The Spine Chapter 20 Pages 488-515

Bony Anatomy Bones: 33 individual bones called vertebrae Cervical Spine: 7 vertebrae Thoracic Spine: 12 vertebrae Lumbar Spine: 5 vertebrae Sacrum: 5 fused vertebrae Coccyx: 4 fused vertebrae ROM of Vertebral Column: flexion, extension, lateral flexion, and rotation

Vertebrae Pictures

Anatomy, Cont’d Intervertebral articulations and disks: Annulus Fibrosus Nucleus Propulsus Ligaments: anterior longitudinal, posterior longitudinal, and supraspinous Muscles: erector spinae Spinal Cord and Nerves: the spinal cord is part of the CNS that is housed within the vertebral canal of the spinal column. 31 pairs of spinal nerves

Prevention of Injuries to the Spine Cervical spine Strength Flexibility Using proper technique Lumbar spine Strength and flexibility

Assessment: History What do you think happened? Did you hit someone or land directly on top of your head? Where you knocked unconscious? Do you have any pain in your neck? Do you have any tingling, numbness, or burning in your shoulders, arms, or hands? Do you have equal muscle strength in both hands? Are you able to move your ankles and toes? Any bowel or bladder changes?

Abnormal Postures

Assessment: Observation Does posture show signs of kyphosis, lordosis, or scoliosis? Is the athlete willing to move the head and neck freely? Are the shoulders level and symmetrical? Is the head tilted to one side? Is the scapula lower or more prominent than the other? Is the trunk bent or curved to one side? Is the space between the body and arm greater on one side? Is one hip tilted? More prominent? Are the ribs more pronounced on one side? Does one arm hang lower? Forward? Is one patella lower than the other?

Assessment: Palpation and Special Tests Athlete should be lying prone (on stomach) Bony palpation: spinous/transverse processes, sacrum, and coccyx. Soft tissue palpation: musculature on each side of the spine for spasm and guarding. Special Tests Straight leg raises Compression and distraction tests

Recognition and Management of Injuries to the Cervical Spine Cervical Fractures Cervical Dislocations Acute Muscle Strains of the Neck and Upper Back Cervical Sprain (Whiplash) Acute Torticollis (Wryneck) Pinched Nerve (Brachial Plexus Injury)

Cervical Fractures MOI: S&S: Treatment: Axial loading is a blow to the top of the athlete’s head while in flexion. S&S: Neck point tenderness, restricted movement, cervical muscle spasm, cervical pain, pain in the chest, and extremities, numbness in the trunk/limbs, weakness/paralysis in the trunk/limbs, loss of bowel/bladder control. Treatment: Do not move the athlete. Activate EMS. Stabilize head and neck.

Cervical Dislocations MOI: A result of violent flexion and rotation of the head. S&S: Similar to cervical fracture. A unilateral dislocation causes the neck to be tilted toward the dislocated side. Treatment: Do not move the athlete. Activate EMS. Stabilize head and neck.

Acute Muscle Strains of the Neck and Upper Back MOI: Forced flexion, extension, and/or rotation of the head suddenly. Muscles: upper trapezius, SCM, scalenes, splenus capitus and cervicis. S&S: Localized pain, point tenderness, restricted ROM, muscle guarding. Treatment: RICE, cervical collar, ROM, isometric exercises, isotonic exercises, and modalities for pain control. Whiplash

Pinched Nerve MOI: S&S: Treatment: Stretching or compression of the brachial plexus. The neck is forced laterally to the opposite side while the shoulder is depressed. S&S: Burning sensation, numbness, tingling, pain from shoulder to the hand, loss of function of the arm and hand. Treatment: Once the symptoms have completely resolved and there are no neurological symptoms, the athlete may return to participation. Strengthening and stretching of neck muscles.

Recognition and Management of Injuries to the Lumbar Spine Low Back Pain (LBP) Lumbar Vertebrae Fracture and Dislocation Low Back Muscle Strains Lumbar Sprains Back Contusions Sciatica Herniated Lumbar Disk Spondylolysis and Spondylolisthesis

Low Back Pain MOI: S&S: Prevention: Congenital anomalies and/or mechanical back defects (faulty posture, trauma to the back). S&S: Muscular weakness, impairment of sensation and reflex responses. Prevention: Avoid unnecessary stresses and strains associated with standing, sitting, lying, working, or exercising.

Lumbar Vertebrae Fracture and Dislocation MOI: Compression fractures usually occur from falling from a height and landing on the feet/buttocks, a kick and/or direct impact to the back. S&S: May be palpable over spinous and transverse processes, point tenderness, swelling, and muscle guarding in the area. Treatment: Spine board the athlete and refer to physician.

Low Back Muscle Strains MOI: Sudden extension in combination with trunk rotation and chronic strain because of faulty posture. S&S: Pain may be diffused or in one area. Pain with active extension and passive flexion. Treatment: Ice, abdominal support, graduated program of stretching and strengthening .

Lumbar Sprains MOI: S&S: Treatment: Bending forward and twisting while lifting an object. S&S: Localized pain that is lateral to the spinous process, pain becomes sharp with certain movements/postures, flexion/extension/rotational movements of the vertebrae increase pain. Treatment: RICE, strengthening for back extensors and abdominals, and stretching in all directions. May take some time to heal.

Back Contusions MOI: S&S: Treatment: Direct trauma. Be wary of the kidneys. S&S: Local pain, muscle spasm, and point tenderness, swelling, and discoloration. Treatment: Ice for 72 hours, rest, gradual stretching. Recovery ranges from 2 days to 2 weeks.

Sciatica MOI: S&S: Treatment: Sciatica is an inflammatory condition of the sciatic nerve that can accompany recurrent/chronic LBP. S&S: Onset may be sudden or gradual, a sharp/shooting pain that follows the nerve pathway along posterior and medial thigh, tingling and numbness along the nerve pathway, sensitive to palpation, and pain with straight leg raises. Treatment: Rest, identify cause of inflammation, NSAIDS, sometimes surgery may be indicated.

Herniated Lumbar Disk MOI: S&S: Treatment: Forward bending and twisting that places abnormal strain on the lumbar region. S&S: Centrally located pain that radiates on one side of the buttocks and down the back of the leg or pain that spreads across the back, symptoms are worse in the morning, onset may be sudden or gradual, posture is bent forward and away from the side of pain, and pain with straight leg raises. Treatment: Rest and ice, back extensor and abdominal stabilization exercises, sometimes surgery is necessary.

Herniated Disk Picture

Visual Aids Courtesy of the Following Websites: http://www.sci-recovery.org/sci.htm http://www.nationalpainfoundation.org/MyTreatment/articles/BackAndNeck_Part_2.asp http://www.getbodysmart.com/ap/skeletalsystem/skeleton/axial/vertebrae/menu/animation.html http://www.spineuniverse.com/displayarticle.php/article2245.html http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/19469.jpg http://lc3.littlechute.k12.wi.us/staff/hthomas1/Anatomy%20and%20Physiology/Notes/Skeletal%20System_files/image007.jpg http://www.healthatoz.com/healthatoz/Atoz/images/ency/00042710.jpg