Chapter 20: The Spine Anatomy of the Spine - PowerPoint Presentation

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Chapter 20: The Spine

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Anatomy of the Spine

http://youtu.be/aDvbAvBLQuM

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Ligaments and Vertebral Discs

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Muscular Anatomy

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Neurological Anatomy

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Prevention of Injuries to the Spine

Cervical Spine

Muscle Strengthening

Muscles of the neck resist hyperflexion, hyperextension and rotational forces

Prior to impact the athlete should brace by “bulling” the neck (isometric contraction of neck and shoulder muscles)

Exercises can be used to strengthen the neck

Range of Motion

Must have full ROM to prevent injury

improved through stretching exercises

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Prevention of Injuries to the Spine

Using Correct Technique

Athletes should be taught and use correct technique to reduce the likelihood of cervical spine injuries

Avoid using head as a

weapon

Spearing in football, diving

into shallow water

Lumbar Spine

Avoid Stress

Avoid unnecessary stresses and strains of daily living

Avoid postures and positions that can cause injury

Strength and Flexibility

Basic

conditioning should emphasize trunk flexibility

Spinal

and Core strength

should be stressed in order to maintain proper alignment

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Prevention of Injuries to the Spine

Using Correct Lifting Techniques

Weight lifters can minimize injury of the lumbar spine by using proper technique

Incorporation of appropriate breathing techniques can also help to stabilize the spine

Weight belts can

be

useful in providing

stabilization

Use

spotters

when lifting

Core Stabilization

Core stabilization, dynamic abdominal bracing and maintaining neutral position can be used to increase

lumbo

-pelvic-hip

stability

Increased stability helps the athlete maintain the spine and pelvis in a comfortable and acceptable mechanical position (prevents

microtrauma

)

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Assessment of the Spine

History

Mechanism of injury (rule out spinal cord injury)

What happened? Did you hit someone or did someone hit you? Did you lose consciousness

Pain in your neck? Numbness, tingling, burning?

Can you move your ankles and toes?

Do you have equal strength in both hands

Positive responses to any of these questions will necessitate extreme caution when the athlete is moved

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Assessment of the Spine

Other general questions

Where is the pain and what kind of pain are you experiencing?

What were you doing when the pain started?

Did the pain begin immediately and how long have you had it?

Positions or movements that increase/decrease pain?

Past history of back pain

Sleep position and patterns, seated positions and postures

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Assessment of the Spine

ObservationsBody typePostural alignments and asymmetries should be observed from all viewsAssess height differences between anatomical landmarks

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Assessment of the Spine

Palpation

Should be performed with athlete prone

Head and neck should be slightly flexed, pillow under hips if suffering from low back pain

Spinous and transverse processes of each vertebrae should be palpated along with sacrum and coccyx

Muscles should be palpated bilaterally

Be aware of the possibility of referred pain

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Assessment of the Spine

Special Tests

Test for lumbar spine should be performed standing, sitting, supine, side-lying and prone

Assess levels of pain and motion restriction during the following tests

Forward and backward bending

Side-bending and rotation

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SLR Test

Straight Leg RaisesApplies pressure to SI joint and may indicate problems with sciatic nerve, SI joint or lumbar spine

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SI Compression and Distraction Tests

Used for pathologies involving the SI jointDistraction Compression

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Brachial Plexus Traction/Compression Test

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Hoover Test

Athlete Position:  SupineAthletic Trainer Position:  Supporting the ankle of each leg while standing at athlete’s feet.Procedure:  Athlete is asked to perform a unilateral straight leg raise actively on the involved extremity.Test is positive if:  The athlete does not push down on the uninvolved leg or athlete does not attempt this maneuver.  Implications:  The athlete is malingering.

