1. SPINAL INJURIES
Chapter 11

2. Anatomy of the Spine Coccyx = tailbone, 3-5 fused vertebrae
Sacrum = tailbone area, 5 fused vertebrae
Lumbar = lower spine, 5 vertebrae
Thoracic = middle spine, 12 vertebrae
Cervical = upper spine, 7 vertebrae
Neutral spine = normal alignment and curvature of the spinal column from top to bottom.

3. Parts of the Vertebrae Body Spinous process Transverse process
Vertebral foramen

5. Function of the Spine Protect the spinal cord
Hold the body in an upright position for walking
Site for muscular attachments

6. Intervertebral Disks Lie between the vertebrae Absorb shock
Resist compression during activity
Keep vertebrae separated, which allows movement and flexibility
Provides space for nerves to exit the spinal cord to the rest of the body
Nucleus pulposus = jellylike core
Annulus fibrosus = outer layers of cartilage
Disks have no blood supply so healing is slow
Compression throughout the day makes you shorter

8. Muscles Abdominal muscles (trunk flexion)
Rectus abdominis
Internal and external obliques
Erector Spinae m. (trunk extension)
Trapezius m. (cervical extension)
Scalenius m. (cervical flexion)
Sternocleidomastoid m. (cervical lateral bending and rotation)

10. Normal Posture
Normal posture would align at the following anatomical locations:
Just behind the ear
Through the center of the shoulder
Middle of the greater trochanter of the hip
Behind the patella
Just in front of the lateral malleolus

11. Abnormal Posture Torticollis = forward head posture
Kyphosis = excessive roundedness of the thoracic spine (shoulder area)
Lordosis = excessive anterior curvature of the lumbar spine
Scoliosis = abnormal curvature from side to side

12. Good Postural Habits and Spinal Injury Prevention
Stand and walk tall with good posture
Alternate which shoulder you carry your book bag on
Exercise regularly
Maintain flexibility
Learn to lift properly
Use back supports (belts) when lifting

13. Ligament Injuries
Sprains occur when the trunk is hyper flexed, or flexed and rotated at the same time
S & S = pain to one side of the spine and limited movement
PRICE for first 48 hours, then switch to heat
Stretch and strengthen

14. Muscle and Tendon Injuries
Pain usually presents to the opposite side of movement
Sprain pain is localized, while strain pain moves up and down the length of the muscle

15. Bone Injuries Fractures occur from trauma, often compression
Spondylolysis = stress fracture or bone degeneration of the vertebrae
Spondylolisthesis = forward slippage of the vertebra on the one below it due to spondylolysis

17. Other Common Spine Injuries
Disk Bulge – when the nucleus pulposus pushes through the annulus fibrosis.
Not common in younger athletes, but can occur in older athletes.
Usually bulge posterior or to the side, which puts pressure on the nerve.
It doesn’t usually occur anterior because of the anterior longitudinal lig.

19. Disk Bulge Cont. S & S = numbness, tingling, and pain down the leg
Low back pain that increases with sitting
Work on mechanics with rehabilitation as well as posture

20. Cervical Spine Injuries and Conditions
Ligament injuries – usually due to hyperflexion or hyperextension of the neck
Hyperextension injuries = whiplash
S & S = neck and arm pain, a neck brace may be needed for support
To return to play, an athlete must have:
Full strength
Full range of motion
Full confidence
No symptoms
Physician clearance

21. Muscle and Tendon Injuries
Can also occur from whiplash
S & S = muscle spasm, restricted ROM, weakness against resistance, pain, and tenderness of the muscle
Same return to play criteria as for a ligament injury

22. Bone Injuries
Fractures and dislocations to the cervical spine are usually due to an axial load and may cause paralysis
S & S = pain and weakness around the cervical spine, numbness, and tingling down the arms
With a dislocation there is obvious deformity
Call 911 for proper transport

23. Brachial Plexus Injuries
The brachial plexus is a network of nerves that exit the cervical spine and run through the shoulder and down the arm
Mechanism of injury = hyper lateral flexion of the neck and depression of the shoulder
S & S = burning, tingling, numbness and stinging sensation of the arm and shoulder
Called a “burner” or a “stinger”
Treat with strengthening & ROM stretches