Transcript The Spine - Chapter 1

The Spine
Chapter 20
Pages 488-515
Bony Anatomy
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Bones: 33 individual bones
called vertebrae
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Cervical Spine: 7 vertebrae
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Thoracic Spine: 12
vertebrae
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Lumbar Spine: 5 vertebrae
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Sacrum: 5 fused vertebrae
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Coccyx: 4 fused vertebrae
ROM of Vertebral Column:
flexion, extension, lateral
flexion, and rotation
Vertebrae Pictures
Anatomy, Cont’d
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Intervertebral articulations
and disks:
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Annulus Fibrosus
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Nucleus Propulsus
Ligaments: anterior
longitudinal, posterior
longitudinal, and supraspinous
Muscles: erector spinae
Spinal Cord and Nerves: the
spinal cord is part of the CNS
that is housed within the
vertebral canal of the spinal
column. 31 pairs of spinal
nerves
Prevention of Injuries to the
Spine
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Cervical spine
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Strength
Flexibility
Using proper technique
Lumbar spine
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Strength and flexibility
Using proper technique
Assessment: History
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What do you think happened?
Did you hit someone or land directly on top of your
head?
Where you knocked unconscious?
Do you have any pain in your neck?
Do you have any tingling, numbness, or burning in
your shoulders, arms, or hands?
Do you have equal muscle strength in both hands?
Are you able to move your ankles and toes?
Any bowel or bladder changes?
Abnormal Postures
Assessment: Observation
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Does posture show signs of kyphosis, lordosis, or
scoliosis?
Is the athlete willing to move the head and neck freely?
Are the shoulders level and symmetrical?
Is the head tilted to one side?
Is the scapula lower or more prominent than the other?
Is the trunk bent or curved to one side?
Is the space between the body and arm greater on one
side?
Is one hip tilted? More prominent?
Are the ribs more pronounced on one side?
Does one arm hang lower? Forward?
Is one patella lower than the other?
Assessment: Palpation and
Special Tests
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Palpation
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Athlete should be lying prone (on stomach)
Bony palpation: spinous/transverse processes,
sacrum, and coccyx.
Soft tissue palpation: musculature on each side of
the spine for spasm and guarding.
Special Tests
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Straight leg raises
Compression and distraction tests
Recognition and Management of
Injuries to the Cervical Spine
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Cervical Fractures
Cervical Dislocations
Acute Muscle Strains of
the Neck and Upper
Back
Cervical Sprain
(Whiplash)
Acute Torticollis
(Wryneck)
Pinched Nerve (Brachial
Plexus Injury)
Cervical Fractures
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MOI:
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S&S:
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Axial loading is a blow to the top of the athlete’s head while
in flexion.
Neck point tenderness, restricted movement, cervical muscle
spasm, cervical pain, pain in the chest, and extremities,
numbness in the trunk/limbs, weakness/paralysis in the
trunk/limbs, loss of bowel/bladder control.
Treatment:
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Do not move the athlete. Activate EMS. Stabilize head and
neck.
Cervical Dislocations
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MOI:
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S&S:
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A result of violent flexion and rotation of the head.
Similar to cervical fracture.
A unilateral dislocation causes the neck to be tilted
toward the dislocated side.
Treatment:
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Do not move the athlete. Activate EMS. Stabilize
head and neck.
Acute Muscle Strains of the Neck
and Upper Back
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MOI:
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S&S:
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Localized pain, point tenderness, restricted ROM, muscle
guarding.
Treatment:
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Forced flexion, extension, and/or rotation of the head
suddenly.
Muscles: upper trapezius, SCM, scalenes, splenus capitus
and cervicis.
RICE, cervical collar, ROM, isometric exercises, isotonic
exercises, and modalities for pain control.
Whiplash
Pinched Nerve
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MOI:
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S&S:
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Stretching or compression of the brachial plexus. The neck
is forced laterally to the opposite side while the shoulder is
depressed.
