1. Spine & Abdomen

2. The spinal column is very complex compared to other joint in the body
Because it protects the spinal cord, injury to the spinal column can be permanently debilitating or even life threatening.

3. Bones Complex structure 4 segments Sacrum (Tailbone) Lumbar Spine
Thoracic Spine
Cervical Spine

4. Individual bones named vertebrae
Cervical vertebrae: 7
Thoracic vertebrae: 12
Lumbar vertebrae: 5
Sacral vertebrae: 5
Each vertebrae separated by discs and held together by ligaments
Disc comprised of cartilaginous rings (Annulus Fibrous) with a jelly-like center (Nucleus Pulposus)

5. Segments of vertebrae Atlas and Axis (C1,-C2) Atlas Axis
Articulating cartilage
Anter. Arch
Trans Process
Post. Arch
Vertebral Foramen
Axis
Body
Dens
Sup. Artic. Facet
Spinous Process

6. Segments of Vertebrae Cervical Vertebrae Body Vertebral Foramen
Trans Process (A/P) Spinous Process
Artic Facet (Sup/Inf) Lamina

7. Segments of Vertebrae Thoracic Body Art Facet (Sup/Inf)
Trans Costal Facet
Trans Process
Spinous Process
Vertebral Foramen

8. Segments of Vertebrae Lumbar Body Art Facet (Sup/Inf) Lamina
Trans Process
Vertebral Foramen
Spinous Process

9. Segments of Vertebrae Sacrum Coccyx (tail bone)
Sup Art Facet (What articulates)
Sacral Canal
Spinous Tubercles
Doral Sacral Foramina
Coccyx (tail bone)

10. Spinal Column Function of boney column
Protecting spinal cord (nerves)
Holding body up-right for walking
Sites for muscular attachment
Function of intervertebral disks
Absorb shock
Resist compression
Provide separation for nerve roots to exit canal

11. Muscles Function: Upper Trapezius Scalene Sternocleidomastoid
Keep spine stable
Unstable spine = inability to perform athletic duties
Upper Trapezius
Extends cervical spine
Scalene
Cervical flexion
Breathing
Sternocleidomastoid
Cervical side bending
Rotation (opposite of attachment)

12. Abnormal curves of spine

13. Posture Forward head posture Kyphosis Lordosis Scoliosis
Head projects forward with rounded shoulders
Kyphosis
Excessive roundedness of shoulders and upper back
Lordosis
Forward curve of lumbar spine
Scoliosis
Lateral curvature of the spine

14. Common Spinal Injuries
Bone:
Spondylolysis
Stress fracture or bone degeneration
Spondylolisthesis
Superior vertebrae “shunts” forward on vertebrae beneath
Progression of un-healed spondylolysis
Most commonly found in gymnasts and cheerleaders
MOI: excessive hyperextension of vertebral column
Cervical spine Fx
MOI: axial load
C/O: Pain, tingling, weakness in arms.
If ath c/o during acute trauma, leave ath in position found, including helmet ON

17. Common Spinal Injuries
Disk Injuries
Disk bulge: not common in younger athletes (higher incidence in contact sports)
MOI: Axial Load, Excessive trunk flexions during loading
Sometimes referred to as “slipped disk” – not appropriate term
Disk bulge: nucleus pulposus is pushed through cartilage until is protrudes
Can put pressure on nerve causing tingling, numbness, pain and eventually loss of function.
Bulge can never be fully retracted, however tx can reduce bulge.
Tx: strengthen core, use good posture, traction

19. Common Spinal Injuries
Muscle/Tendon Injuries:
Mild to moderate strains of musculature and tendons
C/O P opposite the side they bend, muscle spasm, decreased ROM secondary to P
Tx: Pain is controlled first, then PRE and ROM routine. AT should observe ath in weight room/tx to make sure correct posture and mechanics are utilized

20. Fun Fact 12% of American Indians have 25 vertebrae (instead of 24)
High % of African American WOMEN have 23 instead of 24 vertebrae
Both of these conditions are due to genetic anomaly passed down
Both can be the cause of idiopathic back pain

21. Abdominal Anatomy Boundaries: Posterorly: Spinal column
Superiorly: Diaphragm
Anteriorly: Abdominal Musculature
Inferiorly: Pelvis
Abdomen is divided into 4-quadrants
Right Upper Quadrant (RUQ)
Left Upper Quadrant (LUQ)
Right Lower Quadrant (RLQ)
Left Lower Quadrant (LLQ)

22. Abdominal Anatomy
RUQ: contains liver, portion of pancreas, right kidney, gallbladder (if you have one) Large and small intestines
LUQ: contains Stomach, portion of Liver, portions of Pancreas, left Kidney, the spleen, large and small intestines
RLQ: contains large and small intestines, appendix, portion of bladder, uterus and R ovary (females) prostate (males).
LLQ: large and small intestines, portion of bladder, uterus and L ovary (females) prostate (males)

23. Abdominal Anatomy Contains both solid and hollow organs.
Injuries to HOLLOW organs (such as bladder, intestines etc) RARELY cause rapid death; injuries to SOLID organs (such as liver, kidney, spleen) CAN cuase rapid death due to large blood supply
Hollow organs tend to bend and move out of the way upon impact

24. Hollow Organs and Solid Organs
esophagus,
small intestine, 
colon (large intestine),
stomach.
Solid organs: 
gall bladder, 
spleen,
pancreas, 
Liver
kidney
adrenal glands

25. Abdominal Anatomy Bones: Musculature: Ribs: Manubrium, Sternum,
True,
False,
Floating,
Manubrium,
Sternum,
Xyphoid Process
Musculature:
Rectus Abdominis,
Oblique,
Diaphragm

27. Common Abdominal Injuries
Hernia
Lump of tissue, usually the intestine that bulges through the weakened abdominal wall.
MOI: Holding breath while lifting weights or going to the bathroom
May go away when ath lies down and re-appear when they stand up/exerts abdominal pressure
May be asymptomatic
Tx: sx. Use of a Truss (truss can not be used for athletes in contact sports or weightlifters)
Complications: if left untreated strangulation may occur. Lack of blood supply leads to cell death. bowel obstruction may also occur

29. Common Abdominal Injuries
Pancreas
Found behind stomach, near liver and spinal cord
MOI: upon impact, pancreas tears away from wall
Medical Emergency: ath will have p in middle of abdomen, c/o of nausea, vomiting and experience signs of shock. Abdomen may be distented from internal bleeding
Liver
MOI: Blow to RUQ
C/O P that may radiate to R shoulder
Medical Emergency is ruptured: experience signs of shock, have rapid, weak pulse; drop in BP

30. Pancreas & Liver

31. Common Abdominal Injuries
Kidney
MOI: Direct blow
3 levels: contusion, laceration, rupture
C/O P in the back may radiate towards bladder. P increase w/ trunk extension, decrease with knee/hip flexion. Nausea, vomiting, visible blood in urine, shock.
Spleen
Direct blow
C/O p over spleen or in L shoulder (Kehr’s sign) (L shoulder pain is caused by internal bleeding putting pressure on the diaphragm, which puts pressure on nerve), Abdominal P, rapid pulse, vomiting, decreased BP, shock.

32. Kidney and Ruptured Spleen

33. Extra Credit Short power-point report on referred pain
Organ-shaped food to share with class