinal – Collagen and elastic fibers
Locomotion which means gait is controlled by various systems. Janda described these systems in three different linkages; articular, muscular and neural. The slide show also, describes in the same the locomotion control as described by Janda in brief.
Trauma Image Interpretation of the Pelvis and Hip Radiographs: Using ABCSuk121chris
An informative presentation describing basics of image interpretation for the Pelvis and Proximal Hip by utilising ABCS; a step-by-step method described by Otto Chan's book entitled ABC to Emergency Radiology. This presentation includes local and external image examples of traumatic abnormalities of the pelvis and hip. Radiographers, Nurses and Emergency Doctors may find this useful to enhance their image interpretation skills. This presentation was developed for a In-service CPD session in 2013. Questions and/or feedback are welcome by email: abigheadache [at] gmail.com
The stomatognathic system is a functional unit characterized by several structures: skeletal components, the Temporomandibular joint and masticatory muscles. These structures act in harmony to perform different functional tasks (to speak, to break food down into small pieces, and to swallow).
Similar to "The iliolumbar ligaments" from Luc Peeters (20)
Osteopathy_Introduction_Course
The International Academy of Osteopathy provides Osteopathy Courses in Copenhagen
http://www.osteopathie.eu/en
http://www.osteopathie.eu/en/publications
Modern Principles of Osteopathy
The International Academy of Osteopathy provides osteopathic education in Europe and beyond.
Contact us for more information: info@osteopathy.eu
http://www.osteopathie.eu/en/publications
http://www.osteopathie.eu/en
Op 2 oktober vond op de campus van The International Academy of Osteopathy (IAO) te Gent een wetenschappelijke avond plaats. Het research team van de IAO, onder leiding van Prof. Dr. Frank Comhaire, heeft op dit event de meest interessante onderzoeksresultaten en onderzoeksplannen toegelicht. De meer dan dertig deelnemers waren heel enthousiast en het research team was heel tevreden over het verloop van de avond. De IAO draagt wetenschappelijk onderzoek hoog in het vaandel. Vorig jaar investeerden ze in het DIERS formetric 4D toestel. Dit toestel brengt op een niet-invasieve manier de wervelkolom van de patiënt in beeld en is uniek in de osteopathie wereld. Het DIERS toestel speelt dan ook een belangrijke rol in de diverse onderzoekslijnen die momenteel op de IAO campus te Gent actief zijn.
The Place of Osteopathy in “First-line Therapy”, “Primary Care” or “Primary-contact Health-care”.
Document by Luc Peeters, MSc.Ost. and Grégoire Lason, MSc.Ost.
Joint principals of the International Academy of Osteopathy (I.A.O.)
More information at www.osteopathy.eu
Whiplash describes a range of injuries to the neck caused by or related to a sudden distortion of the neck. The typical clinical picture in whiplash injury is that following the injury there is no obvious immediate pain.
Also visit: http://www.ineuro.be/Welcome.html - A must have for every osteopath and health care provider. Simple to use and no unnecessary information. It keeps your knowledge sharp for daily patient care!
Also look for iBooks in the iBook store from Luc Peeters and Grégoire Lason.
Also visit: http://www.ineuro.be/Welcome.html - A must have for every osteopath and health care provider. Simple to use and no unnecessary information. It keeps your knowledge sharp for daily patient care!
Also look for iBooks in the iBook store from Luc Peeters and Grégoire Lason.
More from IAO The International Academy of Osteopathy (14)
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
NVBDCP.pptx Nation vector borne disease control program
"The iliolumbar ligaments" from Luc Peeters
1. The iliolumbar ligaments – a literature study
Luc Peeters, MSc.Ost.
1. Introduction
As A.T.Still stated, anatomy is the most important basic medical science upon which
osteopathy is based. In this context the following literature study of the anatomy and the
resultant biomechanics and palpation provides an update of anatomy and biomechanical
functional knowledge of the osteopath.
2. Development
Ligaments normally develop during the late embryonal or early foetal period. After dissection
of 5 newborns Luk A.D. et al (1986) found no iliolumbar ligaments.
