1. Chapter 9
Spinal Injuries

2. Objectives Describe the basic anatomy of the spine.
Explain common spinal injuries that occur with athletic participation.
Identify common signs and symptoms of spinal injuries.
Explain the treatments performed by an ATC for specific spinal injuries.
Describe common postural problems.

3. Anatomy Four segments Sacrum (tailbone) Lumbar (lower spine)
Thoracic (middle spine)
Cervical (upper/neck spine)

4. Anatomy
Normal anatomical alignment and muscular strength keep the spine aligned
Normal alignment and curvature is called neutral spine

5. Bones Separated by disks Held together by ligaments
Muscles also permit many movements and stabilize the spine
7 cervical vertebrae
12 thoracic vertebrae
5 lumbar vertebrae
5 sacral (fused) vertebrae
4 coccyx (fused)

6. Bones
All vertebrae have a body, a spinous process, and a canal through which the spinal cord passes
Functions
Protecting the spinal cord
Hold body upright when walking
Sight for muscle attachment

7. Bones Cervical Thoracic Lumbar Sacral C1= atlas C2= axis
C7= very prominent spine
Thoracic
Large spinous processes
Lumbar
Most chronic injuries occur to this region
Sacral

8. Thoracic vertebrae

9. Lumbar vertebrae

10. Sacrum and coccyx

11. Intervertebral Disks Function Absorb shock
Resist compression during activity
Keep vertebrae separate
Allow for movement and flexibility
Provide space for nerves to exit the spinal cord

12. Intervertebral disks Two specific parts
Nucleus pulposus (jelly-like core)
Annulus fibrosus ( layer rings of cartilage that surround the nucleus pulposus)
Disks receive no blood supply, therefore do not heal well when injured
Disks are compressible
Possible to be taller first thing in the morning
Shorter with age

13. Nucleus pulposus and annulus fibrosis

14. Muscles Mast Spine Cables stabilize the sails
Many cables that attach at various points
Many muscles attach to different places like pelvis, legs, and arms
Cables stabilize the sails
Muscles stabilize spine while body performs functions like throwing, catching, and kicking
Provides stability to ensure sails catch in the wind
Provides stability to body so it can function correctly
Numerous muscles that provide a wide range of movements and stability
Spine=mast on a ship

15. Muscles Spinal extensors Upper trapezius
Run entire length of spine posteriorly
Attach to ribs, pelvis, and vertebrae
Keep body upright
Upper trapezius
Extends the cervical spine
Attaches to occipital bone and fans out to each side of neck and attaches on acromion process of scapula

16. Muscles Scalene muscles ( 3 total each side) Cervical flexion
Attach to cervical vertebrae and run down to the first and second ribs
Help with breathing process

17. Muscles Sternocleidomastoid Cervical side bending and rotation
Attaches to top of sternum and attaches to mastoid process just behind ear

18. Muscles Abdominals Rectus abdominus and internal and external obliques
Support trunk movement

19. Posture
Normal
Plumb line- imaginary vertical line that helps determine posture
View from side
Correct posture, plumb line should pass through these anatomical landmarks
Just behind ear
Through center of shoulder
Down through middle of the greater trochanter of hip
Behind the patella
Just in front of lateral malleolus

20. Posture Abnormal Forward head posture Rounded shoulders
Ear projects in front of plumb line
Stresses back of neck
Rounded shoulders
Line passes through back of shoulders instead of middle

21. Posture Kyphosis Excessive rounding of the thoracic spine
Decreases ability of spine to absorb shock effectively
More prone to injury

22. Posture Lordosis Excessive forward curve of the lumbar spine
Decreases ability of spine to absorb shock effectively
More prone to injury

23. Posture Scoliosis Side bend to spine
Looks crooked from a posterior view
If undiagnosed and suspect, should refer for further assessment

24. Posture Improving posture Keep top of head as high as possible
Don’t always carry bag on same shoulder
Regular exercise
Focus on good posture and it will become habit

25. Preventing spinal injuries
Active process
Exercise
Concentrate on flexibility
Maintain proper posture
Use correct lifting techniques
Use back support if necessary when lifting

26. Injury prevention Proper balance of muscles strength and flexibility
Strong abs decrease stress on lumbar region
Hip strength also has effect on spine
Need to be strong and flexible