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Faber’s Test

FABER’S

: Flexion Abduction External Rotation

Assess SI joint pathology

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Recognition and Management of Specific Injuries and Conditions

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Cervical Spine Injuries

Cervical Fractures

Cause of Injury

Generally an axial load w/ some degree of cervical flexion

Addition of rotation may result in dislocation

Signs of Injury

Neck point tenderness, restricted motion, cervical muscle spasm, cervical pain, pain in the chest and extremities, numbness in the trunk and or limbs, weakness in the trunk and/or limbs, loss of bladder and bowel control

Care

Treat like an unconscious athlete until otherwise

ruled

out - use extreme

care

Spine Board and transport

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Cervical Fracture and Dislocation

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Cervical Spine Injuries

Cervical Dislocation

Cause of Injury

Usually the result of violent flexion and rotation of the head

Signs of Injury

Considerable pain, numbness, weakness, or paralysis

Unilateral dislocation causes the head to be tilted toward the dislocated side with extreme muscle tightness on the elongated side

Care

Extreme care must be used - more likely to cause spinal cord injury than a fracture

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Cervical Spine Injuries

Acute Strains of the Neck and Upper Back

Cause of Injury

Sudden turn of the head, forced flexion, extension or rotation

Generally involves upper

trapezius

Signs of Injury

Localized pain and point tenderness, restricted motion, reluctance to move the neck in any direction

Care

RICE and application of a cervical

collar in severe cases

Follow-up care will involve ROM exercises, isometrics which progress to a full isotonic strengthening program,

cryotherapy

and superficial thermotherapy, analgesic medications

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Cervical Spine Injuries

Cervical Sprain (Whiplash)

Cause of Injury

Generally the same mechanism as a strain, just move violent

Involves a snapping of the head and neck

Signs of Injury

Similar signs and symptoms to a strain - however, they last longer

Tenderness over the transverse and spinous processes

Pain will usually arise the day after the trauma (result of muscle spasm)

Management

Rule out fracture, dislocation, disk injury or cord injury

RICE for first 48-72 hours, possibly bed rest if severe enough

Analgesics and NSAID’s, mechanical traction

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Cervical Spine Injuries

Acute

Torticollis

Cause of Injury

Pain on one side of the neck upon wakening

Result of synovial capsule impingement w/in a facet

Signs of Injury

Palpable point tenderness and muscle spasm, restricted ROM, muscle guarding,

Care

Variety of techniques including traction, superficial heat and cold treatments, NSAID’s

Use of a soft collar can be helpful as well

May last 2-3 days

Gradual strengthening and stretching exercises should be utilized for neck and shoulders for prevention

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Cervical Spine Injuries

Pinched Nerve (Brachial Plexus Injury)

Cause of Injury

Result of stretching or compression of the brachial plexus

Referred to as stinger or burner

Signs of Injury

Burning sensation, numbness and tingling as well as pain extending from the shoulder into the hand

Some loss of function of the arm and hand for several minutes

Symptoms rarely persist for several days

Repeated injury can result in neuritis, muscular atrophy, and permanent damage

Care

Return to activity once S&S have returned to normal

Strengthening and stretching program

Padding to limit neck ROM during impact

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Lumbar Spine Conditions

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Lumbar Spine Conditions

Low Back Pain

Cause of Injury

Congenital/biomechanical

anomalies

Mechanical defects of the spine (posture, obesity and body mechanics)

Back trauma

Recurrent and chronic low back pain

Signs of Injury

Pain, possible weakness,

antalgic

gait,

ligament

sprain, muscle strains and bony defects

Neurological signs and symptoms if it becomes disk related

Care

Correct alignments and body

mechanics (better posture, lifting techniques, lose weight, etc)

Strengthening and stretching – avoid unnecessary stresses and strains associated with daily living

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Lumbar Spine Conditions

Lumbar Vertebrae Fracture and Dislocation

Cause

Compression fractures or fracture of the spinous or transverse processes

Compression fractures are usually the result of trunk hyperflexion or falling from a height

Fractures of the processes are generally the result of a direct blow

Stress from improper lifting or too much weight

Dislocations tend to be rare

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Lumbar Fractures

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Lumbar Spine Conditions

Signs of Injury

Compression fractures will require X-rays for detection

Point tenderness over the affected area

Palpable defects over the

spinous

and transverse processes

Localized swelling and guarding

Care

X-ray and physician referral

Transport with extreme caution and care to minimize movement of the segments

Utilize a spine board

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Lumbar Spine Conditions

Low Back Muscle Strain

Cause of Injury

Sudden extension contraction overload generally in conjunction w/ some type of rotation

