Sports Medicine Chapter 20 Neck And Spine Sports Medicine Chapter 20

Vocabulary I knew that word!! Annulus Fibrosis- periphery of the intervetebral disk, strong fibrosis tissue Axial Loading -Direct blow to the top of your head Cervical nerve stretch syndrome- brachial plexus injury Cyanosis- blue/gray color of the face Kyphosis-Thoracic curvature of the spine, humpback Nucleus Pulposus- the inside of the intervetebral disk. Jelly like substance Paraplegia- paralysis of the lower extremity Quadriplegia- paralysis of the upper/lower extremities Sciatica- inflammation of the sciatic nerve in your lumbar spine Scoliosis- lateral curvature of the spine Spondylolisthesis- forward slipping of the vertebrae L5 most common Spondylolysis- stress fracture of the pars interarticuylaris of the vertebrae

Anatomy Characteristics 33 indiv. Bones or vertebrae 24 moveable 9 immovable The spine allows for a high degree of flexibility Cervical 7 vertebrae, first 2 = atlas and axis. Function is to support the head and permit cervical rotation Thoracic 12 vertebrae. #1-10 articulate with the ribs. Muscles that attach to the thoracic vertebrae= trapezius, rhomboid, latissmus dorsi Lumbar 5 vertebrae and is considered the largest and strongest Sacrum As a child grows up, the bottom 5 vertebrae fuse together. Weight is transmitted through the sacroiliac joint Coccyx consist of 4 separate vertebrae which the lower 3 fuse together in adulthood. Anatomy

Brachial Plexus C5 lateral upper arm (deltoid) C6 Sensory Muscle movement C5 lateral upper arm (deltoid) Shoulder abduction (deltoid), elbow flexion (biceps C6 Lateral forearm 1st/2nd phalange Elbow flexion (biceps), wrist extension C7 3rd phalange Elbow extension (triceps), wrist flexors, finger extensors C8 4th/5th phalange, medial forearm Finger flexors, finger abduction/adduction T1 medial elbow finger abduction/adduction Brachial Plexus

Nerve Roots

Injuries to neck Brachial plexus injury Median Nerve Peripheral nerves Nerves that could be involved and should be evaluated: C5-T1 nerve roots Peripheral nerves Radial nerve Wrist/thumb extension Dorsal web space between thumb and index finger Ulnar nerve: Abduction of 5th phalange Distal ulnar aspect of little finger Median Nerve Thumb pinch Distal radial aspect of 2nd phalange Axillary nerve Deltoid movement Lateral arm silver dollar patch in the middle of the deltoid Musculocutaneous nerve Biceps Lateral forearm

Neurological Exam Sensation Testing If there is nerve root compression, sensation can be disrupted

Lumbar Plexus L3 Distal anterior thigh L4 Sensory Muscle movement L3 Distal anterior thigh Knee extension L4 Patella and medial surface of tibia Dorsi flexion (anterior tibialis) L5 Top of foot Great toe extension S1 Lateral surface of foot/5th metatarsal Ankle Eversion Lumbar Plexus

Mechanism of Injury pg 413 An axial load to the top of the head a flexion force a hyperextension force a flexion-rotation force a hyperextension-rotation force a lateral flexion force

Evaluation of neck and spine injuries.

Postural Malalignments

Low Back Injuries History My aching radiating pain back pain when? weakness loss of function tingling or numbness check posture constant pain My aching back

Lumbar plexus nerve roots Sensory Muscle movement L1,2,3,4 Upper to Mid to lower thigh Quadriceps: Knee extension L4 Medial lower leg Tibialis anterior: Foot dorsiflexion/inversion L5 Lateral leg and dorsum of foot Extensor hallicus longus: great toe extension S1 Lateral foot Peroneal longus/brevis: foot eversion

Rehabilitation for your low back Williams low back exercises Laying down, sitting, driving, standing, lifting, and carrying

Injuries stingers burners fractures disc problems sciatica scoliosis strains/sprains fractures disc problems spondylolisthesis spondylolysis sciatica scoliosis kyphosis

Injuries to neck Cervical sprain or whiplash S/S= Pain in the neck like a muscle strain but is pt tender over the spinous processes (lig.). Pain may appear the day after the trauma RX: Dr., collar, RICE, NSAID’s, contrast therapy and possibly traction Acute Torticollis (wryneck) S/S= Pt tender, muscle spasm, head ROM is limited Rx: Contrast therapy, gentle traction, rotation and lateral bending stretching, wear a soft collar possibly, usually lasts for 2-3 days

Injuries Low back strain: S/S= pain in the low back 2 causes: sudden extension and trunk rotation Chronic strain associated with poor posture S/S= pain in the low back Rx: ice, ice massage, massage, stretching and rest. Work on good posture

Spondylolysis and Spondylolisthesis Common is activities that cause hyperextension. Gymnastics, lifting weights, blocking in football, serving in tennis, spike in volleyball, butterfly stroke S/S= pain over the low back after exercise not during. Rx: rest and exercises to stabilize the area

Lumbar sprains and/or herniated lumbar disc Mechanism of injury: bending forward and twisting while lifting. S/S= pain is localized but radiates if lumbar disc is herniated down the back of your legs RX: RICE to reduce pain, strengthening exercises for abdominals and back extensors. Stretching and good posture need to be preformed daily

Low back special evaluation tests Straight leg raise (SLR) Used for evaluation of sciatic nerve problem, sacroiliac joint, and lumbar spine Compression distraction tests For sacroiliac (SI) joint