Anatomy and Injuries to the Spine Spain Park Sports Medicine

Function of anatomy  Protects spinal cord  Holds body upright  Site for muscle & ligament attachment (support spine)  Discs provide shock absorption  Nerves provide sensation and motor function

Bony anatomy  Vertebrae 7 cervical (flexion, extension, lateral flexion, rotation)  1 st -atlas  2 nd -axis 12 thoracic (little movement) 5 lumbar (less flexion than extension, some rotation 5 sacral (fused) 3-4 coccyx (fused)

Anatomy of spine  Parts of vertebrae Spinous process Transverse process Body

Cervical vertebrae

First 2 cervical vertebrae

Thoracic vertebra

Lumbar Vertebrae

Sacrum and coccyx

Vertebrae and ribs

Posture  Neutral spine Normal alignment  Thoracic curve Excessive--kyphosis  Lumbar curve Excessive--lordosis

Discs  Fibrocartilaginous  Shock absorbers  Resist compression  Keep vertebrae separated  Allows movement & flexibility  Provides space for nerves to exit  No blood supply

Discs Nucleus pulposus  Jelly-like core Annulous fibrosus  Cartilaginous outer rings

Muscles  Provide movement & stability  Superficial—erector spinae Attach to vertebrae, ribs, pelvis 3 groups  Spinalis, iliocostalis, longissimus In 3 areas  Cervicis, thoracicis, lumborum

Muscles  Abdominal muscles play big role in stabilizing back  Trunk flexion, lateral flexion, rotation Rectus abdominus External oblique Internal oblique Transverse abdominus

Muscles  Trapezius Upper portion aids in cervical extension  Sternomastoid Lateral flexion, rotation  Scaleneus Flexion of cervical area  Multifidis Rotation of spine

Muscles

Nerves  Each vertebrae has a nerve that exits either below or above it  31 pairs of spinal nerves 8 cervical nerves 12 thoracic nerves 5 lumbar 5 sacral 1 coccygeal

Spinal Cord  Part of the CNS along with brain  Contained within vertebral canal  Extends from cranium to 1 st -2 nd lumbar vertebrae  Lumbar roots & sacral nerves for a “horse-like tail” called cauda equina  2 plexuses Brachial, lumbosacral

Brachial Plexus

Lumbosacral plexus

CNS

Dermatomes  Area of body that has nerve sensation for each nerve root

Dermatomes  Cervical C4-shoulder C5-lateral arm C6-lateral forearm C7-middle finger C8-medial half of ring finger & forearm T1-medial arm

Dermatomes  Thoracic At the level of the respective thoracic vertebrae

Dermatomes  Lumbar/Sacral L1-upper anterior thigh L2-middle anterior thigh L3-lower anterior thigh L4-medial side of leg L5-lateral side of leg, dorsum of foot S1,2-lateral malleolus, plantar surface of foot S2,3,4-nerve supply for bladder, intrinsic muscles of toes

Myotomes  Area of the body that has motor function

Myotomes  C5-deltoid—shoulder abduction  C5-6-biceps—elbow Flexion  C6-wrist extensors—extension  C7-triceps & wrist/finger flexors— elbow extension, wrist/finger flexion  C8-finger flexors—finger flexion  T1-finger Abductors--abduction

Myotomes  L1,2,3-iliopsoas—hip flexion  L2,3,4-Quads—knee extension  L4-tibialis anterior— dorsiflexion/inversion at ankle  L5-Extensor hallicus longus, extensor digitorum longus/brevis, extension/inversion at ankle  S1-peroneus longus/brevis-eversion  S1,2-gastroc/soleus—plantar flexion

Posture  Normal Slight curve at thoracic and lumbar areas, ears in line w/ shoulders

Posture  Problems Forward head position-ears in front of line with shoulder Kyphosis-excessive curve of thoracic spine Lordosis-excessive curve of lumbar spine Scoliosis-lateral curve of spine

Posture  Preventing poor posture Don’t be lazy Walk and stand as if something is pulling you up straight Carry bags/backpacks on both shoulders/alternate Carry bags at small of back (lumbar area)

Posture

Prevention of Injuries  Most injuries to cervical/lumbar area  Maintain adequate strength and flexibility of hip flexors and back  Maintain strong abdominals/core strength  Work on proper posture

Prevention  Learn to lift properly Maintain slight curve in lumbar spine Lift with knees and hips (legs)  Keep head up  Keep your butt behind you!!!

