AHS Sports Medicine Prentice

 Bones (p )  Lumbar vertebrae 1-5  Sacrum  Coccyx  Joints  Intervertebral Joints  Facet Joints

 Ligaments (p. 737)  Anterior Longitudinal  Posterior Longitudinal  Supraspinous  Cartilage  Intervertebral Disk

 Muscles (p.737)  SUPERFICIAL: (Extensors)  Erector Spinae-Long muscles, run the length of the spine)  DEEP: (Extensors and rotators)- Short, connect one vertebra to the next  Multifidus  Rotatores,  Semispinales  Splenius

 Nervous structures (p. 738)  Cauda Equina of Spinal Cord  Spinal Nerves L1-S4  Lumbar Plexus  Sacral Plexus  Coccygeal Plexus

 5 basic questions  Additional important questions  Do you have equal strength in both legs?  What kind of pain are you experiencing?  What sensations other than pain are you experiencing?  Are you able to move your ankles and toes?  Do certain movements cause more pain?  Is their pain in the buttocks or back of the legs?

 Athlete standing and Sitting  Are you iliac crests symmetrical?  How is their posture from their pelvis all the way to their shoulders?  When standing look at anterior view for:  Head upright or titled to one side,  Shoulder height equal  A shoulder that may be carried forward comparatively  Scapula that is lower or more prominent than other  Trunk leaning ton once side  Space between arm and body greater on one side  One hip more prominent than the other  Hips tilted to one side  Trochanters unequal height

 When looking at a lateral view, look for alignment of:  Back of ear  Middle of shoulder  Middle of greater trochanter  Back of patella  Front of lateral malleolus

 Skin Changes  Color  Texture  Scars  Hair

 Bony  Spinous processes of L1-L5  Sacral processes of S1-S5  Coccyx (posterior aspect)  Iliac crests  Iliac spines  Ischial Tuberosity  Greater Trochanters

 Soft Tissue  Paraspinal muscles (muscles around the spine)  Gluteal muscles  Sciatic Nerve  Abdominal muscles  Inguinal Area

 Range of Motion-(Flexion, extension, lateral flexion, rotation)  Passive  Active  Resistive

 Neurological Tests:  Dermatomes:  L1,  L2,  L3,  L4,  L5,  S1,  S2

 Neurological Tests:  Myotomes (these are being tested by resistive ROM):  L2 – Hip Flexion  L3 – Knee Extension  L4 - Ankle Dorsiflexion  L5 - Toe Extension  S1 - Plantar Flexion

 Neurological Tests:  Deep Tendon Reflexes:  L4-Patellar Tendon  S1-Achilles Tendon

 Sciatic Nerve Tests  Straight Leg Raise -Lasegue’s Sign (p. 752)  How to perform:  Positive sign:  Contralateral SLR (Well Straight Leg Raise) (p.752)  How to perform:  Positive sign:  Bowstring (p. 753)  How to perform:  Positive sign:

 Sacroiliac Joint  Pelvic Rock Test (p 754)  How to perform:  Positive sign:  FABER/Patrick (p. 753)  How to perform:  Positive sign:  Gaenslen’s Sign (p. 753)  How to perform:  Positive sign:

 Tests for Disc or Meningeal Irritation  Kernig (p. 752)  How to perform:  Positive sign:  Milgram (p. 752)  How to perform:  Positive sign:  Slump (p. 751)  How to perform:  Positive sign:  Valsalva Maneuver (p. 98)  How to perform:  Positive sign:

 Functional tests  Think of 3 different types of athletes. What are some functional tests for the low back for each?  ALWAYS REFER TO A PHYSICIAN!!

 Fractures:  Vertebral body – Compression Fx  Mechanism: Hyperflexion  Transverse or spinous process  Mechanism: Impact to the back

 Muscle Strains  Two common Mechanisms:  Sudden extension contraction against too much weight  Chronic strain from bad posture

 Myofascial Pain Syndrome  Mechanism: Tight band of muscle (trigger point)  Symptoms:  Tenderness and pain at area of tightness  Palpation of trigger point refers pain to a predictable other area. (see photo)

 Lumbar Sprains-Most common low back injury!  Can occur in any ligament  Most common at facet joints  Common Mechanism: Forward bend and twist while lifting an object  Can be chronic or acute  Sx: Pain lateral to spinous process that gets worse with certain movements.

 Contusions-2 nd most common  Mechanism: Impact to back  Concerns: Sometimes contusion and fracture can only be differentiated by x- ray  Sx: Pain, spasm, point tenderness  Tx: Ice regimen 72 hrs, Stretching, possible ultrasound

 Sciatica  Definition: Sciatic nerve pain  Mechanism: Nerve compression from vertebrae, or piriformis muscle tightness  Sx: Sharp, shooting pain along posterior, medical thigh, possible neurological sx  Tx: Rest, treat cause of inflammation

 Herniated Disk  Most common at L4/5, 2 nd most common at L5/S1  Mechanism: repeated poor technique/movement, degeneration of disk tissue  Sx: Sharp pain, radiates to dermatome on one side, possible myotome weekness

 Spondylolysis  Definition: degeneration of vertebrae at facet joint resulting in a stress fracture there.

 Spondylolisthesis  Slipping forward of one vertebra on another, usually considered a complication of Spondylolysis

 Sacroiliac Sprain  Overstretch of SI joint ligaments  Mechanisms:  Twist with both feet on ground  Stumble forward  Fall backward  Step down heavy on one leg  Bend forward while lifting with back rather than legs

 Coccygeal Injuries  Common Mechanism: Direct impact, often from falling on buttocks or being kicked by an opponent