1. THE SPINE
Chapter 15

2. THE SPINE
Injuries can result in major disability and life threatening consequence.

3. BONY ANATOMY The bones that make up the spine are called vertebrae
Regions of the spinal column:
(A) Cervical Spine
(B) Thoracic Spine
(C) Lumbar Spine
(D) Sacrum
(E) Coccyx

5. Consists of the first seven vertebrae. The first two are different
(A) CERVICAL SPINE
The upper spine, or neck
Consists of the first seven vertebrae.
The first two are different
Atlas - supports the head
Axis - designed to allow the skull & atlas to rotate.

6. (B) THORACIC SPINE
The upper back
Consists of the next 12 vertebrae.
Articulate with the ribs.

7. (C) LUMBAR SPINE
~ Is generally considered the lower back.
~ Consists of the last 5 movable vertebrae.

8. (D) SACRUM Consists of 5 fused vertabrae
Articulates with Pelvic bones to form SacroIliac SI joint
Goes over into the coccyx

9. (E) Coccyx We refer to as our tailbone
Consists of 4 or more fused vertebrae
Gluteus Maximus attaches here posteriorly

10. Vertebrae Anatomy
Each section is slightly different, however, they share the
following similarities:
Each vertebra has a
Body
Spinous process
Two Transverse processes
Vertebral Canal (foramen) – for spinal cord

12. THE SPINE
24 of the vertebrae are classified as movable or true.
9 of the vertebrae are classified as immovable or false.

13. SPINAL CORD
The portion of the
central nervous system
that is contained within
the vertebral canal of the
spinal column.

15. THE SPINAL CORD
31 pairs of spinal nerves extend from the sides of the spinal cord.
8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccygeal

16. THE SPINAL CORD
Each nerve has TWO roots:
Anterior Root (motor root)
Posterior Root (sensory root)
Each root comes together to form a single nerve.

17. Between the intervertebral articulations lie INTERVERTEBRAL DISKS.
Act as important shock absorbers for the spine.
Like a jelly filled doughnut...N.P. Inside, surrounded by multiple layers of A.F.

18. They are composed of two components:
DISKS
They are composed of two components:
Annulus Fibrosus (layers of cartilage)
Nucleus Pulposus (jellylike core)

19. INTERVERTEBRAL DISKS
Have very poor healing potential due to a lack of blood supply
They are compressable:
allows for movement
Reason why a person is slightly taller in the mornings than in the evening
Reason for old people to become shorter
gravity compresses disks all day
In elderly people discs aren‘t as spongy anymore, which leads to a constant compression and loss of height

20. MOVEMENTS
Flexion
Extension
Lateral Flexion
Rotation

21. MUSCLES
Muscles of the trunk, neck, shoulder, & pelvis attach to the spinal column.
Provide wide range of mobility & much needed stability as we are running, throwing, catching, and kicking

22. Internal & External obliques Scalenes
A. Spinal Flexors
Rectus abdominis
AKA your “six pack”
Internal & External obliques
Love handles
Scalenes
Color all muscles in coloring book...unfortunately I do not have e-pics of them

23. B. Spinal extensors
run entire length of spine posteriorly, attaching to pelvis, ribs, and vertebrae
Work with spinal flexors to keep the body upright
Erector Spinae
Trapezius (3)

26. 1. Upper Trapezius
Extends the neck
Attaches to occipital bone (back of the head) and fans out to attach to the acromion process of the scapula (shoulder blade)

27. Assist in breathing by pulling rib cage up
2. Scalenes
Three total:
Flex the neck
Originate at the cervical vertebrae and attach to first and second ribs
Assist in breathing by pulling rib cage up

28. Lateral flexion and rotation of the cervical spine (neck)
3. Sternocleidomastoid
Lateral flexion and rotation of the cervical spine (neck)
Originates at the top of the sternum (sterno) & attaches at the Mastoid process (just behind the ear lobe) (mastoid)

29. Normal Posture
From the side an imaginary straight line runs from just behind the ear through the middle of the shoulder, the middle of the greater trochanter of the femur, the back of the patella, & the front of the malleolus.

