3/11/2015 Entry Task: Get out your injuries, grab your portfolio Journals DUE: Tuesday March 31 – FIND YOUR OWN ARTICLE* *Must be peer reviewed

 One of most common and disabling ailments known to humans!  Lumbar sprain  Lumbar strain  Lumbar Fracture  Disc Herniation

 MOI  Flexion + rotation  Usually while lifting or moving an object  May be acute or caused by repetitive stresses over time

 Structures  Any ligament in the lumbar spine  S&S  Pt tenderness, localized swelling, mm guarding  Tx  Ice, support, stretching, stabilize, bed rest?

 Special Tests:  Spring Test  Hoover’s test for Malingering

 MOI  Sudden extension  Usually c rotation  Could be chronic (bad posture)  Structures  S&S  May be diffuse or local pain  Pn with AROM ext, PROM flex  Tx  Ice, support, stretching, stabilize

 Special Tests?

 MOI  Compression : Hyper flexion, falling from a height  Transverse or spinous process fx : direct force  Structures  S&S  Pt tender, may be able to palpate, localized swelling and muscle guarding  Tx  Referral, minimize movement

 MOI  Same as lumbar sprain –  Flexion + Rotation  Structures Involved  Nucleus pulposus herniates posteriorly out of annulus fibrosis  May pinch nerve root  Most commonly between L4 and L5

 S&S  Central pain that radiates (nerve pain)  Down one side or spread across back  Worse in the mornings  Onset sudden or gradual  Increases after periods of sitting  Slight fwd bend in posture and lateral bend away from side of pain  Tx  Ice, core stabilization, traction, nerve damage may need surgery

 Special Tests:  Milgrim’s test  Quadrant test  SLR  Valsalva maneuver

3/13/2015 Entry Task: What do you think is the best way to get someone with a cervical injury onto a spine board without moving their neck? How many people would you need? Where do you hold them/move them? What if they were prone?

 MOI  Whiplash!  Sudden or forced flexion, extension, rotation (snaps suddenly)  Strain may accompany  Structures  S&S  Point tenderness over spinous and transverse processes  Localized pain, restricted ROM, mm guarding, apprehension  Lasts longer than strain  May not have initial pain, but always appears day after  Tx  r/o fracture, cervical collar?, ice, heat, massage, traction

 “Wry neck”  MOI  Stiff after a night’s sleep  Cold draft of air, holding neck in unusual position  Structures  Small piece of synovial membrane gets pinched or trapped between cervical vertebrae

 S&S  Pt tenderness  Muscle spasm  Head movement restricted to contralateral of irritation  Muscle guarding  Tx  Ice, heat  Traction  ROM  Usually lasts 2-3 days

 MOI  Same as sprain, but less violent  Structures  S&S  Local pain, point tender, restricted ROM, mm guarding, apprehension  Tx  Ice, collar?, ROM, heat

 MOI  Relatively uncommon  Axial loading  Causes anterior compression and curvature to flatten  + rotation = dislocation  Structures  S&S  Pt tenderness, restricted movement, mm guarding  Weakness or paralysis, nerve pain  Dislocation : neck tilted toward dx side with extreme tightness on elongated side, relaxed on tilted side

 Treatment  If unconscious, suspect serious neck injury  Call 911  Do not move athlete unless…  Catastrophic spinal injury can result from improper handling and transportation

 Observation  Arrival and Primary Survey  Check LOC  If unconscious?  If conscious?  Position?  Supine  Head turned  Prone

 Reasons not to move neck:  Increased pain  Neurological sx  Muscle spasm  Airway compromise  If it is physically difficult to reposition the spine  Resistance is encountered  Patient expresses apprehension

 Review:  Paraplegic  Hemiplegic  Quadriplegic  Afferent and Efferent Neurons  Motor neuron lesions  Posturing

 MOI  Stretching or compression of brachial plexus  Most common cervical neurological injuries in athletes  Neck is forced laterally while opposite shoulder is depressed  Structures

 S&S  Burning sensation  Numbness, tingling  Pain extending from shoulder down to hand  Transient loss of function  Tx  May RTP after Sx have resolved  Cervical neck roll  Traction? Stretching?  Special Test

 Spoondylosis  Degeneration  Spondylolysis  Stress fracture at pars interarticularis  “Scotty dog” Fracture  Spondylolisthesis  Displaced vertebrae (most commonly L5 slipping anteriorly on S1)  Hypermobility

 MOI  Congenital weakness  More common among boys  Movements that characteristically hyperextend spine  S&S  Persistent aching pain or stiffness across low back  Increased pain after, not during, physical activity  Need to change positions or pop back  Tx  Referral with positive Single Leg Stance Test  Stabilizing exercises

 Constriction of the spinal cord or nerve roots  Narrowing of vertebral foramen  Many causes :  Arthritis  Disc herniations  Sponylolisthesis  Spine curvature  Fracture  Tumor  Infection