THE SPINE Chapter 15

THE SPINE Injuries can result in major disability and life threatening consequence.

BONY ANATOMY The bones that make up the spine are called vertebrae Regions of the spinal column: (A) Cervical Spine (B) Thoracic Spine (C) Lumbar Spine (D) Sacrum (E) Coccyx

Consists of the first seven vertebrae. The first two are different (A) CERVICAL SPINE The upper spine, or neck Consists of the first seven vertebrae. The first two are different Atlas - supports the head Axis - designed to allow the skull & atlas to rotate.

(B) THORACIC SPINE The upper back Consists of the next 12 vertebrae. Articulate with the ribs.

(C) LUMBAR SPINE ~ Is generally considered the lower back. ~ Consists of the last 5 movable vertebrae.

(D) SACRUM Consists of 5 fused vertabrae Articulates with Pelvic bones to form SacroIliac SI joint Goes over into the coccyx

(E) Coccyx We refer to as our tailbone Consists of 4 or more fused vertebrae Gluteus Maximus attaches here posteriorly

Vertebrae Anatomy Each section is slightly different, however, they share the following similarities: Each vertebra has a Body Spinous process Two Transverse processes Vertebral Canal (foramen) – for spinal cord

THE SPINE 24 of the vertebrae are classified as movable or true. 9 of the vertebrae are classified as immovable or false.

SPINAL CORD The portion of the central nervous system that is contained within the vertebral canal of the spinal column.

THE SPINAL CORD 31 pairs of spinal nerves extend from the sides of the spinal cord. 8 cervical 12 thoracic 5 lumbar 5 sacral 1 coccygeal

THE SPINAL CORD Each nerve has TWO roots: Anterior Root (motor root) Posterior Root (sensory root) Each root comes together to form a single nerve.

Between the intervertebral articulations lie INTERVERTEBRAL DISKS. Act as important shock absorbers for the spine. Like a jelly filled doughnut...N.P. Inside, surrounded by multiple layers of A.F.

They are composed of two components: DISKS They are composed of two components: Annulus Fibrosus (layers of cartilage) Nucleus Pulposus (jellylike core)

INTERVERTEBRAL DISKS Have very poor healing potential due to a lack of blood supply They are compressable: allows for movement Reason why a person is slightly taller in the mornings than in the evening Reason for old people to become shorter gravity compresses disks all day In elderly people discs aren‘t as spongy anymore, which leads to a constant compression and loss of height

MOVEMENTS Flexion Extension Lateral Flexion Rotation

MUSCLES Muscles of the trunk, neck, shoulder, & pelvis attach to the spinal column. Provide wide range of mobility & much needed stability as we are running, throwing, catching, and kicking

Internal & External obliques Scalenes A. Spinal Flexors Rectus abdominis AKA your “six pack” Internal & External obliques Love handles Scalenes Color all muscles in coloring book...unfortunately I do not have e-pics of them

B. Spinal extensors run entire length of spine posteriorly, attaching to pelvis, ribs, and vertebrae Work with spinal flexors to keep the body upright Erector Spinae Trapezius (3)

1. Upper Trapezius Extends the neck Attaches to occipital bone (back of the head) and fans out to attach to the acromion process of the scapula (shoulder blade)

Assist in breathing by pulling rib cage up 2. Scalenes Three total: Flex the neck Originate at the cervical vertebrae and attach to first and second ribs Assist in breathing by pulling rib cage up

Lateral flexion and rotation of the cervical spine (neck) 3. Sternocleidomastoid Lateral flexion and rotation of the cervical spine (neck) Originates at the top of the sternum (sterno) & attaches at the Mastoid process (just behind the ear lobe) (mastoid)

Normal Posture From the side an imaginary straight line runs from just behind the ear through the middle of the shoulder, the middle of the greater trochanter of the femur, the back of the patella, & the front of the malleolus.

