© 2005 The McGraw-Hill Companies, Inc. All rights reserved. The Spine PE 236 Juan Cuevas, ATC

© 2005 The McGraw-Hill Companies, Inc. All rights reserved.

Assessment of the Spine History –_____________ (rule out spinal cord injury) _________, tingling, burning? Can you move your ankles and toes? Do you have equal strength in both __________?

© 2005 The McGraw-Hill Companies, Inc. All rights reserved. –Other general questions Where and ________ of pain are you experiencing? What were you doing when the pain started? Did the pain begin immediately and how long have you had it? _______ or movements that increase/decrease pain? Past history of back pain Sleep position and patterns, seated positions and postures

© 2005 The McGraw-Hill Companies, Inc. All rights reserved. ______________ –Body type –Postural alignments and asymmetries should be observed from all views –Assess height differences between anatomical landmarks

© 2005 The McGraw-Hill Companies, Inc. All rights reserved. Postural Malalignments

© 2005 The McGraw-Hill Companies, Inc. All rights reserved. Palpation –Should be performed with athlete __________ Head and neck should be slightly flexed, pillow under hips if suffering from low back pain –_________ and transverse processes of each vertebrae should be palpated along with sacrum and coccyx –__________ should also be palpated bilaterally

© 2005 The McGraw-Hill Companies, Inc. All rights reserved. Special Tests –Test for lumbar spine should be performed standing, sitting, supine, _________ and prone –Assess levels of pain and ________________ during the following tests Forward and backward bending Side-bending and rotation

© 2005 The McGraw-Hill Companies, Inc. All rights reserved. –Straight Leg Raises Applies pressure to SI joint and may indicate problems with __________, SI joint or lumbar spine

© 2005 The McGraw-Hill Companies, Inc. All rights reserved. Low Back Pain –Cause of Injury ___________ anomalies Mechanical defects of the spine (posture, obesity and body mechanics) Back trauma -Signs of Injury Pain, possible weakness, __________ gait, muscle strains and bony defects Neurological signs and symptoms if it becomes disk related –Care Correct alignments and body mechanics Strengthening and stretching – avoid unnecessary stresses and strains associated with daily living

© 2005 The McGraw-Hill Companies, Inc. All rights reserved. Lumbar Vertebrae Fracture and Dislocation –Cause __________ fractures or fracture of the spinous or transverse processes Compression fractures are usually the result of trunk hyperflexion or falling from a _________ Fractures of the processes are generally the result of a direct blow Dislocations tend to be ________ –Signs of Injury Point tenderness over the affected area Palpable ___________ over the spinous and transverse processes Localized swelling and guarding

© 2005 The McGraw-Hill Companies, Inc. All rights reserved. Care –X-ray and physician referral –Transport with extreme caution and care to minimize movement of the segments –Utilize a spine board

© 2005 The McGraw-Hill Companies, Inc. All rights reserved. Low Back Muscle Strain –Cause of Injury Sudden ______________ overload generally in conjunction w/ some type of rotation Chronic strain associated with posture and mechanics –Signs of Injury Pain may be diffuse or localized; pain w/ _________ extension and ____________ flexion –Care RICE to ________ spasm; followed by a graduated stretching and strengthening program Elastic wrap/back brace may be useful for support and compression Complete bed rest may be necessary if it is severe enough ____________

© 2005 The McGraw-Hill Companies, Inc. All rights reserved. Back Contusions –Cause of Injury Significant impact or ___________ to the back –Signs of Injury Pain, swelling, discoloration, muscle spasm and point tenderness –Management RICE for the first _______ hours Ice massage combined with gradual stretching Recovery generally last 2 days to 2 weeks

© 2005 The McGraw-Hill Companies, Inc. All rights reserved. __________ –Cause of Injury ___________ condition of the sciatic nerve Nerve is vulnerable to torsion or direct blows that place abnormal amounts of stretching or pressure on nerve –Signs of Injury Arises abruptly or gradually; produces _______ shooting pain, tingling and numbness Sensitive to palpation with straight leg raises intensifying the pain –Care Rest is _________; acutely – recovery = 2-3 weeks Treat the cause of inflammation; traction if disk protrusion is suspected; NSAID’s

© 2005 The McGraw-Hill Companies, Inc. All rights reserved. Herniated Disk –Cause of Injury Caused by abnormal stresses and degeneration due to use (forward bending and twisting) –________ Pulposus –Annulus ________

© 2005 The McGraw-Hill Companies, Inc. All rights reserved. –Signs of Injury Centrally located pain that radiate Symptoms are worse in the __________ Onset is sudden or gradual, pain may increase after the athlete sits and then tries to resume activity Forward bending and _______ increase pain, while back extension __________ pain Straight leg raise to 30 degrees is ___________ –Care Rest and ice for pain management Extension exercises may be comfortable _________ stabilization exercises should be integrated as athlete improves

© 2005 The McGraw-Hill Companies, Inc. All rights reserved. Spondylolysis and Spondylolisthesis –Cause of Injury Spondylolysis refers to degeneration of the vertebrae due to congenital weakness (____________ results) ___________ of one vertebrae above or below another is referred to as spondylolisthesis and is often associated with a spondylolysis –Signs of Injury Pain and persistent _________, low back stiffness with increased pain after activity Frequent need to change position or “_____” back to reduce pain Localized tenderness to one segment

© 2005 The McGraw-Hill Companies, Inc. All rights reserved.

–Care __________and occasionally bed rest for 1-3 days will help to reduce pain Major focus should be on exercises directed as controlling or stabilizing hypermobile segments Progressive trunk strengthening, dynamic core strengthening, concentration on abdominal work Braces can also be helpful during high level activities Surgery in extreme cases

© 2005 The McGraw-Hill Companies, Inc. All rights reserved. Sacroiliac Joint Dysfunction Sacroiliac Sprain –Cause of Injury Result of twisting with both feet on the ground, stumbles forward, falls backward, steps too far down, heavy landings on ______, bends forward with knees locked during lifting –Signs of Injury Palpable pain and tenderness over the joint, medial to the ________ w/ some muscle guarding Pelvic ____________ are possible

© 2005 The McGraw-Hill Companies, Inc. All rights reserved. Care –Ice can be used to reduce pain –Bracing can be helpful in acute sprains –Strengthening exercises should be used to stabilize the joints