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Chapter 9 Spinal Injuries.

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Presentation on theme: "Chapter 9 Spinal Injuries."— Presentation transcript:

1 Chapter 9 Spinal Injuries

2 Objectives Describe the basic anatomy of the spine.
Explain common spinal injuries that occur with athletic participation. Identify common signs and symptoms of spinal injuries. Explain the treatments performed by an ATC for specific spinal injuries. Describe common postural problems.

3 Anatomy Four segments Sacrum (tailbone) Lumbar (lower spine)
Thoracic (middle spine) Cervical (upper/neck spine)

4 Anatomy Normal anatomical alignment and muscular strength keep the spine aligned Normal alignment and curvature is called neutral spine

5 Bones Separated by disks Held together by ligaments
Muscles also permit many movements and stabilize the spine 7 cervical vertebrae 12 thoracic vertebrae 5 lumbar vertebrae 5 sacral (fused) vertebrae 4 coccyx (fused)

6 Bones All vertebrae have a body, a spinous process, and a canal through which the spinal cord passes Functions Protecting the spinal cord Hold body upright when walking Sight for muscle attachment

7 Bones Cervical Thoracic Lumbar Sacral C1= atlas C2= axis
C7= very prominent spine Thoracic Large spinous processes Lumbar Most chronic injuries occur to this region Sacral

8 Thoracic vertebrae

9 Lumbar vertebrae

10 Sacrum and coccyx

11 Intervertebral Disks Function Absorb shock
Resist compression during activity Keep vertebrae separate Allow for movement and flexibility Provide space for nerves to exit the spinal cord

12 Intervertebral disks Two specific parts
Nucleus pulposus (jelly-like core) Annulus fibrosus ( layer rings of cartilage that surround the nucleus pulposus) Disks receive no blood supply, therefore do not heal well when injured Disks are compressible Possible to be taller first thing in the morning Shorter with age

13 Nucleus pulposus and annulus fibrosis

14 Muscles Mast Spine Cables stabilize the sails
Many cables that attach at various points Many muscles attach to different places like pelvis, legs, and arms Cables stabilize the sails Muscles stabilize spine while body performs functions like throwing, catching, and kicking Provides stability to ensure sails catch in the wind Provides stability to body so it can function correctly Numerous muscles that provide a wide range of movements and stability Spine=mast on a ship

15 Muscles Spinal extensors Upper trapezius
Run entire length of spine posteriorly Attach to ribs, pelvis, and vertebrae Keep body upright Upper trapezius Extends the cervical spine Attaches to occipital bone and fans out to each side of neck and attaches on acromion process of scapula

16 Muscles Scalene muscles ( 3 total each side) Cervical flexion
Attach to cervical vertebrae and run down to the first and second ribs Help with breathing process

17 Muscles Sternocleidomastoid Cervical side bending and rotation
Attaches to top of sternum and attaches to mastoid process just behind ear

18 Muscles Abdominals Rectus abdominus and internal and external obliques
Support trunk movement

19 Posture Normal Plumb line- imaginary vertical line that helps determine posture View from side Correct posture, plumb line should pass through these anatomical landmarks Just behind ear Through center of shoulder Down through middle of the greater trochanter of hip Behind the patella Just in front of lateral malleolus

20 Posture Abnormal Forward head posture Rounded shoulders
Ear projects in front of plumb line Stresses back of neck Rounded shoulders Line passes through back of shoulders instead of middle

21 Posture Kyphosis Excessive rounding of the thoracic spine
Decreases ability of spine to absorb shock effectively More prone to injury

22 Posture Lordosis Excessive forward curve of the lumbar spine
Decreases ability of spine to absorb shock effectively More prone to injury

23 Posture Scoliosis Side bend to spine
Looks crooked from a posterior view If undiagnosed and suspect, should refer for further assessment

24 Posture Improving posture Keep top of head as high as possible
Don’t always carry bag on same shoulder Regular exercise Focus on good posture and it will become habit

25 Preventing spinal injuries
Active process Exercise Concentrate on flexibility Maintain proper posture Use correct lifting techniques Use back support if necessary when lifting

