1. Spinal Injuries
Chapter 11

2. Anatomy of the Spine Cervical Vertebrae – : A1
Thoracic Vertebrae – : A2
Lumbar Vertebrae – : A3
Sacrum – : A4
Coccyx – : A5

3. Cervical Vertebrae
C1 – A
C2 – B C3 C4 C5 C6 C7 C1 C2 C3 C4 C5 C6 C7

4. Specialized Cervical Vertebrae
Yellow = Transverse process (C1 & C2)
Orange = Transverse foramen (C1) Transverse Foramina (C2)
Red = Articular surface for the dens (C1)
Lt. Blue = Superior articular facet (C1 &C2)
Dk. Green = Lateral mass (C1)
Dk. Purple = Posterior Arch (C1)
Lt. Purple = Vertebral foramen (C1 & C2) not seen in picture of C2.
Lt Green = Lamina (C2)
Dk Purple = Bifed Spinous Process (C2)

5. Typical Cervical Vertebrae (C3-C7)
Yellow = Body
Dk. Purple = Superior articular facets
Orange = Vertebral foramen
Red = Transverse foramina
Lt. Purple = Transverse Process
Lt. Green = Pedicle
Lt. Blue = Lamina
White – Spinous Process

6. Thoracic Vertebrae Yellow = Superior demifacet
Lt. Blue = Prominent Lamina
Lt. Green = Inferior Demifacet
Lt. Purple = Transverse Costal Facet

7. Lumbar Vertebrae
Centrum = Body
Yellow = Inferior Vertebral notch

8. Sacrum and Coccyx
Remember that the sacrum is 5 fused vertebrae and the coccyx is 4 fused vertebrae.

9. Intervertebral Discs Disc nucleus = Annulus Fibrosus
No blood supply to disks =
Function:
Nucleus pulposus = jelly-like core of disc.
Annulus Fibrosus = several layers of cartilage surrounding nucleus pulposus.
No blood supply to disks, so they don’t heal very well.
Discs act as shock absorbers for spine.

10. Intrinsic Muscles of the back
“Deep” muscles
Three layers:
Superficial layer – Splenius Muscles
Intermediate layer – divided into 3 vertical columns
Spinalis – medial column
Longissimus – intermediate column
Iliocostalis – lateral column
Deep layer – Semispinalis, Multifidus group, and rotators.
The intrinsic or deep muscles of the back are concerned with the maintenance of posture and movements of the vertebral column and head.
The muscles are named according to their relationship to the surface: (1) a superficial layer, (2) an intermediate layer, and (3) a deep layer.

11. Muscles of the Spine – Superficial Layer
Splenius Capitis: A
Origin
Lower ligament nuchae C3 – C7, C7 – T4 spinous processes and supraspinous ligaments T1-3
Insertion
Temporal bone (mastoid process), occiput (surface below lateral 1/3 of the nuchal line)
Action
ORIGIN - Lower ligament nuchae C3 – C7, C7 – T4 spinous processes and supraspinous ligaments T1-3
INSERTION – Temporal bone (mastoid process), occiput (surface below lateral 1/3 of the nuchal line)
FUNCTION – Extension, rotation, and lateral bending of the cervical spine.

12. Muscles of the Spine – Superficial Layer
Splenius Cervicis: B
Origin
Spinous processes of T3-6.
Insertion
Posterior tubercles of transverse processes of C1-3
Action
ORIGIN - Spinous processes of T3-6.
INSERTION - Posterior tubercles of transverse processes of C1-3
FUNCTION – Extension, rotation, and lateral bending of C-spine.

13. Muscles of the Spine – Intermediate Layer, Medial Column
Spinalis Capitis: I
Origin
C5 – C7 and T1 – T3 vertebrae (spinous processes).
Insertion
Occiput between the superior and inferior nuchal lines.
Action
Spinalis Capitis - ORIGIN – C5 – C7 and T1 – T3 vertebrae (spinous processes).
INSERTION – Occiput between the superior and inferior nuchal lines.
FUNCTION – Extension, rotation, and lateral bending of C-spine

14. Muscles of the Spine – Intermediate Layer, Medial Column
Spinalis Cervicis: J
Origin
C6 – C7 and T1 – T2 spinous processes.
Insertion
C1 – C3 spinous processes.
Action
Not present in every human!!!
ORIGIN – C6 – C7 and T1 – T2 spinous processes.
INSERTION – C1 – C3 spinous processes.
FUNCTION – Extension of the cervical spine.

