1. Injuries to the Spine

2. Background Info: Nervous system is divided into two categories:
Central Nervous System (brain and spinal cord)
Peripheral Nervous System (all peripheral nerves stemming from spinal cord)
Peripheral Nervous System has 3 functions
Connect the body to the Central Nervous System
Control the automatic or involuntary activities of the body
Act as the reflex center of the body

3. Peripheral Nerves There are three types of peripheral nerves:
Sensory (afferent) – carry impulses from the sense organs to the brain or spinal cord
Motor (efferent) – carry impulses from the brain or spinal cord to muscles or glands
Mixed nerve – contains both sensory and motor nerve fibers
Sympathetic v Parasympathetic
*Sympathetic nerves extend to vital internal organs, controls “fight-or-flight” mechanism (i.e. increased heart rate when fear kicks in)
*Parasympathetic – includes vagus and pelvic nerves; counteract effects of sympathetic system

4. Locations of Peripheral Nerves
Nerves making up the peripheral system stem from two different locations
Cranial Nerves
12 pairs; transmit messages to and from the various parts of the head and face; receive sensory information
Spinal Nerves
31 pairs; originate in the spinal cord and carry messages to the rest of the body. (all are mixed nerves)

5. Cranial Nerves - Assessment
Number
Name
Function
Test I II
III IV V VI

6. Cranial Nerves - Assessment
Number
Name
Function
Test
VII
VIII IX X XI
XII

7. Nervous System (Central v Peripheral)

8. Spinal Anatomy Skeletal Anatomy
Vertebral column is divided into 5 sections
Cervical Vertebrae (7) – allows head movement (atlas and axis allow rotation)
Thoracic Vertebrae (12) – chest area; articulate with the ribs
Lumbar Vertebrae (5) – lower back; larger and bear most of the body’s weight
Sacrum – formed by 5 fused bones; articulation point for the hips
Coccyx – tailbone; formed by 4 fused bones

9. Spinal Anatomy Spinal Nerves
Spinal cord begins at the base of the skull and runs through the foramen of all of the vertebrae lined up
Nerves enter and exit the spinal cord through the openings between the vertebrae, and extend out to area of innervation

10. Injuries to the Spine

11. Cervical Spine Injury
Basic info – range from minor neck pain to complete paralysis or death; most common mechanisms are forced movement of the head on the cervical spine (i.e. hyperextension) OR axial loading (cervical compression)
S/S – pain, neurological symptoms (numbness, paralysis, weakness, tingling in extremities)
Treatment – DO NOT MOVE THE ATHLETE! Manage airway if necessary, and perform C-spine immobilization; Activate EMS
Rehab/RTP – athlete will need to undergo extensive rehab/physical therapy, depending on the severity of the injury. Physician will make ultimate decision on RTP, which may or may not include limitations in certain sports

12. Cervical Nerve Syndrome
Basic info – also called “stinger” or “burner” Occurs from forced lateral flexion
S/S – sharp, radiating pain, traveling from posterior scalp, around the neck and down the top of the shoulder. Potential numbness, weakness and loss of function may occur into the affected side arm/hand
Treatment – Remove from play (symptoms usually resolve themselves within minutes) – do not stretch!
Rehab/RTP – Can RTP once parasthesia has subsided and all muscular strength is restored, and athlete has full and pain free cervical ROM. Multiple incidents may require referral and PT.

13. Cervical Fracture / Subluxation
Basic info – Most common mechanism occurs with force to the head while the neck is in flexion; greatest risk occurs in football, gymnastics, and diving; this injury may cause trauma to the spinal cord, which is the most devastating
S/S – swelling within the spinal cord causing temporary or permanent damage; symptoms are neck pain, muscle spasm, and evidence of spinal cord involvement (quadriplegia, neuropraxia
Treatment – same as Cervical Spine Injury
Rehab/RTP – same as Cervical Spine Injury

14. Thoracic / Lumbar Spine Injury
Basic info – Most commonly a sprain, strain, or contusion, usually involving the paraspinal muscles
S/S – tenderness, pain (pain increases with active contraction or stretching), stiffness
Treatment – Physical therapy, and/or referral to physician
Rehab/RTP – Upon resolution of symptoms and full muscular strength.

15. Spondylolysis
Basic info – structural defect of lumbar spine / vertebrae; often considered a stress fracture of the “pars interarticularis”
S/S – pain associated with increased activity (pain subsides with rest or inactivity); pain may radiate into buttocks or upper thighs
Treatment – Referral to physician; Rest, followed by slow, progressive physical therapy
Rehab/RTP – Upon resolution of symptoms and full muscular strength. Requires clearance by physician.

16. Intervertebral Disc Herniation
Basic info – Nucleus pulposus herniates through the annulus fibrosis, potentially pressing against the spinal cord or nerves
S/S – extreme pain and stiffness surrounding injury site, radiating leg pain if severe enough. Pain is often unilateral.
Treatment – Referral to physician; Physical therapy that focuses on strengthening surrounding muscles and postural corrections
Rehab/RTP – Upon resolution of symptoms and full muscular strength. Requires clearance by physician or physical therapist.

17. Intervertebral Disc Herniation

18. Sacroiliac Joint Injury
Basic info – usually sprains occurring from acute or chronic trauma; also associated with poor posture and/or poor lifting mechanics; sometimes related to leg length discrepancy
S/S – stiffness or constant soreness around SI joint; pain often less in the morning and gets worse as day progresses; activity may decrease symptoms, but will return once activity has stopped
Treatment – Referral to physician; Physical therapy that focuses on strengthening surrounding muscles and postural corrections
Rehab/RTP – Upon resolution of symptoms and full muscular strength.

19. Sacroiliac Joint Injury