1. Intro to Sports Medicine
Head and Spine
Intro to Sports Medicine

2. Spine

3. Functions of the Spinal Column
Supporting the majority of body weight
Supporting head, trunk, & upper extremities against gravity
Protection of the spinal cord
Shock absorption
Provide stable structure to maintain upright posture

4. Bony Anatomy 33 segments, divided into 5 regions Cervical - 7
Thoracic - 12
Lumber - 5
Sacrum - 5 (fused)
Coccyx - 4 (fused)

5. Vertebrae

6. Vertebrae
Thoracic- Giraffe
Lumbar- Moose

7. Cervical Vertebrae
C1 is the atlas, ring shaped vertebra connects to the occipital bone to support head
C2 is the axis, bony protrusion points upward to the fit into the ring- shaped atlas
House and protect the spinal cord
Support the head and its movements

8. Thoracic Vertebrae
Rib cage is in conjunction with the thoracic spine to provide stability
Influence motions in spine and shoulder girdle
Provide assistance with weight bearing
Can affect postural alignment

9. Lumbar Vertebrae Support the weight of the entire torso
Lumbosacral joint- L5 meets S1; considerable rotation so pelvis and hips can swing while walking and running

10. Sacrum and Coccyx Sacrum- 5 fused bones
Sacroiliac joint- Connects iliac bones posteriorly to sacrum
Coccyx- 4 fused bones
Commonly known as tailbone

11. Intervertebral Disc
Fibrocartilaginous tissue in between vertebral bodies; two parts: annulus and nucleus
Shock absorption
Movement between vertebrae
Separation between vertebrae
Allow passage of nerve roots through intervertebral foramen

12. Muscles

13. Main Groups Superficial- associated with shoulder girdle
Intermediate- respiration
Deep- vertebral column
Erector spinae: Iliocostalis, Longissimus, Spinalis (I Love Sushi)

14. Superficial Muscles
Trapezius
Latissimus Dorsi

15. Intermediate Muscles Levator Scapulae Rhomboid Major/Minor
Serratus Posterior Superior
Serratus Posterior Inferior

16. Deep Muscles Splenius Capitis Iliocostalis Longissimus Erector Spinae
Spinalis

17. Motions of the Spine Flexion Extension Lateral Flexion Rotation Shear
Distraction
Compression

18. Injuries

19. Postural Deviations
Sway back
Lordosis
Kyphosis
Forward Head

20. Scoliosis Lateral curvature of the spine; “S” shaped curve
Functional- muscle imbalance, leg length discrepancy
Structural- bony abnormality or vertebral rotation

21. Thoracic Outlet Syndrome
Compression, injury, or irritation of the nerves and/or blood vessels (arteries and veins) in the lower neck and upper chest area
CC: radiating arm p!, p! In neck, face, head, chest, shoulder; upper extremity paresthesia, weakness, edema, or Raynaud phenomenon

22. Disc Pathology
Disc Degeneration- general term to describe any change in the shape of the annulus
Disc Prolapse- nucleus of the disc bulges against the intact annulus
Extruded Disc- nucleus of the disc bulges through the annulus but remains within the longitudinal ligament
Sequestrated Disc- nucleus of the disc breaks through all barriers and is free within the spinal column

23. Spondylolysis
Stress fracture in the pars interarticularis, small thin portion of vertebra
Commonly L4 or L5
gymnastics , football, weight lifting
S/Sx: similiar to muscle strain, p!
radiates to butt and thighs, worsen
with activity

24. Spondylolisthesis One vertebrae glides anteriorly over another
Commonly at L4-L5 or L5-S1
Caused by pars interarticularis fracture
S/Sx: same as spondylolysis

25. Head

26. Anatomy 27 bones of the head Brain
Except the mandible, they are all joined together by sutures
Synarthrotic (immovable)
Brain
Cerebrum
Largest part, higher mental function
Cerebellum
Synergistic movement
Pons
Sleep, swallowing
Medulla oblongata
Lowest part of brain stem, regulates heart rate and breathing

29. The Cranial Nerves 29 Number CN Function Sensory/Motor Assessment I
Olfactory
Smell
Sensory
provide distinct smelling objects II
Optic
Visual Acuity
identify # of fingers, read
III
Oculomotor
Pupillary rxn
Motor
shine light in each to assess reaction, upward, downward, & medial gaze IV
Trochlear
Eye movement
have eye follow finger without moving head, downward & lateral gaze V
Trigeminal
Chewing and facial sensation
Both
identify location of touch about face, hold mouth open against resistance, corneal reflex, grit teeth VI
Abducens
Lateral eye movement
have patient move eyes form side to side, lateral gaze
VII
Facial
Facial expressions and sensation
smile, wrinkle forehead, wink, puff cheeks, close eye tight, identify tastes with anterior tongue
VIII
Vestibulo-cochlear
Balance and hearing
identify sounds, finger to nose, heel to knee, Rhomberg’s IX
Glosso-pharyangeal
Voice and swallow
say “ah”, swallow, test gag reflex X
Vagus
Gag reflex
tested with gag reflex of glossopharyngeal XI
Accessory
Neck strength
resist head rotation, shoulder shrugs
XII
Hypoglossal
Tongue movement
stick out tongue, move rapidly, resist with tongue depressor 29

31. I - Olfactory nerve- smell
II - Optic nerve- vision
III - Oculomotor nerve- pupillary reaction
IV - Trochlear nerve- moves eye
V - Trigeminal nerve- face and chew
VI - Abducens nerve- abducts eye
VII - Facial nerve- expression/taste
VIII - Vestibulocochlear nerve – hear/balance
IX - Glossopharyngeal nerve- taste/gag reflex
X - Vagus nerve- gag reflex
XI - Accessory nerve- shoulder shrug
XII - Hypoglossal nerve- swallowing/speech