These authors researched the anatomy and histology of the iliolumbar ligaments in cadavers
of newborns to elderly specimens. They found the structure of the iliolumbar ligaments to be
muscular - not ligamentous - between the ages 10 and 20 years.
The ligamentous structures were formed by metaplasia of certain fibres of the quadratus
lumborum muscle. As of 20 years of age the definitive ligaments are formed. In older
cadavers degenerative changes were found in the iliolumbar ligaments. They concluded that
the iliolumbar ligaments most likely play a stabilising role in the general lumbosacral stability
in patients with disc degeneration, degenerative spondylolisthesis and pelvic unlevelling due
to neuromuscular scoliosis.
Uhthoff H. (1993) studied 21 foetus cadavers younger than 11 weeks and identified no
iliolumbar ligaments. In 12 older foetus cadavers (older than 11.5 weeks old) they found the
iliolumbar structures, contradicting Luk et al (1986). The iliolumbar ligaments were
recognisable from the transverse process of L5 to the anterior surface of the ilium and
dividend into anterior and posterior parts. These could clearly be separated from the quadratus
lumborum, most notably due to different fibre orientation. In only 2 cases were the iliolumbar
ligaments found to be from the transverse process of L4 and clearly defined from the
intertransverse ligaments.
Pun W.K. et al (1987) studied the presence of iliolumbar ligaments in quadrupeds and in
rhesus monkeys. The difference between both groups is that the rhesus monkeys frequently sit
while the quadrupeds do not sit and therefore the spine remains horizontal. Iliolumbar
ligaments were found in the rhesus monkeys but not in the quadrupeds. The iliolumbar
ligaments bound the last, sometimes the second last lumbar vertebra to the ilia. They
concluded that the mechanical stress upon the lumbosacral structures due to the vertical sitting
position in the rhesus monkeys plays an important role in the formation of these ligaments.
Jiang H. et al (1995) studied the presence of lateral ligaments in the spine of quadrupeds and
in bipeds. They found anterior and posterior ligaments but no lateral ligaments in quadrupeds
compared to the bipeds. Furthermore, scoliosis does not develop in quadrupeds but is a
1
2. frequent occurrence in bipeds (Rogola and Drummond 1978). This suggests that the lateral
ligamentous structures play an important role in standing postures.
3. Anatomy
The anatomic descriptions of the iliolumbar ligaments do not provide a unanimous view of
these structures. More specifically, the attachments onto the ilium demonstrate significant
variation. Agur and Dalley (2004), Moore and Dalley (1999) describe the attachments as
being onto the ilium. Hollinshead (1969) describes them as being onto the internal surface of
the ilium. Boileau, Grant and Basmajian (1965), Hall-Craggs (1995) and Snell (1995)
describe the attachment onto the iliac crest. Wood Jones (1953) describes the attachment as
being the medial lip of the iliac crest. Romanes (1972), Woodburne and Burkel (1988)
describe the attachment as onto the posterior surface of the internal lip of the iliac crest.
Hanson and Sonesson (1994) describe the attachments as being the upper and anterior surface
of the iliac tuberosity.
In Gray’s Anatomy (1995) the iliolumbar ligaments are described as running from the tip of
the lower anterior part of the transverse process of L5 with a weak part from the tip of the
transverse process of L4 to lateral/ posterior, attaching onto the anterior/upper surface of the
iliac crest. A lower part of the ligament is also described from the tip of the transverse process
of L5 to the anterior surface of the sacrum.
Luk K.D. et al (1986) found the iliolumbar ligaments to be two different bands, both
beginning from the tip of the transverse process of L5 (Figure 1). The anterior part lies
predominantly in the coronal plane to terminate into the periosteum of the anterior edge of the
iliac crest. The posterior part runs oblique and posterior to insert into the posterior surface of
the iliac crest. The quadratus lumborum (B) lies between both parts. The psoas (A) lies on the
anterior surface of the ligament and the erector spinae (C) upon the posterior side.
