1. Spine Injuries/Special Testing
Sports Med 2

3. Cervical Neck MOI Axial Load Flexion Hyperextension
Rotation and Flexion
Rotation and Hyperflexion
Lateral Flexion

4. Cervical Fracture Gymnasts, hockey, diving, football, rugby MOI S/S TX
Relatively uncommon in athletics but always be prepared.
MOI
Axial loading and flexion, rotation, hyperextension
S/S
common in C4-C6
Point tenderness
Muscle spasms = decrease ROM
Numbness & pain in extremities, loss of bladder/bowel control TX
Rule out spinal injury
stabilize, refer for x-ray

5. Cervical Sprain Whiplash
MOI
Violent flexion, extension or rotation
Affects anterior and posterior ligaments
S/S
Persistent, tender over transverse and spinous processes
Pain occurs a day later TX
X-ray to rule out a fx
Neurological exam
PRICE, traction

7. Acute torticollis Wry Neck
MOI
Pain on one side of the neck upon waking up
Synovial lining or capsule is pinched
S/S
Palpable pt. tenderness and muscle spasm
Limited side flexion, and rotation TX
X-ray, traction, AROM, PROM

8. Cervical MMTs
Flexion
Extension
Lateral Bending
Rotation

9. Cervical Distraction
Procedure: athlete lies supine. Examiner grasps the patient's head under the occiput and chin and gradually applies traction.
Positive Test: reduction or elimination of symptoms caused by cervical radiculopathy

10. Spurling Test (cervical compression)
Procedure: seated with neck bent to affected side. Carefully compress straight through the head. Repeat on opposite side.
Positive Test: pain in the upper extremity on the side the head is flexed = pressure on the nerve root

11. Scheuermann’s Disease Thoracic
Gymnastics, butterfly swimming
MOI
Kyphosis resulting from wedged fx of 3 or more vertebrae
Causes nucleous pulposis to enter into vertebrae
S/S
Kyphosis and lumbar lordosis but no pain
Point tender over spinous processes and back ache at end of day TX
Prevent progressive kyphosis
Extension exercises, NSAIDS

12. Rib Compression
Procedure: athlete is seated or standing. The examiner pushes the hands together to compress the ribcage and then releases the pressure.
Positive Test: Pain with compression or release of pressure indicates the possibility of a rib fracture, rib contusion, or costochondral separation.

13. Lumbar MOI Congenital Idiopathic Mechanical Present at birth Traumatic
Overuse injury
Strains, sprains

14. Lumbar Strain MOI S/S TX Sudden extension and rotation
Faulty posture, excessive lumbar lordosis
S/S
Pain with active extension and passive flexion TX
PRICE, elastic wrap to compress
Stretching, strengthening exercises should not cause pain

15. Lumbar MMTs
Flexion
Extension
Rotation

16. Sciatica Inflammatory condition of the sciatic nerve MOI S/S TX
Nerve compression, irregularities in vertebrae
tight piriformis muscle
S/S
Acute or chronic
Sharp shooting pain that follows the nerve pathway TX
Rest, traction (if necessary), stretching, NSAIDS

17. Straight Leg Raise
Procedure: Athlete is supine. Examiner slowly raises the legs until tightness or pain is noted
Positive Test:
30 degrees = hip problem or inflamed nerve
= sciatic nerve
= SI joint

18. Spondylolysis MOI S/S TX Congenital degeneration of the vertebrae
Appears as a stress fx, most common in boys
S/S
Asymptomatic until hyperextension or disk herniation TX
Bracing, rest, stabilization exercises

19. Spondylolisthesis MOI S/S TX One vertebrae slipping on one below it
A complication of spondy higher in girls
S/S
hyperlordosis TX
Bracing, rest, stabilization exercises

20. Valsalva test Procedure: subject is sitting
ask subject to take a deep breath and blow against closed fist (bowel movement)
This increases intrathecal pressure
Positive Test: Pain or neurologic symptoms in buttox and thigh = Herniated disc

21. Press Ups
Procedure: Athlete is lying prone. Athlete uses hands to push up upper body and extend spine
Positive test: pain radiating into the buttocks/thigh = herniated disk

22. Stork Test
Procedure:
subject stands on one foot and extend their back, repeat on opposite side.
Positive Test: Lumbar pain= possible fracture of pars of vertebrae

23. Sacroiliac Pain MOI S/S TX Twisting with both feet on the ground
Falling backward, landing heavily on one leg
S/S
Point tender on SI joint
ASIS and PSIS may be asymmetrical
Side bending toward the injury side increases pain TX
Modalities, brace, strengthening, stretching, PRICE

24. SI Compression
Procedure: Athlete is Supine or side lying. Examiner has both hands over the lateral aspect of the pelvis.
Examiner applies downward pressure through the anterior portion of the ilium, spreading the SI joints
Positive Test: SI joint pain

25. SI Distraction Procedure: Athlete is supine
Examiner applies pressure to spread the ASIS
Positive Test: SI joint pain

26. FABERS (Patricks) test
Procedure: Athlete is supine with the foot of the involved side crossed over the opposite thigh (figure–4 position) & the leg resting in the full external rotation
Examiner has one hand on the opposite ASIS & the other hand on the medial apsect of the flexed knee
Examiner applies overpressure at the knee & ASIS
Positive Test: Sacroiliac pain