Burning sensation, numbness, tingling, pain from shoulder to
the hand, loss of function of the arm and hand.
Treatment:
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Once the symptoms have completely resolved and there are
no neurological symptoms, the athlete may return to
participation.
Strengthening and stretching of neck muscles.
Recognition and Management of
Injuries to the Lumbar Spine
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Low Back Pain (LBP)
Lumbar Vertebrae Fracture and Dislocation
Low Back Muscle Strains
Lumbar Sprains
Back Contusions
Sciatica
Herniated Lumbar Disk
Spondylolysis and Spondylolisthesis
Low Back Pain
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MOI:
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S&S:
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Congenital anomalies and/or mechanical back
defects (faulty posture, trauma to the back).
Muscular weakness, impairment of sensation and
reflex responses.
Prevention:
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Avoid unnecessary stresses and strains associated
with standing, sitting, lying, working, or
exercising.
Lumbar Vertebrae Fracture and
Dislocation
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MOI:
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S&S:
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Compression fractures usually occur from falling
from a height and landing on the feet/buttocks, a
kick and/or direct impact to the back.
May be palpable over spinous and transverse
processes, point tenderness, swelling, and muscle
guarding in the area.
Treatment:
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Spine board the athlete and refer to physician.
Low Back Muscle Strains
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MOI:
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S&S:
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Sudden extension in combination with trunk
rotation and chronic strain because of faulty
posture.
Pain may be diffused or in one area. Pain with
active extension and passive flexion.
Treatment:
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Ice, abdominal support, graduated program of
stretching and strengthening .
Lumbar Sprains
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MOI:
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S&S:
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Bending forward and twisting while lifting an object.
Localized pain that is lateral to the spinous process, pain
becomes sharp with certain movements/postures,
flexion/extension/rotational movements of the vertebrae
increase pain.
Treatment:
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RICE, strengthening for back extensors and abdominals, and
stretching in all directions.
May take some time to heal.
Back Contusions
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MOI:
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S&S:
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Direct trauma.
Be wary of the kidneys.
Local pain, muscle spasm, and point tenderness,
swelling, and discoloration.
Treatment:
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Ice for 72 hours, rest, gradual stretching.
Recovery ranges from 2 days to 2 weeks.
Sciatica
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MOI:
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S&S:
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Sciatica is an inflammatory condition of the sciatic nerve that
can accompany recurrent/chronic LBP.
Onset may be sudden or gradual, a sharp/shooting pain that
follows the nerve pathway along posterior and medial thigh,
tingling and numbness along the nerve pathway, sensitive to
palpation, and pain with straight leg raises.
Treatment:
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Rest, identify cause of inflammation, NSAIDS, sometimes
surgery may be indicated.
Herniated Lumbar Disk
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MOI:
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S&S:
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Forward bending and twisting that places abnormal strain on
the lumbar region.
Centrally located pain that radiates on one side of the
buttocks and down the back of the leg or pain that spreads
across the back, symptoms are worse in the morning, onset
may be sudden or gradual, posture is bent forward and
away from the side of pain, and pain with straight leg raises.
Treatment:
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Rest and ice, back extensor and abdominal stabilization
exercises, sometimes surgery is necessary.
Herniated Disk Picture
Visual Aids Courtesy of the
Following Websites:
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http://www.sci-recovery.org/sci.htm
http://www.nationalpainfoundation.org/MyTreatment/articles/Ba
ckAndNeck_Part_2.asp
http://www.getbodysmart.com/ap/skeletalsystem/skeleton/axial
/vertebrae/menu/animation.html
http://www.spineuniverse.com/displayarticle.php/article2245.ht
ml
http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/
19469.jpg
http://lc3.littlechute.k12.wi.us/staff/hthomas1/Anatomy%20and
%20Physiology/Notes/Skeletal%20System_files/image007.jpg
http://www.healthatoz.com/healthatoz/Atoz/images/ency/00042
710.jpg