31. Abnormal Postures:

32. Movements of the Neck
A) Flexion
B) Extension
C) Lateral Flexion
D) Rotation

33. MECHANISMS of CERVICAL INJURIES

34. NECK INJURIES

35. Usually a result of hyperflexion or hyperextension
Cervical Sprain
Usually a result of hyperflexion or hyperextension
e.g. A receiver who stops, turns toward the QB, and gets tackled from behind
WHIPLASH

36. Cervical Sprain - Mechanism
Body is forced forward by the blow while the head snaps backward - stretches muscles & ligaments in anterior neck. When the body stops moving because it hits the ground the head then snaps forward, stretching the structures in the posterior neck

37. Pain in neck and possibly the arm
Signs and Symptoms:
Pain in neck and possibly the arm
Athlete will be apprehensive in moving the head

38. Ice, rest, possibly a neck brace
Treatment:
Ice, rest, possibly a neck brace
Do not apply compression, since circulation and respiration might be cut off!
Send to team physician to rule out more serious injury

39. CERVICAL STRAIN
Same Mechanism and Treatment as Cervical Sprain

40. Signs and Symptoms: Muscle spasm and weakness Restricted ROM
Pain and point tenderness along course of muscle

41. Fractures and Dislocations
Can have devastating results such as permanent disability or even death
Often a result of an axial load (FB player lowering his head to make a tackle)
Bring straw and demonstrate an axial load
Hold it between thumb and index finger, compress down until it snaps->that‘s how a neck breaks, too.

42. Cervical Fractures: Are relatively uncommon Usually involve C3 and C4
High Incidence Sports:
~ Gymnastics ~ Rugby
~ Ice Hockey ~ Diving

43. Cervical Dislocation:
Not common but occur much more frequently in sports than fractures.
Result of violent flexion & rotation of the head.
Pool diving accidents.
Affect C4, C5, and C6.

44. Pain in midline cervical spine and radiating outwards
Signs and Symptoms:
Pain in midline cervical spine and radiating outwards
Tingling, numbness, weakness down the arms
S.b. Should stabilize the head, talk to the athlete and calm him down. Do not remove any equipment except a facemask of a FB helmet. Prepare to start Rescue Breathing and CPR (just in case)

45. Stabilize athlete in position found (DO NOT MOVE HIM!!!)
Treatment:
Stabilize athlete in position found (DO NOT MOVE HIM!!!)
Check and maintain ABCs
And CALL 911!!!!!!!!

46. Spinal Cord Shock:
Occurs after a severe twist or snap to the neck.
Same signs and symptoms of a fracture or dislocation but dissolve after a short time.

47. Treatment
Should be the same as a fracture or dislocation (because you never know)

48. Brachial Plexus Injuries
The brachial plexus is a bundle of nerves that exits the spine and runs the course of the shoulder and down the arm (C5 – T1)

49. Lateral flexion of the neck with opposite shoulder being pushed down
Mechanism of Injury
Lateral flexion of the neck with opposite shoulder being pushed down
FB player tackling an opponent

50. Brachial Plexus Injuries
Results in stretching of the brachial plexus which causes burning, tingling, & stinging, sensation in combination with weakness of the arm
Commonly referred to as a „burner“ or a „stinger“

51. Brachial Plexus Injuries
Symptoms can last from seconds (mild stinger) to several weeks (severe stinger)

52. May return to activity when he has Full ROM Full strength No symptoms
Treatment
R I C E
FB – fit with a neck roll
May return to activity when he has
Full ROM
Full strength
No symptoms

53. Lumbar Disk Disease:
Subject to constant abnormal stresses stemming from faulty body mechanics, trauma, or both - over a period of time, can cause degeneration, tears, & cracks in the annulus fibrosus.
Can produce a herniation or bulging.

54. Lumbar Disk Disease Commonly referred to as a „slipped disk“
Inappropriate term, since disks are attached to the body of the vertebra and rarely slip
Actually, the jellylike nucleus pulposus at the center of the disk pushes through the layers of cartilage of the annulus fibrosus.

55. Lumbar Disk Disease
(just like squeezing a jelly doughnut between your hands...the jelly squeezes out)
A disk usually bulges posteriorly and can cause pain, numbness, and tingling when pressing on a nerve

56. Injury Prevention
Muscle Strengthening – both abdominals and back musculature
Core stabilizations
Posture
Range of Motion – flexibility
Using Correct Techniques
slow and control weight lifting
Proper form, correct footwear

57. Special Tests

58. Postural Evaluation

60. Milgram Straight Leg Raise
Lumbar Spine
Patient – laying supine on table, holds both feet above table for 30 seconds (legs straight)
AT – observes
Pain and/or pressure in lower lumbar spine

61. SI Compression and Distraction
SI irritation or sprain
Patient - laying supine AT
Compression – apply pressure separating pelvis
Distraction – apply pressure pushing ASIS of pelvis medially
Positive - pain

62. Other Tests Hoover – malingering Manual Muscle Testing
Superman – upper back strength and lower back pain
Piriformis – piriformis muscle strength
Rhomboid – strength of rhomboid muscles