32. Injuries

33. Epistaxis (Nosebleed)
Direct blow, allergies, foreign body, head injury
DO NOT TIP HEAD BACK
- upright with a cold compress, pinch bridge of nose; roll of gauze between upper lip and gums
DO NOT BLOW YOUR NOSE

34. Auricular Hematoma (Cauliflower ear)
Compression of shearing injury to ear (acute or chronic)
Hemorrhage and fluid accumulation
Wear head gear to avoid it
Reduce friction
Drain if need be

35. Orbital Hematoma (black eye)
Blow to the area surrounding the eye, resulting in capillary bleeding
Swelling and discoloration
Apply ice for at least 30 minutes and rest
DO NOT BLOW NOSE- may cause capillaries to bleed more

36. Conjunctivitis (pink eye)
Allergies, dust, smoke, common with upper respiratory infections
Eyes discharge and swell, severe redness of eye, itching
VERY CONTAGIOUS LIMIT ALL CONTACT WITH PATIENT

37. Skull fracture Etiology: Blunt trauma Signs and symptoms: Management
Severe headache and nausea
Possible defect upon palpation
Blood in the middle ear
May be blood in the middle ear, ear canal, nose, ecchymosis around the eyes (raccoon eyes) or behind the ear (Battle’s sign)
Cerebrospinal fluid in the ear and nose
Management
Skull fracture is not the problem
Complications from intracranial bleeding
Bone fragments in brain
Infection
Refer to DR.

39. Concussion

40. Vocab
Antegrade amnesia: Can’t remember things that happened after the injury
Retrograde amnesia: Can’t remember things that happened prior to the injury
Nystagmus: Involuntary movement of the eyeball; up/down, back and forth, rotary
Second impact syndrome: rapid swelling and herniation of the brain from a second head injury, because symptoms of previous head injury have not resolved

41. Traumatic Brain Injury
Compression- crushing force on tissue
Tension- pulling or stretching of tissue
Shearing- force across parallel organization of tissue
Coup- maximum injury beneath impact point
Contrecoup- Maximum injury opposite impact point

42. Concussion
“Immediate and transient post traumatic impairment of neural function”
Alterations of consciousness
Disturbance of vision
Loss of equilibrium
Brain stem involvement
Etiology
Direct blow (250,000 a year in football)
Can be direct or indirect (contrecoup injury)
Injuries are not visible

44. Concussion Symptoms Headache Memory loss or disorientation
Feeling “in a fog”
+ BESS, Romberg
Dizziness
Look for blank stare or vacant look
Visual disturbances
Concentration difficulties
Slurred or incoherent speech
Personality changes
Light, noise sensitivity
Delayed verbal or motor response
Poor balance, coordination
Nausea, vomiting

45. Concussions
New classifications include; concentration deficits, attention span difficulties, and balance and coordination problems
Management
Returning to play is a dilemma (Dr./ATC)
I just had my bell rung? (decisions can be very costly for all involved)
A few things to think about
Any loss of consciousness and they are out until seen by a doctor
Any loss of conscious ness equals a spine board ride
The problem is that most concussions don’t lose consciousness

46. Management--Return to play
No one returns to play until all post concussion symptoms are gone
But they will lie!!!!!
Headache, nausea, vomiting, poor balance, tinnitus, blurred vision, poor concentration, drowsiness, fatigue, irritability, sensitivity to light
Once symptom free, they must begin sport specific RTP Protocol
Not popular with coaches
Look for second impact syndrome (3-6 times greater after 1st concussion)

47. Cerebral Hematoma
Blood accumulation between dura mater and inner surface of skull from arterial bleeding
Altered consciousness, neurological deficits
******THIS IS WHY WE DON’T GIVE IBUPROFEN TO PATIENTS RIGHT AFTER A CONCUSSION********

48. Second-Impact Syndrome
Mechanism
2nd blow soon after 1st trauma
Presentation
Collapse
Coma
Dilated pupils
Cerebral edema
Eye movement lost
Brainstem failure
Respiratory failure

49. Assessment of head injuries
Recognize injury and severity
Determine the need for emergency medical attention or EAP enactment
Monitor CONSTANTLY

50. Special tests Neurological exam (beyond this class)
Cerebral testing (cognitive function)
Cranial nerve testing
Motor function
Sensory testing
Reflex testing
Eye function (often related to head injury)
PEARL: Pupil equal and reactive to light
Tract smoothly
Nystagmus
Looking for potential cerebral involvement

51. Rhomberg special test (balance)
Original
Feet together, eyes closed, hands at side
Looking for loss of balance/proprioception
Modifications
Stand on foam
Single leg stand
Test has taken a lot of criticism
Still a good start and initial assessment (qualitative)
Movement toward scoring systems and tests to quantify results

52. Balance error scoring system (BESS)
Quantifiable
3 stances: Double, Single, and Tandem
Once on firm surface and once on foam
Instructions----stand for 20 seconds
Errors include:
Hands lifted off the iliac crest
Opening eyes
Step, stumble or fall
Moving the hip greater than 30 deg of abduction
Lifting forefoot or heal
Remaining out of testing position for more than 5 seconds

53. BESS

54. Injuries to the Head Helmet and NOCSAE label
ATC has a responsibility to make sure that coaches are teaching and athletes are using correct and safe techniques
Proper techniques for initiating contact
Danger of concussive brain injury and second impact syndrome