15. Muscles of the Spine – Intermediate Layer, Medial Column
Spinalis Thoracis: K
Origin
T11 – T12 spinous processes
Insertion
T1 – T4 spinous processes
Action
ORIGIN - T11 – T12 spinous processes
INSERTION – T1 – T4 spinous processes
FUNCTION – Extension of vertebral column.

16. Muscles of the Spine – Intermediate Layer, Intermediate Column
Longissimus Capitis: F
Origin
T1 – T5 transverse processes, C4 – C7 articular processes
Insertion
Temporal bone (mastoid process [posterior margin])
Action
ORIGIN – T1 – T5 transverse processes, C4 – C7 articular processes
INSERTION – Temporal bone (mastoid process [posterior margin])
FUNCTION – Extension, rotation, and lateral bending of C-spine

17. Muscles of the Spine – Intermediate Layer, Intermediate Column
Longissimus Cervicis: G
Origin
T1 – T5 vertebrae tips of transverse processes
Insertion
C2 – C6 vertebrae posterior tubercles of transverse processes
Function
ORIGIN – T1 – T5 vertebrae tips of transverse processes
INSERTION – C2 – C6 vertebrae posterior tubercles of transverse processes
FUNCTION – Extension and lateral bending of C-spine, and aids in depression of the ribs.

18. Muscles of the Spine – Intermediate Layer, Intermediate Column
Longissimus Thoracis: H
Origin
L1 – L5 vertebrae transverse processes
Insertion
L1 – L3 vertebrae superior articular facets, T1 – T12 vertebrae transverse processes, ribs 2 – 12.
Function
ORIGIN – L1 – L5 vertebrae transverse processes
INSERTION – L1 – L3 vertebrae superior articular facets, T1 – T12 vertebrae transverse processes, ribs 2 – 12.
FUNCTION – Extension of spine, Lateral bending of spine, depression of ribs.

19. Muscles of the Spine – Intermediate Layer, Lateral Column
Iliocostalis Cervicis: C
Origin
Ribs 3 – 6 (angles), sometimes also ribs 1 and 2.
Insertion
C4 – C6 vertebrae transverse processes, posterior tubercles.
Action
ORIGIN – Ribs 3 – 6 (angles), sometimes also ribs 1 and 2.
INSERTION – C4 – C6 vertebrae transverse processes, posterior tubercles.
FUNCTION – Extension of c-spine, lateral bending, and assists in depression of ribs.

20. Muscles of the Spine – Intermediate Layer, Lateral Column
Iliocostalis Thoracis: D
Origin
Ribs 12 – 7 upper borders at angles
Insertion
Ribs 1 – 6 at angles, C7 transverse processes dorsal aspect (bottom)
Action
ORIGIN – Ribs 12 – 7 upper borders at angles
INSERTION – Ribs 1 – 6 at angles, C7 transverse processes dorsal aspect (bottom)
FUNCTION – Extension of spine, lateral bending, depression of ribs.

21. Muscles of the Spine – Intermediate Layer, Lateral Column
Iliocostalis Lumborum: E
Origin
Iliac Crest (external lip) and Sacrum (posterior surface)
Insertion
Ribs 5 or 6 – 12 (angles on inferior borders)
Action
ORIGIN – Iliac Crest (external lip) and Sacrum (posterior surface)
INSERTION – Ribs 5 or 6 – 12 (angles on inferior borders)
FUNCTION – Extension of spine, lateral bending, depression of ribs.

