Friday, February 20, 2009


See the sagittal image downloaded from google image:

My comments on the image:

1. The slice taken is passing through mid way between two vertebral bodies i.e. passing through the middle of the transverse foramina.
2. look at the inverted triangle- that is the TS of spinal cord.
3. look at the two arms of the triagle- they are the two spinal roots.
4. look at the angle of the triangle from which the roots are coming you can see black dots on a white back ground. That portion is the area that shows TS of roots that are going to exit on levels below.

Mixed nerves carrying all fibers i.e. sensory, motor & autonomic fibers can be entrapped here by posterior or posterior-lateral disc prolapses.

Automomic fibers control many visceral functions. At lumbar level they control functions of bowel & bladder. Autonomic inputs to control peripheral vascular tone in the lower limb also pass through the lumbar spine.

There are evidences that tell us that; by graded mobilizations the mechanical impacts of local venous congestion caused by discogenic or spondylogenic pathology are reduced. And many more neurophysiological effects occur (I have described in one of my priious blogs). The question is as physios do we influence autonomic nervous system functioning by spinal mobilization technique? Physiotherapeutic management of lumbar disorders often utilises specific segmental joint mobilisation techniques; however, there is only limited evidence of any neurophysiological effects and much of this has focused on the cervical spine and upper limbs.

A randomized placebo controlled trial carried out by Jo Perry and Ann Green was published in Manual Therapy, 2008, 13(6), 492-499. This study aims to extend the knowledge base underpinning the use of a unilaterally applied lumbar spinal mobilisation technique by exploring its effects on the peripheral sympathetic nervous system (SNS) of the lower limbs. SNS activity was determined by recording skin conductance (SC) obtained from lower limb electrodes.

Their findings indicated that there was a significant change in skin conductance from baseline levels (13.5%) that was specific to the side treated for the treatment group during the intervention period (compared to placebo and control conditions).

This study provides preliminary evidence that a unilaterally applied postero-anterior mobilisation technique performed, at a rate of 2 Hz, to the left L4/5 lumbar zygopophyseal joint results in side-specific peripheral SNS changes in the lower limbs.


Manual Therapy, 2008, 13(6), 492-499

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