26 Injury prevention Proper balance of muscles strength and flexibility
Strong abs decrease stress on lumbar region Hip strength also has effect on spine Need to be strong and flexible

27 Injury prevention Proper lifting procedures
Maintaining slight curve in lumbar spine while lifting with knees and hips…not back Keep head up Injury most often occurs when spine is too rounded or flexed and causes a strain or disk injury Back supports common in many work environments

28 Treatment of lumbar spine injuries and conditions

29 Ligament injuries Often occur from forced excessive trunk flexion or flexion and rotation at the same time Example: a football player tackled and forced forward Posterior aspect of the vertebral joints can separate and stretch ligaments

30 Ligament injuries Characteristics of a lumbar sprain
Pain to one side of the spine Limited movement due to pain and muscle spasm Often difficult to differentiate a sprain from a strain Can test by pushing each of the vertebrae anteriorly, should not be painful Do not perform if signs/symptoms of a fracture are present

31 Ligament injuries Treat like any other acute injury
PRICE Always use ice in first 48 hours of an acute injury Return to activity includes Proper flexibility Proper strengthening Pain free motion

32 Muscle and tendon injuries
Rare to see a ruptured muscle at the spine Characteristics of strain Pain to one side Muscle spasm Lack of movement Pain on the opposite side from the direction the athlete bends (bend to right, pain on left) Pain from sprain usually localized (small area), pain from strain usually travels length of muscle

33 Muscle and tendon injuries
Treat with PRICE Return to activity Proper stretching Proper strengthening Pain free activity Observe athlete for proper posture and lifting technique

34 Bone Injuries Caused by Compression Direct blow
Forcefully landing on buttocks Direct blow

35 Bone injuries Spondylolysis Most common in gymnasts
Stress fracture at the pars interarticularis Fracture that fails to heal can separate, causing spinal instability

36 Spondylolysthesis Occurs when a spondylolysis slips forward on the vertebrae below it Most often occurs when L5 slips forward on S1 (as shown)

37 Bone injuries Spondylolysis and spondylolisthesis are serious injuries
Need physician exam Require rest and possible lumbar brace Extensive rehab strengthening trunk muscles

38 Bulging disk Not common in young athletes
Some call slipped disk, not appropriate term Nucleus pulposus bulges through annulus fibrosis

39 Bulging disk Rarely bulges toward front of spine
Covered with thick ligament (anterior longitudinal ligament) Most people have postures that flex the spine forward most of the time which pushes nucleus pulposus toward the posterior aspect Puts pressure on the nerves exiting the spinal cord Causes numbness, tingling, and pain down the leg Can cause low back pain that increases while sitting

40 Bulging disk Treatment Improve posture
Improve body mechanics and lifting techniques Rest Traction Strengthening

41 Cervical spine Ligament injuries
Caused by forceful movement beyond normal range Hyperflexion Hyperextension Cause neck and arm pain Always rule out spinal cord injury PRICE, no C Strengthen, regain full ROM

42 Cervical spine Return to activity guidelines Full strength Full ROM
Full confidence No symptoms Physician clearance

43 Muscle and tendon injuries
Can also be caused by whiplash Characteristics Muscle spasm Limited ROM Weakness against resistance Pain and tenderness Treat like a sprain (PRI) Same return to activity guidelines Manual resistance work well for rehab

44 Bone injuries Fractures Dislocations Often a result of axial loading
often result of a combination of excessive flexion and rotation

45 Fractures and dislocations
Similar signs and symptoms Pain around cervical vertebrae Weakness Numbness Tingling down arms Dislocation usually has deformity

46 Fractures and dislocation
Care/treatment Immobilize and spineboard Helmet procedures Call EMS

47 Disk injuries Not as common as in lumbar spine
Person reports more neck pain with sitting and forward flexion Some discomfort down the back and between the shoulders Treatment Improve posture Cervical extension exercises traction

48 Brachial plexus injuries
Exit through the cervical spine Stretching nerves causes stinger/burner Can last seconds or minutes Severe even longer (weeks) Treatment Strengthening ROM stretching Neck roll (FB) to limit lateral flexion

49 Brachial plexus Return to play guidelines No symptoms Full strength
Full ROM Problem-free neck and shoulder eval by ATC and team physician

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