1. ATC 222 The Spine Chapter 25 Natasha Tibbetts, ATC

2. Quiz 1. What is the medical or technical term for spearing? 2. List 3 signs of a serious cervical spine injury. 3. What is the name given to the first cervical vertebra? 4. Define hypoesthesia.

3. Anatomy Vertebral column Vertebral column 7 cervical vertebra 7 cervical vertebra C1=Atlas C1=Atlas C2=Axis C2=Axis 12 thoracic vertebra 12 thoracic vertebra 5 lumbar vertebra 5 lumbar vertebra 5 sacral vertebra 5 sacral vertebra Intervertebral disks Intervertebral disks Annulus pulposus Annulus pulposus Nucleus pulposus Nucleus pulposus

4. Anatomy (Cont’d) Ligaments Ligaments Anterior longitudinal Anterior longitudinal Posterior longitudinal Posterior longitudinal Supraspinous Supraspinous Interspinous Interspinous Spinal cord and Spinal nerves Spinal cord and Spinal nerves

5. Anatomy Examples

6. Spinal Anatomy

7. Anatomy (Cont’d)

8. Ligaments

9. Motion of the Spine Vertebral Column General Motions Vertebral Column General Motions Flexion/Extension Flexion/Extension Right/Left lateral flexion Right/Left lateral flexion Right/Left rotation Right/Left rotation Specific Cervical Motion Specific Cervical Motion Rotation occurs at C1-C2 Rotation occurs at C1-C2 Flexion/Extension=atlanto-occipital joint Flexion/Extension=atlanto-occipital joint Specific Thoracic Motion Specific Thoracic Motion Flexion/Extension is 20-30 degrees MAX! Flexion/Extension is 20-30 degrees MAX! Specific Lumbar Motion Specific Lumbar Motion 90% of Flexion/Extension occurs at L4-L5-S1 90% of Flexion/Extension occurs at L4-L5-S1

10. Cervical Injury Catastrophic injury Catastrophic injury Definition Definition Warning signs Warning signs Unconsciousness Unconsciousness Deformity Deformity Loss of strength/movement in extremities Loss of strength/movement in extremities Anesthesia/paresthesia/hypoesthesia in extremities Anesthesia/paresthesia/hypoesthesia in extremities Assessment Assessment Stabilize and calm athlete Stabilize and calm athlete Call EMS Call EMS ABC’s ABC’s

11. Mechanisms of Injury Axial loading Axial loading Spearing Spearing Straight column Straight column Hyper-flexion Hyper-flexion Hyper-extension Hyper-extension Lateral hyperflexion Lateral hyperflexion Rotation Rotation Combination Combination Whiplash Whiplash

12. Specific Injuries Fractures Fractures Dislocations Dislocations Strain Strain Pain in muscle primarily (localized) Pain in muscle primarily (localized) Point tenderness Point tenderness Pain with AROM (restricted motion) Pain with AROM (restricted motion) Pain with passive stretch of muscle Pain with passive stretch of muscle Pain/weakness with strength testing Pain/weakness with strength testing

13. Injuries (Cont’d) Brachial Plexus Syndrome Brachial Plexus Syndrome C5-T1 C5-T1 Can be caused by traction or compression Can be caused by traction or compression Paresthesia and weakness Paresthesia and weakness Burning/Tingling Burning/Tingling Return to play criteria Return to play criteria Treatment Treatment

14. Thoracic and Lumbar Injuries Postural deviations Postural deviations Kyphosis Kyphosis Lordosis Lordosis Scoliosis Scoliosis Normal posture Normal posture Pages 645-648 Pages 645-648 Ear-shoulder-hip-knee-ankle Ear-shoulder-hip-knee-ankle Level knees, hips, and shoulders Level knees, hips, and shoulders Normal vertebral curves Normal vertebral curves

15. Postural Examples

16. Injuries (Cont’d) Congenital abnormalities Congenital abnormalities May also be mechanical May also be mechanical Spondylolysis vs. Spondylolysisthesis Spondylolysis vs. Spondylolysisthesis Causes and treatment Causes and treatment

18. Sciatica Definition Definition Signs and symptoms Signs and symptoms Causes Causes Mechanical Mechanical Structural Structural Compression Compression Swelling Swelling Disc Herniation Disc Herniation Tumor Tumor

19. Herniated Lumbar Disk Lumbar disks are under constant stress Lumbar disks are under constant stress Degeneration Degeneration Tears Tears Cracks Cracks Most often injured between L4-L5, 2 nd most common is between L5-S1 Most often injured between L4-L5, 2 nd most common is between L5-S1 Mechanism Mechanism Forward bending and twisting places abnormal strain on lumbar region Forward bending and twisting places abnormal strain on lumbar region Signs and Symptoms Signs and Symptoms Centrally located pain that radiates unilaterally Centrally located pain that radiates unilaterally Symptoms worse in morning Symptoms worse in morning Forward bending/sitting increases pain Forward bending/sitting increases pain Treatment Treatment Pain reducing modalities Pain reducing modalities Postural self-correction exercises Postural self-correction exercises Back and abdominal strengthening Back and abdominal strengthening

20. Bulging

21. Prolapsed

22. Extrusion

23. Prevention of Spinal Injuries Cervical Spine Cervical Spine Muscle Strengthening Muscle Strengthening Cervical region Cervical region Range of Motion Range of Motion C-spine should have full ROM C-spine should have full ROM Can be increased through stretching Can be increased through stretching Using correct techniques Using correct techniques Rules and regulations Rules and regulations Head should not be used as a weapon! Head should not be used as a weapon!

24. Prevention (Cont’d) Lumbar Spine Lumbar Spine Correction of Biomechanical Abnormalities Correction of Biomechanical Abnormalities Emphasis on trunk flexibility Emphasis on trunk flexibility Maximum ROM Maximum ROM Abdominal strength Abdominal strength Correct lifting techniques Correct lifting techniques Appropriate breathing Appropriate breathing “Lift with your legs, not your back” “Lift with your legs, not your back” Core Stabilization Core Stabilization Increase stability of trunk Increase stability of trunk Helps athlete maintain spine and pelvis in comfortable and acceptable mechanical position Helps athlete maintain spine and pelvis in comfortable and acceptable mechanical position