1. Anatomy and Injuries to the Spine
Adapted from Connie Rauser

2. Function of anatomy Protects spinal cord Holds body upright
Site for muscle & ligament attachment (support spine)
Discs provide shock absorption
Nerves provide sensation and motor function

3. Bony anatomy Vertebrae
7 cervical (flexion, extension, lateral flexion, rotation)
1st-atlas
2nd-axis
12 thoracic (little movement)
5 lumbar (less flexion than extension, some rotation
5 sacral (fused)
3-4 coccyx (fused)

4. Anatomy of spine Parts of vertebrae Spinous process Transverse process
Body

5. Cervical vertebrae

6. Thoracic vertebra

7. Lumbar Vertebrae

8. Sacrum and coccyx

9. Posture Neutral spine Thoracic curve Lumbar curve Normal alignment
Excessive--kyphosis
Lumbar curve
Excessive--lordosis

10. Discs Fibrocartilaginous Shock absorbers Resist compression
Keep vertebrae separated
Allows movement & flexibility
Provides space for nerves to exit
No blood supply

11. Discs Nucleus pulposus Annulous fibrosus Jelly-like core
Cartilaginous outer rings

12. Muscles Provide movement & stability Deep—erector spinae
Attach to vertebrae, ribs, pelvis
3 groups (ERECTOR SPINAE)
Spinalis, iliocostalis, longissimus

13. Muscles Abdominal muscles play big role in stabilizing back
Trunk flexion, lateral flexion, rotation
Rectus abdominus
External oblique
Internal oblique
Transverse abdominus

15. Muscles Trapezius Sternocleidomastoid Scalenes Multifidis
Upper portion aids in cervical extension
Sternocleidomastoid
Lateral flexion, rotation
Scalenes
Flexion of cervical area
Multifidis
Rotation of spine

17. Muscles

20. Nerves Each vertebrae has a nerve that exits either below or above it
31 pairs of spinal nerves
8 cervical nerves
12 thoracic nerves
5 lumbar
5 sacral
1 coccygeal

21. Spinal Cord Part of the CNS along with brain
Contained within vertebral canal
Extends from cranium to 1st-2nd lumbar vertebrae
Lumbar roots & sacral nerves for a “horse-like tail” called cauda equina
2 plexuses
Brachial, lumbosacral

22. Brachial Plexus

23. Brachial Plexus

24. Lumbosacral plexus

25. Lumbosacral plexus

27. Dermatomes
Area of body that has nerve sensation for each nerve root

28. Dermatomes Cervical C4-shoulder C5-lateral arm C6-lateral forearm
C7-middle finger
C8-medial half of ring finger & forearm
T1-medial arm

29. Dermatomes
Thoracic
At the level of the respective thoracic vertebrae

30. Dermatomes Lumbar/Sacral L1-upper anterior thigh
L2-middle anterior thigh
L3-lower anterior thigh
L4-medial side of leg
L5-lateral side of leg, dorsum of foot
S1,2-lateral malleolus, plantar surface of foot
S2,3,4-nerve supply for bladder, intrinsic muscles of toes

33. Myotomes
Area of the body that has motor function

34. Myotomes C5-deltoid—shoulder abduction C5-6-biceps—elbow Flexion
C6-wrist extensors—extension
C7-triceps & wrist/finger flexors—elbow extension, wrist/finger flexion
C8-finger flexors—finger flexion
T1-finger Abductors--abduction

35. Myotomes L1,2,3-iliopsoas—hip flexion L2,3,4-Quads—knee extension
L4-tibialis anterior—dorsiflexion/inversion at ankle
L5-Extensor hallicus longus, extensor digitorum longus/brevis, extension/inversion at ankle
S1-peroneus longus/brevis-eversion
S1,2-gastroc/soleus—plantar flexion

37. Posture
Normal
Slight curve at thoracic and lumbar areas, ears in line w/ shoulders

38. Posture
Problems
Forward head position-ears in front of line with shoulder
Kyphosis-excessive curve of thoracic spine
Lordosis-excessive curve of lumbar spine
Scoliosis-lateral curve of spine

39. Posture Preventing poor posture Don’t be lazy
Walk and stand as if something is pulling you up straight
Carry bags/backpacks on both shoulders/alternate
Carry bags at small of back (lumbar area)

42. Prevention of Injuries
Most injuries to cervical/lumbar area
Maintain adequate strength and flexibility of hip flexors and back
Maintain strong abdominals/core strength
Work on proper posture

43. Prevention Learn to lift properly Keep head up
Maintain slight curve in lumbar spine
Lift with knees and hips (legs)
Keep head up
Keep your butt behind you!!!

44. Lumbar spine injuries Sprain Strains Fractures Spinal Cord Injury
Dislocation
Disc injury

45. Lumbar Sprain
MOI: forced into excessive trunk flexion and rotation at some time
Posterior aspect of vertebral joints separate and stretch ligaments
Active vs. Passive Rule
Active and passive ROM will hurt with ligament (sprain)
Active without passive ROM will hurt with muscle (strain)

46. Lumbar Sprains S/S: localized pain to one side of spine Limited ROM
Spasms
Push each vertebra anteriorly to attempt to reproduce pain

47. Lumbar Sprains TX: RICE After 48 hours—heat Active rest
Maintain comfortable neutral spine
Stretching
Strengthening and stability exercises

48. Lumbar Strain Mild/moderate strains very common
MOI: same as for sprains
S/S:
pain on one side
spasms
decreased ROM
pain moves up and down length of muscles