Figure 1 - Two bands attaching onto the tip of the transverse process L5
In their study they found that these structures in newborns were muscular while between the
ages of 20-40 years muscular fibres were still found between the ligamentous fibres. As from
the age of 50 years clear degeneration and fatty infiltrations were seen. Such fatty infiltrations
were more evident in women than men.
The change from muscular to collagen fibres occurs as from the transverse process and
gradually spreads towards the iliac crest.
2
3. Bassadonna et al (1996) described the anterior part of the iliolumbar ligament as broad and
flat, from the inferior, lateral part of the tip of the transverse process spreading to anterior part
of the iliac tuberosity, caudal from the posterior part of the ligament. The posterior part of the
ligament descends form the apex of the tip of the transverse process of L5 to the iliac crest
(anterior edge to apex). The posterior part is thinner and rounder than the anterior part.
Fujiwara et al (2000) studied the morphology, the length and the width of the iliolumbar
ligaments and could identify two different types:
Type A: (74) the anterior and posterior parts were in different directions.
Type B: (32) the anterior and posterior parts were in the same direction.
The angle of the posterior part of the type A ligament was orientated more to posterior than
that of the type B ligament. The posterior part was also shorter and orientated more to
posterior in males than in females.
Rucco et al (1996) analysed 15 volunteers via MRI. They found that the part of the iliolumbar
ligament that originated from the transverse process of L5 consists of two bands (anterior and
posterior). The anterior band is flat and broad and has two anatomical varieties: type 1,
originating from the anterior part of the inferolateral surface of the transverse process of L5
and attaches broadly onto the iliac tuberosity; type 2, originates from the anterior, lateral and
posterior part of the inferolateral surface of the transverse process of L5 and attaches broadly
onto the anterior part of the iliac tuberosity.
The posterior band attaches onto the apex of the transverse process of L5 and is fusiform. It
runs to the anterior edge of the apex of the iliac crest.
In the transverse plane the anterior band is in a horizontal line through the transverse process
of L5 and the posterior band forms an angle of 45 -55° (open posterolateral). In the coronal
plane the iliolumbar ligament shows more variation related to the size of the vertebra. If L5 is
situated low in the pelvis the iliolumbar ligaments are longer and more oblique while if the L5
is situated high in the pelvis the iliolumbar ligaments are shorter and more horizontal. The
posterior band is thinner and rounder than the anterior band, which leads to more
susceptibility for over-stretch and torsion. This is a likely explanation for the painful
iliolumbar ligament syndrome.
Hanson et al (1998) found that the length of the iliolumbar ligaments was also different
between races. Negroid subjects had longer (mean 61.6 mm) iliolumbar ligaments than
Caucasian subjects (mean 33.2 mm). This difference was demonstrated in both sexes. One
band was more common amongst negroids where as caucasions demonstrated a split into two
bands.
4. Biomechanics and function
4.1. Influence upon the iliosacral stability
3
4. Goudzwaard et al (2003) found that following severing of the iliolumbar ligaments the range
of motion of the iliosacral joint was significantly higher. According to that study the anterior
part of the ligament provides the strongest influence upon this mobility. They suggested that it
is highly likely that surgical severing of this ligament during lumbosacral surgery could
explain post-operative symptoms and instability.
Figure 2 - Posterior part directly along the plane of the IS joint
The direction of the posterior part of the iliolumbar ligament is directly along the plane of the
iliosacral joint (Figure 2). It also provides a compressing/coaptating function for the iliosacral
joint.
4.2. Influence upon the stability and mobility of L5 and L4
4.2.1. In flexion/extension
Snijders (2004) suggests that the iliolumbar ligaments plays an important role in the motion of
the lumbosacral junction in the sagittal plane. Counter-nutation places the ligaments under
stretch and nutation shortens it. In osteopathic terms this means that an unstable pelvis
involves shortening of the ligaments and a fixed pelvis involves ligaments under stretch.
4.2.2. During anterior glide
Aihara et al (2000) fixed the sacrum and ilia in 5 fresh cadavers with spondylolysis of L5.