22. Muscles of the Spine – Deep Layer
Semispinalis Capitis: L
Origin
C7 and T1 – T6 as a series of tendons from the tips of the transverse processes.
Insertion
Occiput between the inferior and superior nuchal line
Action
ORIGIN – C7 and T1 – T6 as a series of tendons from the tips of the transverse processes.
INSERTION – Occiput between the inferior and superior nuchal line
FUNCTION – Extension, rotation, and lateral bending of c-spine.

23. Muscles of the Spine – Deep Layer
Semispinalis Thoracis: N
Origin
T6 – T10 vertebrae transverse processes
Insertion
C6 – C7 and T1 – T4 vertebrae spinous processes
Action
ORIGIN – T6 – T10 vertebrae transverse processes
INSERTION – C6 – C7 and T1 – T4 vertebrae spinous processes
FUNCTION – Extension and rotation of the thoracic spine

24. Muscles of the Spine – Deep Layer
Mulitfidus Group: O
Origin
Sacrum (as low as S4 foramen), Erector spinae aponeurosis, Ilium (PSIS) and adjacent crest, Sacroiliac ligaments (posterior), T1 – T12 vertebrae transverse processes, and C4 – C7 vertebrae articular processes
Insertion
A higher vertebra (spinous process) – may span 2 – 4 vertebrae before inserting.
Action
ORIGIN – Sacrum (as low as S4 foramen), Erector spinae aponeurosis, Ilium (PSIS) and adjacent crest, Sacroiliac ligaments (posterior), T1 – T12 vertebrae transverse processes, and C4 – C7 vertebrae articular processes
INSERTION – A higher vertebra (spinous process) – may span 2 – 4 vertebrae before inserting.
FUNCTION – Extension, rotates, and lateral bends whole spine (specifically lumbar).

25. Muscles of the Spine – Deep Layer
Rotators Group:m P
Origin
Transverse process of one lumbar, or thoracic vertebra
Insertion
Base of spine of the next highest vertebra
Action
Deep to multifidus group
ORIGIN – Transverse process of one lumbar, or thoracic vertebra
INSERTION – Base of spine of the next highest vertebra
FUNCTION – extension of thoracic and lumbar spine and rotation of lumbar spine.

26. Normal Posture
Everything lines up

27. Head Forward Posture

28. Postural Concerns
Excessive roundedness of the shoulders.

29. Postural Concerns - Lordosis
Normal Curve
Lordosis Curve
Lumbar spine too far forward
Very common in gymnasts.

30. Postural Concerns - Scoliosis
Side to Side curvature

31. Common Injuries Posterior Disc Bulge Brachial Plexus Injury
Cervical Spine Injury

32. Posterior Disc Bulge Also known as a herniated disc
Not common in younger athletes
Numbness, tingling, and pain can occur
Poor posture and body mechanics most likely cause
Rehab to improve posture may relieve pain, but surgery may be necessary

33. Brachial Plexus Injury
“Stinger” or “Burner”
Three ways it can happen
Common for football players
“Cowboy” collar or neck rolls help prevent this
May get numbness, tingling, burning sensation, and loss of strength/ROM.
May return when symptom free, full strength, full ROM, and problem free evaluation by ATC or team physician
A. Traction injury caused by head and neck lateral flexion with shoulder depression which results in the stretching of the brachial plexus
B. Direct blow to the supraclavicular region which causes depression of the plexus at its superficial point
C. Cervical hyperextension and lateral flexion, which causes ipsilateral compression of the nerve roots within the foraminae.

34. Cervical Spine Injury
Medical Emergency – activate EMS ASAP.
Maintain C-spine Stability. May have to “log-roll” the athlete.
Equipment should not be removed (if present) until x-rays have been taken to rule out fracture.
Face mask can be cut away to allow access to airway.

35. Cervical Spine Fracture Cervical Spine Strain
Causes:
Axial load/direct blow
Signs/Symptoms:
 Loss ROM or pain with movement
 Bruising / Swelling
 Numbness/tingling
 Muscle weakness in appendages
Pain (can radiate to shoulders and arms)
Cervical Spine Strain
Causes:
Whiplash
Sleeping in an incorrect position
Burner/stinger
Signs/Symptoms:
Loss ROM
Pain with movement