THE SPINE Chris A. Gillespie, MEd, ATC, LAT Director, Athletic Training Education Samford University

SKELETAL ANATOMY OF THE SPINE CERVICAL SPINE THORACIC SPINE LUMBAR SPINE SACRUM COCCYX

ADDITIONAL ANATOMY ARTICULATIONS & LIGAMENTS INTERVERTEBRAL DISKS MUSCULATURE NEUROANATOMY THE LINKAGE SYSTEM SUM OF THE PARTS IS GREATER THAN THE INDIVIDUAL PARTS

NEUROANATOMY OF THE SPINE Sensory Motor Reflexes Extremely Important Make a mistake here and someone could die or….

NEUROANATOMY OF THE SPINE “A CLOSER LOOK”

MOVEMENTS OF THE SPINE FLEXION EXTENSION LATERAL FLEXION (RIGHT & LEFT) ROTATION (RIGHT & LEFT) CIRCUMDUCTION INTERVERTEBRAL MOTION SEGMENTS

ANATOMICAL VARIATIONS LORDOSIS KYPHOSIS SCOLIOSIS PARS DEFECTS SPINAL STENOSIS

INJURIES OF THE SPINE Most of the injuries of the spine that we deal with on a daily basis are minor, yet the significant injuries are the ones that we remember the most.

MECHANISMS OF INJURY AXIAL LOADING HYPEREXTENSION FLEXION ROTATIONAL STRESS LATERAL BENDING DYNAMIC OVERLOAD DIRECT BLOW MECHANICAL

CERVICAL INJURIES CONTUSIONS SPRAINS STRAINS SPINAL STENOSIS SPINAL CORD INJURY FRACTURES DISLOCATIONS DISK PROBLEMS CERVICAL PLEXUS INJURY BRACHIAL PLEXUS INJURY

CERVICAL STENOSIS

CERVICAL FRACTURES, etc. C1 FRACTURE C4 WEDGE FRACTURE C5-6 FACET SUBLUXATION

BRACIAL PLEXUS INJURIES

BRACHIAL PLEXUS INJURIES

THORACIC INJURIES CONTUSTIONS SPRAINS STRAINS FRACTURES NERVE INJURIES

LUMBAR INJURIES CONTUSIONS SPRAINS STRAINS FRACTURES DISLOCATIONS DISK PROBLEMS LUMBAR PLEXUS INJURIES SPONDYLOLYSIS SPONDYLOLISTHESIS

DISK HERNIATION

SACRUM & COCCYX INJURIES CONTUSIONS SPRAINS STRAINS FRACTURES NERVE INJURIES

EVALUATION OF THE SPINE

MEDICAL EMERGENCY A condition whereby without prompt medical care, death will occur ---

ATHLETIC TRAUMA ASSESSMENT & MANAGEMENT Scene Size-up Initial Assessment Focused Physical Exam and History / Rapid Trauma Assessment Detailed Physical Examination

DETAILED PHYSICAL EXAM Assess Head Assess Neck Assess Chest Assess Abdomen/Pelvis Assess Extremities Assess Posterior Manage Secondary Injuries Reassess Vitals

PRIMARY SURVEY RESPONSIVENESS AIRWAY BREATHING CIRCULATION SHOCK

SECONDARY SURVEY History Observation Palpation Functional tests Neurological tests Special tests Referral & Plan

HISTORY Areas of pain Onset of injury Mechanism of injury Nature of pain Activities that cause pain Bowel and/or bladder problems Previous history of injury related to area

INSPECTION Curves of the spinal column Gait Position of the other parts of the body Alignment and symmetry Breathing patterns Posture Swelling and discoloration

PALPATION Cervical spine Thoracic spine Lumbar spine Sacrum Coccyx Pelvis Palpate of tenderness, swelling, deformity, etc.

FUNCTIONAL TESTS Range of Motion of the Spine –Active range of motion –Passive range of motion –Resistive range of motion Do not check if there is any doubt regarding severity of the injury to the spinal column.

NEUROLOGICAL TESTS SENSORY MOTOR REFLEX Check all areas: –Cervical –Thoracic –Lumbar –Sacral

SPECIAL TESTS Babinski Test Oppenheim’s Test Brachial Plexus Traction Test Cervical Axial Load Cervical Distraction Shoulder Abduction Spurling’s Test Single Leg Stance Test Straight Leg Raise Well Straight Leg Raise Valsalva Test Beevor’s Sign Milgram Test Kernig’s Test Femoral Nerve Stretch Hoover Test Lasegue’s Test Sacroiliac Tests

REFER THE ATHLETE IF: You have a doubt There is paralysis Pain or tenderness Deformity Weakness Unusual sensations Head injury involvement

A 13-year-old female gymnast comes to you complaining of low back pain. The pain increases when she extends the spine. Like most gymnasts, she is hypermobile in most of her joints. Describe you assessment plan for this athlete. What condition(s) do you suspect and what are the potential mechanisms of injury? What about competition? Can she continue?

Questions Age? Chronic? Repetitive Stress? Radiating pain? Special Tests? Impression? Referral and Plan?

A 30-year-old recreational athlete comes to you complaining of a chronic backache for 6 months duration. The pain has been gradually increasing in severity and is worse at rest and in the morning on arising from bed. When present, the pain is centered in the low back and radiates into her buttocks and posterior left thigh. Describe your assessment plan for this individual. What condition(s) do you suspect? What are the possible mechanisms of injury?

Questions Age? Chronic? Radiating pain? Special Tests? Impression? Referral and Plan?

L4 REFLEX

SENSORY AREAS FOR L4-S2

WELL LEG STRAIGHT LEG TEST VS. STRAIGHT LEG TEST

GAENSLEN’S TEST

SINGLE LEG STANCE TEST

HOOVER TEST

SI COMPRESSION & DISTRACTION TESTS

SPONDYLOLISTEHSIS VS. SPONDYLOLYSIS

MOTOR TESTS FOR L4-S2