Chapter 10 Injuries to the Spine

Back and Spine

Bones of the Spine

Cervical Spine The cervical spine is made up of 7 separate vertebrae that support the base of the skull and make up the neck

Thoracic Spine/Ribs The thoracic spine is made up of 12 vertebrae. Each vertebrae corresponds with a pair of ribs and the sternum to form the thoracic cage (rib cage). 10 pair of true ribs 2 pair of floating ribs

Lumbar Spine The lumbar spine is made up of 5 separate vertebra that support the majority of motion, weight, and stress created by everyday activities and sport.

Sacrum and Coccyx The Sacrum consists of five fused vertebrae. The Sacrum connects the spinal column to the pelvis. Right and left sacroiliac (SI) joints are formed by the union of the sacrum and pelvis. The Coccyx (tailbone) is most distal portion of the vertebral column.

The Vertebrae Pars Interarticularis

Intervertebral Disc The intervetebral disc is located between majority of the vertebrae. The discs are made up of a thick cartilage that act as a shock absorber for the spine.

Intervertebral Disc The intervertebral disc has 2 sections. Nucleus Inner section of intervertebral disc that is jelly like and consist of approximatley 80% water and 20% cartilage Annulus Outer section of intervertebral disc that is made up of primarily cartilage

Ligaments of the Back There are 2 primary ligaments of the spine Anterior Longitudinal Ligament Posterior Longitudinal Ligament

Motions of the Back

Superficial Muscles of the Back The 2 largest muscles that act on the back are the: Trapezius Fans along neck, shoulders and mid- back Latissimus Dorsi Fans along mid and lower back while connecting on the ribs They help perform all back motions except back flexion

Deep Muscles of the Back There are 2 primary muscle groups that make up the deep muscles of the back: Paraspinals Very small group of muscles that run along the spinous and transverse processes of the spine Erector Spinae Small group of muscles that run along the spine and ribs These muscles perform back extension

Muscles of the Abdomen The abdomen is made up of 3 primary muscles: Rectus Abdominus 6-pack muscle Helps perform back flexion Transverse Abdominus Muscle that wraps around the torso like a belt to provide support Helps in stability of core Helps to perform back rotation and lateral flexion Obliques Diagonal running muscles that originate from the spine and ribs Helps to perform back rotation and lateral flexion

Core Muscles The core is a group of muscles that create a foundation of support from all sides of the body in order to generate power and protect from injury Includes: Paraspinals Erector spinae Obliques Rectus abdominus Glutes

Spinal Fractures Skeletal Injuries of the vertebrae Compression fractures of the vertebral body are most common injury. Such fractures usually occur at junction of thoracic and lumbar spine. Athlete with recent history of trauma to the region in conjunction with pain or numbness should be referred to a physician.

Spinal Fractures Cont. External blows may result in internal injury. Deep abdominal pain, hematuria, and shock are signs and symptoms of internal injury. Immobilize on spine board and transport to medical facility. Blows to the coccyx can result from landing on the buttocks. Fractures of the coccyx result in severe pain, point tenderness, swelling, and bruising. Refer athlete to physician for evaluation.

Rib Fractures Such fractures are associated with direct blows to lateral or posterior thorax and can occur anywhere along the rib. The ribs commonly fracture near the anatomic angle, which is the weakest point. Posterior rib fractures can potentially result in a pneumothorax or hemothorax.

Rib Fractures (cont.) Signs and symptoms include: Painful respiration. Deformity in the region of the injury, including a protruding rib or depression where the normal contour of the rib should be. Swelling and discoloration. Pain when rib cage is gently compressed.

Rib Fractures (cont.) First Aid Immediate application of RICE. Treat for shock. Refer athlete to physician.

Spondylolysis and Spondylolisthesis Spondylolysis is a defect in the neural arch (pars interarticularis). Such defects compromise the articulation between two vertebrae. If the condition is bilateraI, the affected vertebra can slip forward resulting in spondylolisthesis.

Spondylolysis and Spondylolisthesis (cont.) Symptoms include lower back pain that worsens during hyperextension, and radiating pain to the buttocks and upper thighs. Treatment includes rest, drug therapy, lumbar bracing, exclusion from certain sports, and surgery.

Sprains Sprains occur whenever a joint is forced beyond its normal ROM resulting in damage to ligaments and joint capsules. Evaluation of a sprain to the thoracic spine is difficult. A consistent symptom is painful respiration. First Aid Apply RICE. If dyspnea persists for more than 24 hours, refer the athlete to a physician.

Strains Involve contractile tissue and their support structures, such as the erector spinae and intercostals. Are related to maximal exertions. Result in muscle spasm and point tenderness. First Aid Application of RICE to the injured area.

Strains & Sprains Sprains occur whenever a joint is forced beyond its normal ROM resulting in damage to ligaments and joint capsules. Evaluation of a sprain is difficult. A consistent symptom is painful respiration. Strains involve contractile tissue and their support structures, such as the erector spinae and paraspinals. Are related to maximal exertions. Result in muscle spasm and point tenderness.

Strains & Sprains (cont.) Signs and symptoms include: Localized muscle spasm. Pain that does not radiate into buttocks or lower extremity. Acute postural abnormalities associated with recent trauma. First Aid Have athlete maintain a supine position with soft support for lumbar region and application of ice. If not improved or if dyspnea persists for more than 24 hours, refer the athlete to a physician.

Disk Injuries A serious form of soft tissue injury is a herniated disk, aka; slipped, protruding, bulging disk. Most commonly occurs at L4 or L5. Four stages: Degeneration, prolapse, extrusion, sequestration.

Disk Injuries (cont.) Herniation results from a weakened annulus that allows nucleus pulposus to protrude through the wall of the annulus. Protrusion may put pressure directly on spinal nerves resulting in: Intense local or radiating pain. Sensory loss or burning/tingling sensation in lower extremity. Muscle spasm and postural abnormalities.

Disk Injuries (cont.) First Aid Place athlete in supine or most comfortable position. Support lumbar region with rolled towel or other soft material. Apply crushed ice to lumbar region. Arrange for transport to medical facility.