SPINAL INJURIES Chapter 11

Anatomy of the Spine Coccyx = tailbone, 3-5 fused vertebrae Sacrum = tailbone area, 5 fused vertebrae Lumbar = lower spine, 5 vertebrae Thoracic = middle spine, 12 vertebrae Cervical = upper spine, 7 vertebrae Neutral spine = normal alignment and curvature of the spinal column from top to bottom.

Parts of the Vertebrae Body Spinous process Transverse process Vertebral foramen

Function of the Spine Protect the spinal cord Hold the body in an upright position for walking Site for muscular attachments

Intervertebral Disks Lie between the vertebrae Absorb shock Resist compression during activity Keep vertebrae separated, which allows movement and flexibility Provides space for nerves to exit the spinal cord to the rest of the body Nucleus pulposus = jellylike core Annulus fibrosus = outer layers of cartilage Disks have no blood supply so healing is slow Compression throughout the day makes you shorter

Muscles Abdominal muscles (trunk flexion) Rectus abdominis Internal and external obliques Erector Spinae m. (trunk extension) Trapezius m. (cervical extension) Scalenius m. (cervical flexion) Sternocleidomastoid m. (cervical lateral bending and rotation)

Normal Posture Normal posture would align at the following anatomical locations: Just behind the ear Through the center of the shoulder Middle of the greater trochanter of the hip Behind the patella Just in front of the lateral malleolus

Abnormal Posture Torticollis = forward head posture Kyphosis = excessive roundedness of the thoracic spine (shoulder area) Lordosis = excessive anterior curvature of the lumbar spine Scoliosis = abnormal curvature from side to side

Good Postural Habits and Spinal Injury Prevention Stand and walk tall with good posture Alternate which shoulder you carry your book bag on Exercise regularly Maintain flexibility Learn to lift properly Use back supports (belts) when lifting

Ligament Injuries Sprains occur when the trunk is hyper flexed, or flexed and rotated at the same time S & S = pain to one side of the spine and limited movement PRICE for first 48 hours, then switch to heat Stretch and strengthen

Muscle and Tendon Injuries Pain usually presents to the opposite side of movement Sprain pain is localized, while strain pain moves up and down the length of the muscle

Bone Injuries Fractures occur from trauma, often compression Spondylolysis = stress fracture or bone degeneration of the vertebrae Spondylolisthesis = forward slippage of the vertebra on the one below it due to spondylolysis

Other Common Spine Injuries Disk Bulge – when the nucleus pulposus pushes through the annulus fibrosis. Not common in younger athletes, but can occur in older athletes. Usually bulge posterior or to the side, which puts pressure on the nerve. It doesn’t usually occur anterior because of the anterior longitudinal lig.

Disk Bulge Cont. S & S = numbness, tingling, and pain down the leg Low back pain that increases with sitting Work on mechanics with rehabilitation as well as posture

Cervical Spine Injuries and Conditions Ligament injuries – usually due to hyperflexion or hyperextension of the neck Hyperextension injuries = whiplash S & S = neck and arm pain, a neck brace may be needed for support To return to play, an athlete must have: Full strength Full range of motion Full confidence No symptoms Physician clearance

Muscle and Tendon Injuries Can also occur from whiplash S & S = muscle spasm, restricted ROM, weakness against resistance, pain, and tenderness of the muscle Same return to play criteria as for a ligament injury

Bone Injuries Fractures and dislocations to the cervical spine are usually due to an axial load and may cause paralysis S & S = pain and weakness around the cervical spine, numbness, and tingling down the arms With a dislocation there is obvious deformity Call 911 for proper transport

Brachial Plexus Injuries The brachial plexus is a network of nerves that exit the cervical spine and run through the shoulder and down the arm Mechanism of injury = hyper lateral flexion of the neck and depression of the shoulder S & S = burning, tingling, numbness and stinging sensation of the arm and shoulder Called a “burner” or a “stinger” Treat with strengthening & ROM stretches