Lumbar spine injuries  Sprain  Strains  Fractures  Dislocation  Disc injury

Lumbar Sprain  Mxn: forced into excessive trunk flexion and rotation at some time  Posterior aspect of vertebral joints separate and stretch ligaments

Lumbar Sprains  S/S: localized pain to one side of spine  Limited ROM  Pain  Spasms  Push each vertebra anteriorly to attempt to reproduce pain

Lumbar Sprains  TX: RICE After 48 hours—heat Active rest Maintain comfortable neutral spine Stretching Strengthening and stability exercises

Lumbar Strain  Mild/moderate strains very common  Mxn: same as for sprains  S/S: pain on one side spasms decreased ROM pain moves up and down length of muscles

Lumbar Strains  TX: RICE Gentle stretch Heat Strengthening Flexibility

Fractures  Mxn: Severe compression type force Direct blow Extreme flexion

Fractures  S/S: Severe pain POT over vertebra, especially spinous process Muscle spasm LOM Possible tingling, numbness, etc.

Fractures  TX: Be conservative Call 911 Neurological exam Don’t move athlete Spineboard prior to transport

Fractures

Disc Injury  Common in older people but not so much in younger athletes.  Referred to as “slipped” disc  Nucleus pulposus pushes through rings of annulous fibrosus causing a “bulge” which can lead to herniation  Most are posterior to one side  Pressure exerted on nerve root

Disc Injury  Mxn: Improper lifting Poor posture Poor body mechanics (excessive flexion over prolonged time frame) Trauma due to direct fall

Disc  S/S: Pain radiating down leg Numbness Tingling down leg Increased pain with sitting/flexion motion “list” Decreased/absence of reflex

Disc  TX: Active rest Work on posture Extension exercises Proper mechanics Core stability—especially lumbar area Traction Surgery if PT doesn’t work

Herniated disc

Disc injury

Lumbar traction

Cervical Injuries  Similar to those in lumbar area  May have to treat differently due to the increased mobility in that area

Cervical Sprains  Mxn: move beyond normal ROM Hyperextension or hyperflexion of neck Whiplash type mxn  Body forced forward by the blow while the head moves backwards, placing the cervical spine into extension stretching the ligaments & muscles at front of neck. When body stops head snaps forward stretching the posterior ligaments & muscles of neck

Cervical Sprain

Sprains  S/S: Neck and arm pain Pain between scapula Possible numbness or tingling Decreased ROM due to Pain POT over the cervical area, usually localized

Cervical Sprain

Sprains  TX: Check for nerve injury Ice Soft neck collar Medical referral if severe Traction Stretching strengthening

Cervical Strains  Mxn: Whiplash type –same as for sprains  S/S: Muscle spasms, Decreased ROM, Muscle weakness, pain along the muscle, POT over muscles  TX: same as for sprains  Return to Activity: No symptoms, full ROM & strength, Dr. release

Cervical Strain

Cervical sprains/strains

Cervical Traction

Cervical Fractures/Dislocations  Can result in permanent disability/death  Mxn: axial loading—neck flexion with force to top of head (fracture) or flexion w/ rotation (dislocation)

Cervical Fx

Cerivcal Fx

Cervical FX/Dislocations  S/S: Pain & POT over cervical spine Numbness and/or tingling down arms Muscle weakness Loss of motion Visible deformity possible (esp. w/ dislocation) but may not see it due to equipment worn

Cervical Fx/Dislocation

Cervical Fx

Cervical fx

Cervical Fx/dislocation

Cervical Fx/Dislocations  TX: Rule out life-threatening situations Call 911 Stabilize/immobilize head/neck If in helmet/shoulder pads, leave those in place Monitor athlete/treat for shock

Cervical Fx Surgery

Disc injury  Not as common as in lumbar area  Mxn: overuse/previous injury  S/S: pain with sitting/flexing neck down back between scapulae, weakness in arms, tingling, numbness  TX: Improve neck posture, traction, strengthening, stretching, possible surgery

Cervical disc injury

Brachial Plexus Nerve Injury  Also called Burner Stinger

Brachial Plexus Nerve Injury  Mxn: head forced to one side & shoulder depressed (they are spread apart) stretching brachial plexus  S/S: tingling, burning, numbness down arm that lasts for a few seconds to minutes, muscle weakness in any/all muscles of upper extremity

Brachial Plexus Nerve injury  TX: Ice Neck collar Physician referral if necessary Strengthening ROM exercises Return to activity when symptom free, full strength, full ROM of neck and shoulders

Brachial Plexus Nerve injury