Chronic strain associated with posture and mechanics

Signs of Injury

Pain may be diffuse or localized; pain w/ active extension and passive flexion

Care

RICE to decrease spasm; followed by a graduated stretching and strengthening program

Elastic wrap/back brace may be useful for support and compression

Complete bed rest may be necessary if it is severe enough

NSAID’s

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Lumbar Spine Conditions

Lumbar Strains

Cause of Injury

Forward bending and twisting can cause injury

Chronic or repetitive in

nature

Improper lifting techniques

Signs of Injury

Localized pain lateral to the

spinous

process

Pain becomes sharper w/ certain movements or postures

Care

RICE, joint

mobes

, strengthening for abdominals, stretching in all directions

Trunk stabilization exercises

Braces should be worn early to provide support

Will require time for healing

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Lumbar Spine Conditions

Back Contusions

Cause of Injury

Significant impact or direct blow to the back

Signs of Injury

Pain, swelling, discoloration, muscle spasm and point tenderness

Management

RICE for the first 72 hours

Ice massage combined with gradual stretching

Recovery generally last 2 days to 2 weeks

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Lumbar Spine Conditions

Sciatica

Cause of Injury

Inflammatory condition of the sciatic nerve

Nerve is vulnerable to torsion or direct blows that place abnormal amounts of stretching or pressure on nerve

Signs of Injury

Arises abruptly or gradually; produces sharp shooting pain, tingling and numbness

Sensitive to palpation with straight leg raises intensifying the pain

Care

Rest is essential acutely – recovery = 2-3 weeks

Treat the cause of inflammation; traction if disk protrusion is suspected; NSAID’s

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Sciatica / Sciatica Nerves

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Lumbar Spine Conditions

Herniated DiskCause of InjuryCaused by abnormal stresses and degeneration due to use (forward bending and twisting)Improper lifting techiquesOver weight

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Lumbar Spine Conditions

Signs of Injury

Centrally located pain that radiate unilaterally in

dermatomal

pattern

Symptoms are worse in the morning

Onset is sudden or gradual, pain may increase after the athlete sits and then tries to resume activity

Forward bending and sitting increase pain, while back extension reduces pain

Straight leg raise to 30 degrees is painful

Care

Rest and ice for pain management

Extension exercises may be comfortable

Core stabilization exercises should be integrated as athlete improves

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Lumbar Spine Conditions

Spondylolysis

and

Spondylolisthesis

Cause of Injury

Spondylolysis

refers to degeneration of the vertebrae due to congenital weakness (stress fracture results)

Slipping of one vertebrae above or below another is referred to as

spondylolisthesis

and is often associated with a

spondylolysis

Signs of Injury

Pain and persistent aching, low back stiffness with increased pain after activity

Frequent need to change position or “pop” back to reduce pain

Localized tenderness to one segment

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Spondylolysis

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Spondylolisthesis

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Lumbar Spine Conditions

Care

Bracing and occasionally bed rest for 1-3 days will help to reduce pain

Major focus should be on exercises directed as controlling or stabilizing hypermobile segments

Progressive trunk strengthening, dynamic core strengthening, concentration on abdominal work

Braces can also be helpful during high level activities

Increased susceptibility to lumbar strains and sprains and thus vigorous activity may need to be limited

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Sacroiliac and Coccyx Injuries

Sacroiliac Sprain

Cause of Injury

Result of twisting with both feet on the ground, stumbles forward, falls backward, steps too far down, heavy landings on one leg, bends forward with knees locked during lifting

Signs of Injury

Palpable pain and tenderness over the joint, medial to the PSIS w/ some muscle guarding

Pelvic asymmetries are possible

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Sacroiliac and Coccyx Injuries

Care

Ice can be used to reduce pain

Bracing can be helpful in acute sprains

Strengthening exercises should be used to stabilize the joints

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Sacroiliac and Coccyx Injuries

Coccyx Injuries

Cause of Injury

Generally the result of a direct impact which may be caused by forcibly sitting down, falling, or being kicked by an opponent

Signs of Injury

Pain is often prolonged and at times chronic

Tenderness over the bone and pain with sitting

Care

Analgesics and a ring seat to relieve pressure while sitting

Pain from a fractured coccyx could last months

May require protective padding to prevent further injury