1. Sports Medicine Chapter 20
Neck And Spine
Sports Medicine
Chapter 20

2. Vocabulary I knew that word!!
Annulus Fibrosis- periphery of the intervetebral disk, strong fibrosis tissue
Axial Loading -Direct blow to the top of your head
Cervical nerve stretch syndrome- brachial plexus injury
Cyanosis- blue/gray color of the face
Kyphosis-Thoracic curvature of the spine, humpback
Nucleus Pulposus- the inside of the intervetebral disk. Jelly like substance
Paraplegia- paralysis of the lower extremity
Quadriplegia- paralysis of the upper/lower extremities
Sciatica- inflammation of the sciatic nerve in your lumbar spine
Scoliosis- lateral curvature of the spine
Spondylolisthesis- forward slipping of the vertebrae L5 most common
Spondylolysis- stress fracture of the pars interarticuylaris of the vertebrae

3. Anatomy Characteristics 33 indiv. Bones or vertebrae 24 moveable
9 immovable
The spine allows for a high degree of flexibility
Cervical
7 vertebrae, first 2 = atlas and axis. Function is to support the head and permit cervical rotation
Thoracic
12 vertebrae. #1-10 articulate with the ribs. Muscles that attach to the thoracic vertebrae= trapezius, rhomboid, latissmus dorsi
Lumbar
5 vertebrae and is considered the largest and strongest
Sacrum
As a child grows up, the bottom 5 vertebrae fuse together. Weight is transmitted through the sacroiliac joint
Coccyx
consist of 4 separate vertebrae which the lower 3 fuse together in adulthood.
Anatomy

10. Brachial Plexus C5 lateral upper arm (deltoid) C6
Sensory
Muscle movement C5
lateral upper arm (deltoid)
Shoulder abduction (deltoid), elbow flexion (biceps C6
Lateral forearm 1st/2nd phalange
Elbow flexion (biceps), wrist extension C7
3rd phalange
Elbow extension (triceps), wrist flexors, finger extensors C8
4th/5th phalange, medial forearm
Finger flexors, finger abduction/adduction T1
medial elbow
finger abduction/adduction
Brachial Plexus

12. Nerve Roots

13. Injuries to neck Brachial plexus injury Median Nerve Peripheral nerves
Nerves that could be involved and should be evaluated:
C5-T1 nerve roots
Peripheral nerves
Radial nerve
Wrist/thumb extension
Dorsal web space between thumb and index finger
Ulnar nerve:
Abduction of 5th phalange
Distal ulnar aspect of little finger
Median Nerve
Thumb pinch
Distal radial aspect of 2nd phalange
Axillary nerve
Deltoid movement
Lateral arm silver dollar patch in the middle of the deltoid
Musculocutaneous nerve
Biceps
Lateral forearm

14. Neurological Exam Sensation Testing If there is nerve root compression, sensation can be disrupted

15. Lumbar Plexus L3 Distal anterior thigh L4
Sensory
Muscle movement L3
Distal anterior thigh
Knee extension L4
Patella and medial surface of tibia
Dorsi flexion (anterior tibialis) L5
Top of foot
Great toe extension S1
Lateral surface of foot/5th metatarsal
Ankle Eversion
Lumbar Plexus

16. Mechanism of Injury pg 413 An axial load to the top of the head
a flexion force
a hyperextension force
a flexion-rotation force
a hyperextension-rotation force
a lateral flexion force

17. Evaluation of neck and spine injuries.

18. Postural Malalignments

19. Low Back Injuries History My aching radiating pain back pain when?
weakness
loss of function
tingling or numbness
check posture
constant pain
My aching
back

20. Lumbar plexus nerve roots
Sensory
Muscle movement
L1,2,3,4
Upper to Mid to lower thigh
Quadriceps: Knee extension L4
Medial lower leg
Tibialis anterior: Foot dorsiflexion/inversion L5
Lateral leg and dorsum of foot
Extensor hallicus longus: great toe extension S1
Lateral foot
Peroneal longus/brevis: foot eversion

21. Rehabilitation for your low back
Williams low back exercises
Laying down, sitting, driving, standing, lifting, and carrying

22. Injuries stingers burners fractures disc problems sciatica scoliosis
strains/sprains
fractures
disc problems
spondylolisthesis
spondylolysis
sciatica
scoliosis
kyphosis

23. Injuries to neck Cervical sprain or whiplash
S/S=
Pain in the neck like a muscle strain but is pt tender over the spinous processes (lig.). Pain may appear the day after the trauma
RX:
Dr., collar, RICE, NSAID’s, contrast therapy and possibly traction
Acute Torticollis (wryneck)
S/S=
Pt tender, muscle spasm, head ROM is limited
Rx:
Contrast therapy, gentle traction, rotation and lateral bending stretching, wear a soft collar possibly, usually lasts for 2-3 days

24. Injuries Low back strain: S/S= pain in the low back
2 causes: sudden extension and trunk rotation
Chronic strain associated with poor posture
S/S= pain in the low back
Rx: ice, ice massage, massage, stretching and rest. Work on good posture

25. Spondylolysis and Spondylolisthesis
Common is activities that cause hyperextension.
Gymnastics, lifting weights, blocking in football, serving in tennis, spike in volleyball, butterfly stroke
S/S= pain over the low back after exercise not during.
Rx: rest and exercises to stabilize the area

26. Lumbar sprains and/or herniated lumbar disc
Mechanism of injury:
bending forward and twisting while lifting.
S/S=
pain is localized but radiates if lumbar disc is herniated down the back of your legs
RX:
RICE to reduce pain, strengthening exercises for abdominals and back extensors. Stretching and good posture need to be preformed daily

27. Low back special evaluation tests
Straight leg raise (SLR)
Used for evaluation of sciatic nerve problem, sacroiliac joint, and lumbar spine
Compression distraction tests
For sacroiliac (SI) joint