They induced varying flexion/extension and left/right rotation force upon L4 and L5 in
flexion/extension, before and after severing of the iliolumbar ligaments. They found that
flexion and axial rotation is strongly regulated by the iliolumbar ligaments, most notably by
the posterior part of the ligaments. They concluded that the integrity of the iliolumbar
ligaments, certainly the posterior part, determines the stability of the lumbosacral junction
(Figure 3), as well as the grade of anterior glide of L5 upon the sacrum.
4
5. While providing local treatment for an anterolysthesis of L5 this fact must always be kept in
mind. In this case the iliolumbar ligaments must not be placed under extreme stretch so that
addition anterior glide is avoided.
Figure 3 - Side view of spondylolysis
4.3. Biomechanics in the frontal plane
The iliolumbar ligaments have a stabilising capacity in the frontal plane at the spinal levels of
L5 and L4 (Figure 4). While the iliolumbar ligaments are not always attached to the transverse
process of L4, the stabilising capacity is continued to L4 via the intertransverse ligaments
(Figure 5 & 6). The stabilising function allows approximately 8° of left sidebending and 8° of
right sidebending. More sidebending than this means likely over-stretch of the ligaments.
5
6. Figure 4 - Stability in the frontal plane
Figure 5 - Anatomical variants Figure 6 - Anatomical variants
4.4. Biomechanics in the sagittal plane
The iliolumbar ligaments stabilise the lower lumbar spine in the sagittal plane (Figure 7).
They act to control the flexion/extension mobility of L4 and most importantly L5.
During flexion the iliolumbar ligaments are under stretch while they shorten during extension.
6
7. Figure 7 - Stabilising function in flexion/extension
4.5. Biomechanics in the horizontal plane
In the horizontal plane the iliolumbar ligaments also have a stabilising role and limit the
rotation of L5 (Figure 8). In this way the facet joints are protected from intense and repetitive
compression. In cases of severed iliolumbar ligaments, facet degeneration is frequently found.
Figure 8 - Horizontal view of the posterior section
5. Pathology
5.1. Disc degeneration
7
8. In cadavers with disc degeneration of L4-L5 more than L5-S1 the anterior and posterior bands
of the iliolumbar ligaments were generally shorter and thicker. In cadavers with disc
degeneration of L5-S1 more than L4-L5 the ligaments were noticeably longer. From these
observations Aihata (2002) concluded that short strong iliolumbar ligaments protect the disc
of L5-S1 against degeneration. Fujiwara (1999) made the same conclusions in another study.
Ahn et al (2002) used MRI examinations to conclude that it is not actually the length of the
iliolumbar ligaments but the left/right asymmetry in the orientation of the ligaments that plays
the most important role in unilateral disc herniation of L5-S1.
5.2. Over-stretch
Ligamentous tension can lead to ligamentous complaints. Specifically, lower lumbar kyphosis
leads - even without the factor of bodyweight - to over-stretch according to Snijders (2004)
who advises a sitting posture that is not in kyphosis but more straight-back or with a lumbar
support.
According to Sims and Moorman (1996) microtraumas of the iliolumbar ligaments are often
the cause of chronic lower back pain. The ligaments have significant nociceptive innervation
and are placed under stretch during sacral flexion (sacrum posterior, fixed pelvis).
Keel (2007) showed this in a case study.
Hirschberg (1979) described the “Iliac Crest Syndrome” in which the patient complains about
unilateral pain over the iliac crest. The pain can also present bilaterally and occurs mostly
after long periods of sitting and / or bending forwards.
Chronic over-stretch or traumatic over-stretch can lead to inflammation. This can in turn lead
to periostitis, even osteitis at the insertion of the involved ligament. Traumatically this can
occur in sports (such as gymnastics) where extreme motions of the lumbosacral junction and
legs are required.
5.3. Influence on the spinal ganglion of nerve root L5
Briggs and Chandraraj (1995) dissected 65 cadavers and identified the iliolumbar ligaments in
all specimens. In 34% of the cases the ligament made contact with the ventral ramus of L5 and
in 9% there was a clear presence of flattening and compression of the ramus. The nerve was
then clearly thickened and showed an increase in perineural connective tissue. The cells in the
spinal ganglion were smaller than normal and surrounded by connective tissue, most notably
at the peripheral part of the spinal ganglion.
