Injuries to the Spine

Background Info: Nervous system is divided into two categories: Central Nervous System (brain and spinal cord) Peripheral Nervous System (all peripheral nerves stemming from spinal cord) Peripheral Nervous System has 3 functions Connect the body to the Central Nervous System Control the automatic or involuntary activities of the body Act as the reflex center of the body

Peripheral Nerves There are three types of peripheral nerves: Sensory (afferent) – carry impulses from the sense organs to the brain or spinal cord Motor (efferent) – carry impulses from the brain or spinal cord to muscles or glands Mixed nerve – contains both sensory and motor nerve fibers Sympathetic v Parasympathetic *Sympathetic nerves extend to vital internal organs, controls “fight-or-flight” mechanism (i.e. increased heart rate when fear kicks in) *Parasympathetic – includes vagus and pelvic nerves; counteract effects of sympathetic system

Locations of Peripheral Nerves Nerves making up the peripheral system stem from two different locations Cranial Nerves 12 pairs; transmit messages to and from the various parts of the head and face; receive sensory information Spinal Nerves 31 pairs; originate in the spinal cord and carry messages to the rest of the body. (all are mixed nerves)

Cranial Nerves - Assessment Number Name Function Test I II III IV V VI

Cranial Nerves - Assessment Number Name Function Test VII VIII IX X XI XII

Nervous System (Central v Peripheral)

Spinal Anatomy Skeletal Anatomy Vertebral column is divided into 5 sections Cervical Vertebrae (7) – allows head movement (atlas and axis allow rotation) Thoracic Vertebrae (12) – chest area; articulate with the ribs Lumbar Vertebrae (5) – lower back; larger and bear most of the body’s weight Sacrum – formed by 5 fused bones; articulation point for the hips Coccyx – tailbone; formed by 4 fused bones

Spinal Anatomy Spinal Nerves Spinal cord begins at the base of the skull and runs through the foramen of all of the vertebrae lined up Nerves enter and exit the spinal cord through the openings between the vertebrae, and extend out to area of innervation

Injuries to the Spine

Cervical Spine Injury Basic info – range from minor neck pain to complete paralysis or death; most common mechanisms are forced movement of the head on the cervical spine (i.e. hyperextension) OR axial loading (cervical compression) S/S – pain, neurological symptoms (numbness, paralysis, weakness, tingling in extremities) Treatment – DO NOT MOVE THE ATHLETE! Manage airway if necessary, and perform C-spine immobilization; Activate EMS Rehab/RTP – athlete will need to undergo extensive rehab/physical therapy, depending on the severity of the injury. Physician will make ultimate decision on RTP, which may or may not include limitations in certain sports

Cervical Nerve Syndrome Basic info – also called “stinger” or “burner” Occurs from forced lateral flexion S/S – sharp, radiating pain, traveling from posterior scalp, around the neck and down the top of the shoulder. Potential numbness, weakness and loss of function may occur into the affected side arm/hand Treatment – Remove from play (symptoms usually resolve themselves within minutes) – do not stretch! Rehab/RTP – Can RTP once parasthesia has subsided and all muscular strength is restored, and athlete has full and pain free cervical ROM. Multiple incidents may require referral and PT.

Cervical Fracture / Subluxation Basic info – Most common mechanism occurs with force to the head while the neck is in flexion; greatest risk occurs in football, gymnastics, and diving; this injury may cause trauma to the spinal cord, which is the most devastating S/S – swelling within the spinal cord causing temporary or permanent damage; symptoms are neck pain, muscle spasm, and evidence of spinal cord involvement (quadriplegia, neuropraxia Treatment – same as Cervical Spine Injury Rehab/RTP – same as Cervical Spine Injury

Thoracic / Lumbar Spine Injury Basic info – Most commonly a sprain, strain, or contusion, usually involving the paraspinal muscles S/S – tenderness, pain (pain increases with active contraction or stretching), stiffness Treatment – Physical therapy, and/or referral to physician Rehab/RTP – Upon resolution of symptoms and full muscular strength.

Spondylolysis Basic info – structural defect of lumbar spine / vertebrae; often considered a stress fracture of the “pars interarticularis” S/S – pain associated with increased activity (pain subsides with rest or inactivity); pain may radiate into buttocks or upper thighs Treatment – Referral to physician; Rest, followed by slow, progressive physical therapy Rehab/RTP – Upon resolution of symptoms and full muscular strength. Requires clearance by physician.

Intervertebral Disc Herniation Basic info – Nucleus pulposus herniates through the annulus fibrosis, potentially pressing against the spinal cord or nerves S/S – extreme pain and stiffness surrounding injury site, radiating leg pain if severe enough. Pain is often unilateral. Treatment – Referral to physician; Physical therapy that focuses on strengthening surrounding muscles and postural corrections Rehab/RTP – Upon resolution of symptoms and full muscular strength. Requires clearance by physician or physical therapist.

Intervertebral Disc Herniation

Sacroiliac Joint Injury Basic info – usually sprains occurring from acute or chronic trauma; also associated with poor posture and/or poor lifting mechanics; sometimes related to leg length discrepancy S/S – stiffness or constant soreness around SI joint; pain often less in the morning and gets worse as day progresses; activity may decrease symptoms, but will return once activity has stopped Treatment – Referral to physician; Physical therapy that focuses on strengthening surrounding muscles and postural corrections Rehab/RTP – Upon resolution of symptoms and full muscular strength.

Sacroiliac Joint Injury