Neck and Spine

Skeletal Anatomy

Terminology Vertebrae: The bones making up the spinal column Cervical: The seven vertebrae that make up the upper most region of the spine Thoracic: Pertaining to the chest region of the body Lumbar: The five vertebrae that make up the low back Sacrum: The bottom most segment of the spine which consist of bones that are fused Coccyx: Three to four very small vertebrae also called the “Tail Bone” Body of vertebrae: Anterior portion of vertebrae Spinous Process: Posterior portion of vertebrae Transverse Process: Lateral portion of vertebrae

Terminology continued Vertebral Foramen: Hole or space where spinal cord runs Intervertebral Disc: Cartilage cushioning between vertebrae Vertebral Column: The skeletal spine Nerve Root: Opening on the lateral side of vertebrae where peripheral nerves leave the spinal column Spinal Cord: Portion of the central nervous system that is contained within the vertebral foramen.

Lateral view of Vertebral Column

Lateral view of a Vertebrae

Superior View of Thoracic Vertebrae

Muscular Anatomy

Neck & Spine Movements Neck extension Neck flexion Neck rotation Neck lateral flexion Trunk extension Trunk flexion Trunk rotation

Terminology Unilaterally: to one side Superficial: close to the body’s surface Deep: away from the body’s surface Trunk: mid-portion of body excluding arms, legs, and head

Neck Flexors Sternocleidomastoid Scalene

Neck Flexors Scaleni Sternocleidomastoid

Neck Extensors Upper trapezius Deep spine and neck muscles

Neck Lateral Flexion All muscles on one side of the vertebral column contracting unilaterally.

Neck Rotation Occurs when the sternocleidomastoid, Scalenes, and other neck flexors contract on the opposite side of the direction of rotation

http://www.plagiocephalypillow.info/baby_flat_head.php

Trunk Flexion Lengthening of the deep and superficial back muscles and contraction of the abdominal muscles and hip flexor muscles.

Trunk Extension Lengthening of the abdominal muscles and the contraction of the erector spinae and the strongest hip extensor, the gluteus maximus.

Trunk Rotation Produced by the external oblique and internal oblique

Trunk Lateral Flexion Produced by the quadratus lumborum muscle and the obliques, and rectus abdominus on the side of the direction of movement.

Trunk Flexion Trunk Rotation Lateral Flexion http://www.twohundredsitups.com/what.html

Sprains and strains of the neck & spine

Terminology Cervical collar: soft brace that fits around an athletes’ neck Intermittently: alternating stopping and beginning again Radiating: to spread out in a direction from the center

Cervical Sprain Despite having an excellent Range of Motion, it is subject to ligament sprains when it is forcefully moved beyond its normal range. MOI: turning head to catch a ball and then athlete gets tackled by a defender. When hit forcefully from behind, the receiver often suffers a whiplash injury. The body is forced forward by the blow while the head moves backward which places the cervical spine into extension and stretches the ligaments and muscles at the front of the neck.

Cervical Sprain: S/S Usually intense pain if sprain is located in the neck Palpation of the injured area is usually painful if the joint is sprained

Neck Strain: Rx Rest Ice (twenty minutes intermittently 6-8 times a day) Cervical collar if warranted Perform spinal tests to rule out possible paralysis Refer to doctor if needed

Neck Flexors Scaleni Sternocleidomastoid

Cervical Nerve Stretch Syndrome “Burner”: MOI Head is forced into a lateral position while athlete’s arm is pulled in the opposite direction

Cervical Nerve Stretch Syndrome “Burner”: S/S Typically athlete walks off the field with his neck pulled toward the side and the athlete is supporting his arm This mechanism of injury can result in burning, tingling, numbness, and stinging sensations Athlete may recover in seconds or minutes

Cervical Nerve Stretch Syndrome “Burner”: Rx Watch athlete carefully Athlete monitors the intensity of the burning Between 2-5 minutes the intensity should lower dramatically or disappear Manual muscle test for strength and parethesia Athlete stretches neck muscles, shoulder muscles and prepares to re-enter game/practice. Instruct athlete to see athletic trainer after competition is over to re-check his/her neck

Low Back Muscle Strains: MOI Sudden rotation and contraction on an overloaded, unprepared or underdeveloped spine.

Low Back Muscle Strains: S/S Discomfort in low back may be diffused or localized in one area Pain will be present on active extension and with passive flexion No radiating pain

Low Back Muscle Strain: Rx Ice 20 minutes 4-6 times a day Gradual stretching and progressive strengthening once pain has subsided

Lumbar Sprain: MOI Typically occurs when the athlete bends forward and twists while lifting or moving some object. A traumatic force over extends the spinal joints and causes a sudden onset of deep sharp pain.

Lumbar Sprain: S/S Pain is localized Located just lateral of the spinous process Pain becomes sharper with certain movements Any anteroposterior or rotational movement increases pain

Lumbar Sprain: Rx R.I.C.E Athlete may have to wear a supported brace Stretching in all directions, (ROM) should be limited to a pain free range Once appropriate, strengthening exercises for abdominals and back extensors should be initiated Doctor referral may be indicated

Fractures & dislocations of neck & Spine http://www.youtube.com/watch?v=iYy9Vo4P4ew Fractures & dislocations of neck & Spine

Terminology Spearing: Athlete uses top of the helmet to hit another athlete Axial Loading: a force delivered to the top of a straight column of vertebrae

Cervical Spine Fracture/Dislocation: MOI Often the result of combination of excessive neck flexion and rotation Axial loading of the cervical vertebrae from a force to the top of the head combined with flexion of the neck can result in a fracture or dislocation