In the cases where compression of the spinal nerve L5 was found, a narrowed lumbosacral
space was also identified. The disc was also seen to be degenerated in these cases. On the
same side, fibrotic changes of the facet joint were found. Therefore, compression of the spinal
ganglion can occur not only in the intervertebral foramen but also just distal from the
foramen.
5.4. Calcification
8
9. After dissecting 22 cadavers aged over 60 years, Luk et al (1986) found degeneration of the
iliolumbar ligaments in 70% of the cases. Some of the examples were even calcified.
This means that the osteopath must be careful if manipulating this region in this age group.
In the November 2004 edition of “The European Guidelines for the Management of Chronic
Non-specific Low Back Pain” it was advised against using prolotherapy (sclerosing
injections) for the iliolumbar ligaments.
6. Provocation and palpation
The palpation of the iliolumbar ligaments (Photo 1 & 2) is not simple due to their position;
deep to the posterior muscles and fascia and ventral to the iliac crest.
The iliolumbar ligaments are associated with the inferior insertion of the thoracolumbar fascia
and the quadratus lumborum muscle, which also complicates the palpation (Bogduk (1997),
Frazer (1940), Fujiwara et al, (2000), Pool-Goudzwaard et al (2001), Shellshear and
Macintosh (1949), Williams et al, (1995)).
The direct palpation from posterior to anterior is made very difficult by the presence of the
thoracolumbar fascia, the erector spinae and the quadratus lumborum. A more lateral
approach avoids the erector spinae. However the latissimus dorsi, transverse abdominal,
external oblique and quadratus lumborum muscles cannot be avoided.
Palpation from the lateral edge of the paravertebral muscles to ventral/medial and caudal is
the best choice. It is important to position the patient so that the muscles superficial to the
ligament are as relaxed as possible.
The palpation of the iliolumbar ligaments can be done with the patient sitting (Photo 1) with
slight lumbar lordosis while supporting themselves with the hands behind the back or with the
patient prone (Photo 2) with the hips in slight extension or in the so-called sphinx position.
The pain provoked by this palpation is not sharp but deep and aching. As well as the pain, the
elasticity of the ligament can also be evaluated. Elasticity loss can indicate retraction, tension
or even calcification of the ligament.
9
10. Photo 1 - Palpation of the patient sitting Photo 2 - Palpation of the prone patient
The pain from the provocation should not be confused with pain that is due to entrapment of
the dorsal ramus L1 or L2 nerve roots (Figure 9). These nerves cross the iliac crest
approximately 7 cm from the middle line and run through a osteofibrous opening where
entrapment is possible. Maigne et al (1991) first discovered these entrapment locations.
Figure 9 - Palpation in case of nerve entrapment
7. Conclusion
The iliolumbar ligaments play an important role in the stabilisation of L5; most notably
limiting the flexion.
In the frontal plane they also act to stabilise the L5 and L4.
In cases of spondylolysis of L5 they are the only limiting factor for the anterior glide of the L5.
Symmetrical length and quality acts to protect the facet joints from compression during axial
rotation.
They also function to stabilise the iliosacral joints by compressing them.
The iliolumbar ligaments are frequently the painful structure in lumbosacral lower back pain.
They can be over-stretched due to a flexion lesion of L5 or due to a fixed pelvis (sacrum
posterior) and can be retracted due to an extension lesion of L5 or due to an unstable pelvis
(sacrum anterior).
They are placed under stretch during kyphotic sitting and can be injured and even tear during
sports that require extreme motion of the lumbosacral junction.
In cases of tearing or weakening of the iliolumbar ligament, the facet joint loses its protection
against compression and thus degeneration occurs more rapidly.
10
11. Tearing or weakening will also result in lost iliosacral joint coaptation whereby hypermobility
in the joint can result, with more rapid degeneration.
They play an essential protective role for the disc.
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