Abnormal Postures:

Movements of the Neck A) Flexion B) Extension C) Lateral Flexion D) Rotation

MECHANISMS of CERVICAL INJURIES

NECK INJURIES

Usually a result of hyperflexion or hyperextension Cervical Sprain Usually a result of hyperflexion or hyperextension e.g. A receiver who stops, turns toward the QB, and gets tackled from behind WHIPLASH

Cervical Sprain - Mechanism Body is forced forward by the blow while the head snaps backward - stretches muscles & ligaments in anterior neck. When the body stops moving because it hits the ground the head then snaps forward, stretching the structures in the posterior neck

Pain in neck and possibly the arm Signs and Symptoms: Pain in neck and possibly the arm Athlete will be apprehensive in moving the head

Ice, rest, possibly a neck brace Treatment: Ice, rest, possibly a neck brace Do not apply compression, since circulation and respiration might be cut off! Send to team physician to rule out more serious injury

CERVICAL STRAIN Same Mechanism and Treatment as Cervical Sprain

Signs and Symptoms: Muscle spasm and weakness Restricted ROM Pain and point tenderness along course of muscle

Fractures and Dislocations Can have devastating results such as permanent disability or even death Often a result of an axial load (FB player lowering his head to make a tackle) Bring straw and demonstrate an axial load Hold it between thumb and index finger, compress down until it snaps->that‘s how a neck breaks, too.

Cervical Fractures: Are relatively uncommon Usually involve C3 and C4 High Incidence Sports: ~ Gymnastics ~ Rugby ~ Ice Hockey ~ Diving

Cervical Dislocation: Not common but occur much more frequently in sports than fractures. Result of violent flexion & rotation of the head. Pool diving accidents. Affect C4, C5, and C6.

Pain in midline cervical spine and radiating outwards Signs and Symptoms: Pain in midline cervical spine and radiating outwards Tingling, numbness, weakness down the arms S.b. Should stabilize the head, talk to the athlete and calm him down. Do not remove any equipment except a facemask of a FB helmet. Prepare to start Rescue Breathing and CPR (just in case)

Stabilize athlete in position found (DO NOT MOVE HIM!!!) Treatment: Stabilize athlete in position found (DO NOT MOVE HIM!!!) Check and maintain ABCs And CALL 911!!!!!!!!

Spinal Cord Shock: Occurs after a severe twist or snap to the neck. Same signs and symptoms of a fracture or dislocation but dissolve after a short time.

Treatment Should be the same as a fracture or dislocation (because you never know)

Brachial Plexus Injuries The brachial plexus is a bundle of nerves that exits the spine and runs the course of the shoulder and down the arm (C5 – T1)

Lateral flexion of the neck with opposite shoulder being pushed down Mechanism of Injury Lateral flexion of the neck with opposite shoulder being pushed down FB player tackling an opponent

Brachial Plexus Injuries Results in stretching of the brachial plexus which causes burning, tingling, & stinging, sensation in combination with weakness of the arm Commonly referred to as a „burner“ or a „stinger“

Brachial Plexus Injuries Symptoms can last from seconds (mild stinger) to several weeks (severe stinger)

May return to activity when he has Full ROM Full strength No symptoms Treatment R I C E FB – fit with a neck roll May return to activity when he has Full ROM Full strength No symptoms

Lumbar Disk Disease: Subject to constant abnormal stresses stemming from faulty body mechanics, trauma, or both - over a period of time, can cause degeneration, tears, & cracks in the annulus fibrosus. Can produce a herniation or bulging.

Lumbar Disk Disease Commonly referred to as a „slipped disk“ Inappropriate term, since disks are attached to the body of the vertebra and rarely slip Actually, the jellylike nucleus pulposus at the center of the disk pushes through the layers of cartilage of the annulus fibrosus.

Lumbar Disk Disease (just like squeezing a jelly doughnut between your hands...the jelly squeezes out) A disk usually bulges posteriorly and can cause pain, numbness, and tingling when pressing on a nerve

Injury Prevention Muscle Strengthening – both abdominals and back musculature Core stabilizations Posture Range of Motion – flexibility Using Correct Techniques slow and control weight lifting Proper form, correct footwear

Special Tests

Postural Evaluation

Milgram Straight Leg Raise Lumbar Spine Patient – laying supine on table, holds both feet above table for 30 seconds (legs straight) AT – observes Pain and/or pressure in lower lumbar spine

SI Compression and Distraction SI irritation or sprain Patient - laying supine AT Compression – apply pressure separating pelvis Distraction – apply pressure pushing ASIS of pelvis medially Positive - pain

Other Tests Hoover – malingering Manual Muscle Testing Superman – upper back strength and lower back pain Piriformis – piriformis muscle strength Rhomboid – strength of rhomboid muscles