Chapter 9 Spinal Injuries

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.

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

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

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)

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

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

Thoracic vertebrae

Lumbar vertebrae

Sacrum and coccyx

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

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

Nucleus pulposus and annulus fibrosis

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Treatment of lumbar spine injuries and conditions

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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