27. Injury prevention Proper lifting procedures
Maintaining slight curve in lumbar spine while lifting with knees and hips…not back
Keep head up
Injury most often occurs when spine is too rounded or flexed and causes a strain or disk injury
Back supports common in many work environments

28. Treatment of lumbar spine injuries and conditions

29. Ligament injuries
Often occur from forced excessive trunk flexion or flexion and rotation at the same time
Example: a football player tackled and forced forward
Posterior aspect of the vertebral joints can separate and stretch ligaments

30. Ligament injuries Characteristics of a lumbar sprain
Pain to one side of the spine
Limited movement due to pain and muscle spasm
Often difficult to differentiate a sprain from a strain
Can test by pushing each of the vertebrae anteriorly, should not be painful
Do not perform if signs/symptoms of a fracture are present

31. Ligament injuries Treat like any other acute injury
PRICE
Always use ice in first 48 hours of an acute injury
Return to activity includes
Proper flexibility
Proper strengthening
Pain free motion

32. Muscle and tendon injuries
Rare to see a ruptured muscle at the spine
Characteristics of strain
Pain to one side
Muscle spasm
Lack of movement
Pain on the opposite side from the direction the athlete bends (bend to right, pain on left)
Pain from sprain usually localized (small area), pain from strain usually travels length of muscle

33. Muscle and tendon injuries
Treat with PRICE
Return to activity
Proper stretching
Proper strengthening
Pain free activity
Observe athlete for proper posture and lifting technique

34. Bone Injuries Caused by Compression Direct blow
Forcefully landing on buttocks
Direct blow

35. Bone injuries Spondylolysis Most common in gymnasts
Stress fracture at the pars interarticularis
Fracture that fails to heal can separate, causing spinal instability

36. Spondylolysthesis
Occurs when a spondylolysis slips forward on the vertebrae below it
Most often occurs when L5 slips forward on S1 (as shown)

37. Bone injuries Spondylolysis and spondylolisthesis are serious injuries
Need physician exam
Require rest and possible lumbar brace
Extensive rehab strengthening trunk muscles

38. Bulging disk Not common in young athletes
Some call slipped disk, not appropriate term
Nucleus pulposus bulges through annulus fibrosis

39. Bulging disk Rarely bulges toward front of spine
Covered with thick ligament (anterior longitudinal ligament)
Most people have postures that flex the spine forward most of the time which pushes nucleus pulposus toward the posterior aspect
Puts pressure on the nerves exiting the spinal cord
Causes numbness, tingling, and pain down the leg
Can cause low back pain that increases while sitting

40. Bulging disk Treatment Improve posture
Improve body mechanics and lifting techniques
Rest
Traction
Strengthening

41. Cervical spine Ligament injuries
Caused by forceful movement beyond normal range
Hyperflexion
Hyperextension
Cause neck and arm pain
Always rule out spinal cord injury
PRICE, no C
Strengthen, regain full ROM

42. Cervical spine Return to activity guidelines Full strength Full ROM
Full confidence
No symptoms
Physician clearance

43. Muscle and tendon injuries
Can also be caused by whiplash
Characteristics
Muscle spasm
Limited ROM
Weakness against resistance
Pain and tenderness
Treat like a sprain (PRI)
Same return to activity guidelines
Manual resistance work well for rehab

44. Bone injuries Fractures Dislocations Often a result of axial loading
often result of a combination of excessive flexion and rotation

45. Fractures and dislocations
Similar signs and symptoms
Pain around cervical vertebrae
Weakness
Numbness
Tingling down arms
Dislocation usually has deformity

46. Fractures and dislocation
Care/treatment
Immobilize and spineboard
Helmet procedures
Call EMS

47. Disk injuries Not as common as in lumbar spine
Person reports more neck pain with sitting and forward flexion
Some discomfort down the back and between the shoulders
Treatment
Improve posture
Cervical extension exercises
traction

48. Brachial plexus injuries
Exit through the cervical spine
Stretching nerves causes stinger/burner
Can last seconds or minutes
Severe even longer (weeks)
Treatment
Strengthening
ROM stretching
Neck roll (FB) to limit lateral flexion

49. Brachial plexus Return to play guidelines No symptoms Full strength
Full ROM
Problem-free neck and shoulder eval by ATC and team physician