Spine Injuries/Special Testing Sports Med 2

Cervical Neck MOI Axial Load Flexion Hyperextension Rotation and Flexion Rotation and Hyperflexion Lateral Flexion

Cervical Fracture Gymnasts, hockey, diving, football, rugby MOI S/S TX Relatively uncommon in athletics but always be prepared. MOI Axial loading and flexion, rotation, hyperextension S/S common in C4-C6 Point tenderness Muscle spasms = decrease ROM Numbness & pain in extremities, loss of bladder/bowel control TX Rule out spinal injury stabilize, refer for x-ray

Cervical Sprain Whiplash MOI Violent flexion, extension or rotation Affects anterior and posterior ligaments S/S Persistent, tender over transverse and spinous processes Pain occurs a day later TX X-ray to rule out a fx Neurological exam PRICE, traction

Acute torticollis Wry Neck MOI Pain on one side of the neck upon waking up Synovial lining or capsule is pinched S/S Palpable pt. tenderness and muscle spasm Limited side flexion, and rotation TX X-ray, traction, AROM, PROM

Cervical MMTs Flexion Extension Lateral Bending Rotation

Cervical Distraction http://www.youtube.com/watch?feature=player_embedded&v=xDX_TUesdh0 Procedure: athlete lies supine. Examiner grasps the patient's head under the occiput and chin and gradually applies traction. Positive Test: reduction or elimination of symptoms caused by cervical radiculopathy

Spurling Test (cervical compression) Procedure: seated with neck bent to affected side. Carefully compress straight through the head. Repeat on opposite side. Positive Test: pain in the upper extremity on the side the head is flexed = pressure on the nerve root

Scheuermann’s Disease Thoracic Gymnastics, butterfly swimming MOI Kyphosis resulting from wedged fx of 3 or more vertebrae Causes nucleous pulposis to enter into vertebrae S/S Kyphosis and lumbar lordosis but no pain Point tender over spinous processes and back ache at end of day TX Prevent progressive kyphosis Extension exercises, NSAIDS

Rib Compression Procedure: athlete is seated or standing. The examiner pushes the hands together to compress the ribcage and then releases the pressure. Positive Test: Pain with compression or release of pressure indicates the possibility of a rib fracture, rib contusion, or costochondral separation.

Lumbar MOI Congenital Idiopathic Mechanical Present at birth Traumatic Overuse injury Strains, sprains

Lumbar Strain MOI S/S TX Sudden extension and rotation Faulty posture, excessive lumbar lordosis S/S Pain with active extension and passive flexion TX PRICE, elastic wrap to compress Stretching, strengthening exercises should not cause pain

Lumbar MMTs Flexion Extension Rotation

Sciatica Inflammatory condition of the sciatic nerve MOI S/S TX Nerve compression, irregularities in vertebrae tight piriformis muscle S/S Acute or chronic Sharp shooting pain that follows the nerve pathway TX Rest, traction (if necessary), stretching, NSAIDS

Straight Leg Raise Procedure: Athlete is supine. Examiner slowly raises the legs until tightness or pain is noted Positive Test: Pn @ 30 degrees = hip problem or inflamed nerve Pn. @ 30-60 = sciatic nerve Pn. @ 70-90 = SI joint

Spondylolysis MOI S/S TX Congenital degeneration of the vertebrae Appears as a stress fx, most common in boys S/S Asymptomatic until hyperextension or disk herniation TX Bracing, rest, stabilization exercises

Spondylolisthesis MOI S/S TX One vertebrae slipping on one below it A complication of spondy higher in girls S/S hyperlordosis TX Bracing, rest, stabilization exercises

Valsalva test Procedure: subject is sitting ask subject to take a deep breath and blow against closed fist (bowel movement) This increases intrathecal pressure Positive Test: Pain or neurologic symptoms in buttox and thigh = Herniated disc

Press Ups Procedure: Athlete is lying prone. Athlete uses hands to push up upper body and extend spine Positive test: pain radiating into the buttocks/thigh = herniated disk

Stork Test Procedure: subject stands on one foot and extend their back, repeat on opposite side. Positive Test: Lumbar pain= possible fracture of pars of vertebrae

Sacroiliac Pain MOI S/S TX Twisting with both feet on the ground Falling backward, landing heavily on one leg S/S Point tender on SI joint ASIS and PSIS may be asymmetrical Side bending toward the injury side increases pain TX Modalities, brace, strengthening, stretching, PRICE

SI Compression Procedure: Athlete is Supine or side lying. Examiner has both hands over the lateral aspect of the pelvis. Examiner applies downward pressure through the anterior portion of the ilium, spreading the SI joints Positive Test: SI joint pain

SI Distraction Procedure: Athlete is supine Examiner applies pressure to spread the ASIS Positive Test: SI joint pain

FABERS (Patricks) test Procedure: Athlete is supine with the foot of the involved side crossed over the opposite thigh (figure–4 position) & the leg resting in the full external rotation Examiner has one hand on the opposite ASIS & the other hand on the medial apsect of the flexed knee Examiner applies overpressure at the knee & ASIS Positive Test: Sacroiliac pain