Spine & Abdomen

The spinal column is very complex compared to other joint in the body Because it protects the spinal cord, injury to the spinal column can be permanently debilitating or even life threatening.

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 cartilaginous rings (Annulus Fibrous) with a jelly-like center (Nucleus Pulposus)

Segments of vertebrae Atlas and Axis (C1,-C2) Atlas Axis Articulating cartilage Anter. Arch Trans Process Post. Arch Vertebral Foramen Axis Body Dens Sup. Artic. Facet Spinous Process

Segments of Vertebrae Cervical Vertebrae Body Vertebral Foramen Trans Process (A/P) Spinous Process Artic Facet (Sup/Inf) Lamina

Segments of Vertebrae Thoracic Body Art Facet (Sup/Inf) Trans Costal Facet Trans Process Spinous Process Vertebral Foramen

Segments of Vertebrae Lumbar Body Art Facet (Sup/Inf) Lamina Trans Process Vertebral Foramen Spinous Process

Segments of Vertebrae Sacrum Coccyx (tail bone) Sup Art Facet (What articulates) Sacral Canal Spinous Tubercles Doral Sacral Foramina Coccyx (tail bone)

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: Upper Trapezius Scalene Sternocleidomastoid 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)

Abnormal curves of spine

Posture Forward head posture Kyphosis Lordosis Scoliosis Head projects forward with rounded shoulders 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 or 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

Fun Fact 12% of American Indians have 25 vertebrae (instead of 24) High % of African American WOMEN have 23 instead of 24 vertebrae Both of these conditions are due to genetic anomaly passed down Both can be the cause of idiopathic back pain

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

Hollow Organs and Solid Organs esophagus, small intestine,  colon (large intestine), stomach. Solid organs:  gall bladder,  spleen, pancreas,  Liver kidney adrenal glands

Abdominal Anatomy Bones: Musculature: Ribs: Manubrium, Sternum, 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 distented 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 shoulder 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 Short power-point report on referred pain Organ-shaped food to share with class