Hyperrotation laterally Hyperflexion with axial load http://ajs.sagepub.com/content/32/5/1331.full Hyperrotation laterally http://www.cyclenews.com/articles/industry-news/2009/11/04/neck-protection-let-s-talk-about-it/full

Cervical Spine: S/S Athlete reports pain around cervical spine Weakness Numbness Tingling down the arms With a dislocation, there is often a visible deformity Pain in the chest Numbness in the trunk or limbs Sometimes loss of bladder and/or bowel control

Cervical Spine: Rx If signs and symptoms present possibility of a fracture or dislocation call 911 for assistance For both a fracture and dislocation often care for both injuries as identical After ruling out life-threatening conditions the neck should be immobilize and athlete should be put on a spine board

http://www. nj. com/rutgersfootball/index http://www.nj.com/rutgersfootball/index.ssf/2010/10/hospital_where_paralyzed_rutge.html

http://www. nj. com/rutgersfootball/index http://www.nj.com/rutgersfootball/index.ssf/2010/10/hospital_where_paralyzed_rutge.html

FRACTUREE

Chronic injuries of the neck & spine

TERMINOLOGY Ostephytes: outgrowth on a bone Disk bulge: disk moves out between the two vertebrae causing pinching of the disk Impinge: to come into contact with a nerve or disk causing a pinching action Transitory: not lasting, temporary Posterolateral: in the combined direction of posterior and later movements Extrudes: to thrust out Idiopathic: unknown cause

Spinal Stenosis Characterized by a narrowing of the spinal canal in the cervical region that can impinge the spinal cord

Spinal Stenosis MOI: S/S: Either a congenital defect or development of bone spurs osteophytes or disc bulges S/S: Transient quadriplegia may occur from axial loading, hyperextension, or hyperflexion Neck pain my be absent initially Symptoms may be burning and tingling or associated motor weakness in the arms and legs Complete recovery normally occurs within 10-15 minutes

Spinal Stenosis: Rx If athlete demonstrates transient quadriplegia the athletic trainer should use extreme caution initially Athlete must have diagnostic test including x-rays or MRI If identified as having cervical spinal stenosis, athlete should be advised of the potential risks of continued participation Physicians release is required to return to participation

Cervical Disk Injury MOI: S/S: Sustained, repetitive cervical loading during contact sports. The disk extrudes posterolaterally S/S: Neck pain with some restriction in neck motion Pain in upper extremity with associated functional weakness or sensory changes Possible activation of EMS

Cervical Disk Injury: Rx Rest and immobilization of the neck to decrease discomfort Physician referral recommended Cervical traction may also help reduce symptoms

http://www. greatriverspineclinic http://www.greatriverspineclinic.com/causes-of-back-pain/neck-pain/cervical-disk-herniation/

Low Back Pain MOI: Either caused by a congenital or idiopathic defect. S/S: Localized or diffused pain in the low back Low back muscles may be weak Range of motion for back may be painful Athlete may become discouraged with symptoms because they may last a long time

Low Back Pain: Rx Dependent on athlete’s pain tolerance, he/she may continue with regular practice or be in complete rest Alternating ice pack and heat pack (20 minutes) Low back muscular stretching with athletic trainer Athletic trainer teaches and demonstrates exercises the athlete should do at home

Herniated Disk: MOI Develops from extruded posterolateral disk fragment or from degeneration of the disk Primary mechanism involves sustained, repetitive cervical loading during contact sports

Herniated Disk: S/S Neck or back pain Pain may be restricted or diffused Restriction in neck movement At some point in the range of motion of the back and neck the herniated disk may become impinged causing extreme pain

Herniated Disk: Rx Initial treatment involves rest and immobilization of the neck to decrease discomfort If discomfort is in the lumbar area, rest and an immobilization brace may be helpful Cervical traction may help reduce symptoms If this conservative treatment does not help surgical intervention may be necessary

Injury Evaluation for the neck & spine

HOPS/SOAP REVIEW History: questions to determine nature location of injury Observation: Visual examination of injury Palpation: A hands-on exam Stress tests: Tests to check range of motion and degree or injury Subjective: detailed information about patient history, complains Objective: information that is record of test measurements; data gained from inspection Assessment: Identify problem Plan of Action: Treatment

TERMINOLOGY Assessment: Identification of problem Plan of Action: Treatment; rehabilitation

Objective is Hands-On! Completing the S & O Subjective = Oral Objective = Visual Objective is Hands-On!

Objective- Hands-On! Taking a Closer Look……. Perform Palpation Check anatomical structures to determine points of pain Check for abnormalities Perform special test or stress test to assess severity Objective- Hands-On! Click animation to bring in points

Plan of Action: Treatment Subjective Objective Assessment: Identification of problem; determine injury; severity of injury Plan of Action: Treatment Yesterday we learned about Subjective and Objective. Click to fly in A and P part of slide

Injury rehabilitation of the spine & neck

Terminology Range of Motion: the available pain-free movement at a joint Flexibility: the ability to move a joint through a full range of motion without restriction Strength: using higher resistance and lower repetitions Endurance: using low resistance and higher repetitions. Return to Play: sport specific exercises for the athlete to safely return to play. Therapeutic: Healing action Continuously during the rehabilitation process gradual cardiovascular exercises would be utilized.

PHASE I PAIN MANAGEMENT What are you going to use on an injured neck or spine to manage pain and why?

PHASE II How are you going to limit ROM on the neck and spine and why?

PHASE III PROPRIOCEPTION What are you going to do for proprioception on an injured neck or spine?

PHASE IV STRENGTH What could you do to build strength in a person who has a neck or spine injury?

PHASE V ENDURANCE What could you do to build endurance in a person who has injured their neck and spine?

PHASE VI SPORTS SPECIFIC What could you do to help a person who has a head or neck injury continue in their sport?