49. Lumbar Strains
TX:
RICE
Gentle stretch
Heat
Strengthening
Flexibility

50. Fractures MOI: Severe compression type force Direct blow
Extreme flexion

51. Fractures S/S: Secondary Complication: Severe pain
Pt. Tender over vertebra, especially spinous process
Muscle spasm
LOM
Possible tingling, numbness, etc.
Secondary Complication:
Spinal Cord Involvement
Numbness and tingling down both arms/both legs = spinal cord involvement

52. Fractures TX: Be conservative Call 911
Neurological exam (dermatomes/myotomes)
Don’t move athlete
Spineboard prior to transport

53. Fractures

54. Disc Injury
Common in older people but not so much in younger athletes.
Referred to as “slipped” disc
Nucleus pulposus pushes through rings of annulous fibrosus causing a “bulge” which can lead to herniation
Most are posterior to one side
Pressure exerted on nerve root

55. Disc Injury MOI: Improper lifting Poor posture
Poor body mechanics (excessive flexion over prolonged time frame)
Trauma due to direct fall

56. Disc S/S: Pain radiating down leg Numbness Tingling down leg
Increased pain with sitting/flexion motion
Decreased/absence of reflex

57. Disc TX: Active rest Work on posture Extension exercises
Proper mechanics
Core stability—especially lumbar area
Traction
Surgery if rehabilitation doesn’t work

58. Herniated disc

59. Disc injury

60. Lumbar traction

61. Cervical Injuries Similar to those in lumbar area
May have to treat differently due to the increased mobility in that area

62. Cervical Sprains MOI: move beyond normal ROM
Hyperextension or hyperflexion of neck
Whiplash type MOI
Body forced forward by the blow while the head moves backwards, placing the cervical spine into extension stretching the ligaments & muscles at front of neck. When body stops head snaps forward stretching the posterior ligaments & muscles of neck

63. Cervical Sprain

64. Sprains S/S: Neck and arm pain Pain between scapula
Possible numbness or tingling
Decreased ROM due to Pain
Pt. Tender over the cervical area, usually localized

65. Cervical Sprain

66. Sprains TX: Check for nerve injury Ice Soft neck collar
Medical referral if severe
Traction
Stretching
strengthening

67. Cervical Strains MOI: S/S: TX: same as for sprains
Whiplash type –same as for sprains
S/S:
Muscle spasms, Decreased ROM, Muscle weakness, pain along the muscle, Pt. Tender over muscles
TX: same as for sprains
Return to Activity: No symptoms, full ROM & strength, Dr. release

68. Cervical Strain

69. Cervical sprains/strains

70. Cervical Traction

71. Cervical Fractures/Dislocations
Can result in permanent disability/death
MOI: axial loading—neck flexion with force to top of head (fracture) or flexion w/ rotation (dislocation)

72. Cervical Fx

73. Cervical FX/Dislocations
S/S:
Pain & Pt. Tender over cervical spine
Numbness and/or tingling down arms
Muscle weakness
Loss of motion
Visible deformity possible (esp. w/ dislocation) but may not see it due to equipment worn

74. Situations in Which Cervical Spine Injury Should be Suspected
Neck pain or stiffness
Cervical muscle spasm
Asymmetrical or Abnormal head position
Respiratory difficulty (chest not moving)
Unconsciousness
Numbness, tingling, burning
Muscle weakness or paralysis
Loss of bowel or bladder control

75. Cervical Fx/Dislocation

76. Cervical Fx

77. Cervical Fx/Dislocations
TX:
Rule out life-threatening situations
Call 911
Stabilize/immobilize head/neck
If in helmet/shoulder pads, leave those in place
Monitor athlete/treat for shock

78. Spinal Cord Injury
Decerebrate vs. Decorticate Posturing

79. Decerebrate The worse of the two posturings
Disruption of nerve pathway between brain and spinal cord

80. Decorticate Damage to nerve pathway between brain and spinal cord
May occur on one or both sides of the body

82. Spine Boarding Observation: ( On the way to athlete)
If athlete is unconscious ALWAYS assume spinal injury.
Arrival and Primary Survey
Stabilize head and neck
Check for level of consciousness
If unconscious call 911
If conscious and able to communicate signs/symptoms of neck injury call 911

83. Spine Boarding Continued
If unconscious: Look, listen and feel
If not breathing either you (if alone) or another member of medical use pocket mask or remove face mask and begin rescue breathing/CPR
If breathing continue to maintain stabilization and assess athlete

84. Spine boarding continued
Reasons not to move neck:
Increased pain
Neurological symptoms
Muscle spasm
Airway compromise
If it is physically difficult to reposition the spine
Resistance is encountered
Patient expresses apprehension
If athlete is supine with neck turned to side, maintain stabilization and rotate head in align with neck. If athlete is able to communicate, if movement increases symptoms STOP.

85. Disc injury Not as common as in lumbar area
MOI: overuse/previous injury
S/S: pain with sitting/flexing neck down back between scapulae, weakness in arms, tingling, numbness
TX: Improve neck posture, traction, strengthening, stretching, possible surgery

86. Brachial Plexus Nerve Injury
Also called
Burner
Stinger

87. Brachial Plexus Nerve Injury
MOI: head forced to one side & shoulder depressed (they are spread apart) stretching brachial plexus
S/S: tingling, burning, numbness down arm that lasts for a few seconds to minutes, muscle weakness in any/all muscles of upper extremity

88. Brachial Plexus Nerve injury
TX:
Ice
Neck collar
Physician referral if necessary
Strengthening
ROM exercises
Return to activity when symptom free, full strength, full ROM of neck and shoulders

89. Brachial Plexus Nerve injury