Spine & Abdomen

Bones  Complex structure  4 segments  Sacrum (Tailbone)  Lumbar Spine  Thoracic Spine  Cervical Spine

 Individual bones named vertebrae  Cervical vertebrae: 7  Thoracic vertebrae: 12  Lumbar vertebrae: 5  Sacral vertebrae: 5  Each vertebrae separated by discs and held together by ligaments  Disc comprised of cartlaginous rings (Annulus Fibrosus) with a jelly-like center (Nucleus Pulposus)

Spinal Column  Function of boney column  Protecting spinal cord (nerves)  Holding body up-right for walking  Sites for muscular attachment  Function of intervertebral disks  Absorb shock  Resist compression  Provide separation for nerve roots to exit canal

Muscles  Function:  Keep spine stable  Unstable spine = inability to perform athletic duties  Upper Trapezius  Extends cervical spine  Scalene  Cervical flexion  Breathing  Sternocleidomastoid  Cervical side bending  Rotation (opposite of attachment)

Posture  Forward head posture  Kyphosis  Excessive roundedness of shoulders and upper back  Lordosis  Forward curve of lumbar spine  Scoliosis  Lateral curvature of the spine

Common Spinal Injuries  Bone:  Spondylolysis  Stress fracture of bone degeneration  Spondylolisthesis  Superior vertebrae “shunts” forward on vertebrae beneath  Progression of un-healed spondylolysis  Most commonly found in gymnasts and cheerleaders  MOI: excessive hyperextension of vertebral column  Cervical spine Fx  MOI: axial load  C/O: Pain, tingling, weakness in arms.  If ath c/o during acute trauma, leave ath in position found, including helmet ON

Common Spinal Injuries  Disk Injuries  Disk bulge: not common in younger athletes (higher incidence in contact sports)  MOI: Axial Load, Excessive trunk flexions during loading  Sometimes referred to as “slipped disk” – not appropriate term  Disk bulge: nucleus pulposus is pushed through cartilage until is protrudes  Can put pressure on nerve causing tingling, numbness, pain and eventually loss of function.  Bulge can never be fully retracted, however tx can reduce bulge.  Tx: strengthen core, use good posture, traction

Common Spinal Injuries  Muscle/Tendon Injuries:  Mild to moderate strains of musculature and tendons  C/O P opposite the side they bend, muscle spasm, decreased ROM secondary to P  Tx: Pain is controlled first, then PRE and ROM routine. AT should observe ath in weight room/tx to make sure correct posture and mechanics are utilized

Abdominal Anatomy  Boundaries:  Posterorly: Spinal column  Superiorly: Diaphragm  Anteriorly: Abdominal Musculature  Inferiorly: Pelvis  Abdomen is divided into 4-quadrants  Right Upper Quadrant (RUQ)  Left Upper Quadrant (LUQ)  Right Lower Quadrant (RLQ)  Left Lower Quadrant (LLQ)

Abdominal Anatomy  RUQ: contains liver, portion of pancreas, right kidney, gallbladder (if you have one) Large and small intestines  LUQ: contains Stomach, portion of Liver, portions of Pancreas, left Kidney, the spleen, large and small intestines  RLQ: contains large and small intestines, appendix, portion of bladder, uterus and R ovary (females) prostate (males).  LLQ: large and small intestines, portion of bladder, uterus and L ovary (females) prostate (males)

Abdominal Anatomy  Contains both solid and hollow organs.  Injuries to HOLLOW organs (such as bladder, intestines etc) RARELY cause rapid death; injuries to SOLID organs (such as liver, kidney, spleen) CAN cuase rapid death due to large blood supply  Hollow organs tend to bend and move out of the way upon impact

Abdominal Anatomy  Bones:  Ribs: True, False, Floating, Manubrium, Sternum, Xyphoid Process  Musculature:  Rectus Abdominis, Oblique, Diaphragm

Common Abdominal Injuries  Hernia  Lump of tissue, usually the intestine that bulges through the weakened abdominal wall.  MOI: Holding breath while lifting weights or going to the bathroom  May go away when ath lies down and re-appear when they stand up/exerts abdominal pressure  May be asymptomatic  Tx: sx. Use of a Truss (truss can not be used for athletes in contact sports or weightlifters)  Complications: if left untreated strangulation may occur. Lack of blood supply leads to cell death. bowel obstruction may also occur

Common Abdominal Injuries  Pancreas  Found behind stomach, near liver and spinal cord  MOI: upon impact, pancreas tears away from wall  Medical Emergency: ath will have p in middle of abdomen, c/o of nausea, vomiting and experience signs of shock. Abdomen may be dissented from internal bleeding  Liver  MOI: Blow to RUQ  C/O P that may radiate to R shoulder  Medical Emergency is ruptured: experience signs of shock, have rapid, weak pulse; drop in BP

Pancreas & Liver

Common Abdominal Injuries  Kidney  MOI: Direct blow  3 levels: contusion, laceration, rupture  C/O P in the back may radiate towards bladder. P increase w/ trunk extension, decrease with knee/hip flexion. Nausea, vomiting, visible blood in urine, shock.  Spleen  Direct blow  C/O p over spleen or in L shoulder (Kehr’s sign) (L shulder pain is caused by internal bleeding putting pressure on the diaphragm, which puts pressure on nerve), Abdominal P, rapid pulse, vomiting, decreased BP, shock.

Kidney and Ruptured Spleen

Extra Credit  2 page, typed, report on referred pain  Organ-shaped food to share with class