1. Neck and Spine

2. Skeletal Anatomy

3. Terminology
Vertebrae: The bones making up the spinal column Cervical: The seven vertebrae that make up the upper most region of the spine Thoracic: Pertaining to the chest region of the body Lumbar: The five vertebrae that make up the low back Sacrum: The bottom most segment of the spine which consist of bones that are fused Coccyx: Three to four very small vertebrae also called the “Tail Bone” Body of vertebrae: Anterior portion of vertebrae Spinous Process: Posterior portion of vertebrae Transverse Process: Lateral portion of vertebrae

4. Terminology continued
Vertebral Foramen: Hole or space where spinal cord runs
Intervertebral Disc: Cartilage cushioning between vertebrae
Vertebral Column: The skeletal spine
Nerve Root: Opening on the lateral side of vertebrae where peripheral nerves leave the spinal column
Spinal Cord: Portion of the central nervous system that is contained within the vertebral foramen.

5. Lateral view of Vertebral Column

6. Lateral view of a Vertebrae

7. Superior View of Thoracic Vertebrae

8. Muscular Anatomy

9. Neck & Spine Movements Neck extension Neck flexion Neck rotation
Neck lateral flexion
Trunk extension
Trunk flexion
Trunk rotation

10. Terminology Unilaterally: to one side
Superficial: close to the body’s surface
Deep: away from the body’s surface
Trunk: mid-portion of body excluding arms, legs, and head

11. Neck Flexors
Sternocleidomastoid
Scalene

12. Neck Flexors
Scaleni
Sternocleidomastoid

13. Neck Extensors
Upper trapezius
Deep spine and neck muscles

14. Neck Lateral Flexion
All muscles on one side of the vertebral column contracting unilaterally.

15. Neck Rotation
Occurs when the sternocleidomastoid, Scalenes, and other neck flexors contract on the opposite side of the direction of rotation

17. Trunk Flexion
Lengthening of the deep and superficial back muscles and contraction of the abdominal muscles and hip flexor muscles.

18. Trunk Extension
Lengthening of the abdominal muscles and the contraction of the erector spinae and the strongest hip extensor, the gluteus maximus.

19. Trunk Rotation
Produced by the external oblique and internal oblique

20. Trunk Lateral Flexion
Produced by the quadratus lumborum muscle and the obliques, and rectus abdominus on the side of the direction of movement.

21. Trunk Flexion Trunk Rotation Lateral Flexion

22. Sprains and strains of the neck & spine

23. Terminology
Cervical collar: soft brace that fits around an athletes’ neck
Intermittently: alternating stopping and beginning again
Radiating: to spread out in a direction from the center

24. Cervical Sprain
Despite having an excellent Range of Motion, it is subject to ligament sprains when it is forcefully moved beyond its normal range.
MOI:
turning head to catch a ball and then athlete gets tackled by a defender. When hit forcefully from behind, the receiver often suffers a whiplash injury. The body is forced forward by the blow while the head moves backward which places the cervical spine into extension and stretches the ligaments and muscles at the front of the neck.

25. Cervical Sprain: S/S
Usually intense pain if sprain is located in the neck
Palpation of the injured area is usually painful if the joint is sprained

26. Neck Strain: Rx
Rest
Ice (twenty minutes intermittently 6-8 times a day)
Cervical collar if warranted
Perform spinal tests to rule out possible paralysis
Refer to doctor if needed

27. Neck Flexors
Scaleni
Sternocleidomastoid

28. Cervical Nerve Stretch Syndrome “Burner”: MOI
Head is forced into a lateral position while athlete’s arm is pulled in the opposite direction

29. Cervical Nerve Stretch Syndrome “Burner”: S/S
Typically athlete walks off the field with his neck pulled toward the side and the athlete is supporting his arm
This mechanism of injury can result in burning,
tingling, numbness, and stinging sensations
Athlete may recover in seconds or minutes

30. Cervical Nerve Stretch Syndrome “Burner”: Rx
Watch athlete carefully
Athlete monitors the intensity of the burning
Between 2-5 minutes the intensity should lower dramatically or disappear
Manual muscle test for strength and parethesia
Athlete stretches neck muscles, shoulder muscles and prepares to re-enter game/practice.
Instruct athlete to see athletic trainer after competition is over to re-check his/her neck

31. Low Back Muscle Strains: MOI
Sudden rotation and contraction on an overloaded, unprepared or underdeveloped spine.

32. Low Back Muscle Strains: S/S
Discomfort in low back may be diffused or localized in one area
Pain will be present on active extension and with passive flexion
No radiating pain

33. Low Back Muscle Strain: Rx
Ice 20 minutes 4-6 times a day
Gradual stretching and progressive strengthening once pain has subsided

34. Lumbar Sprain: MOI
Typically occurs when the athlete bends forward and twists while lifting or moving some object. A traumatic force over extends the spinal joints and causes a sudden onset of deep sharp pain.

35. Lumbar Sprain: S/S Pain is localized
Located just lateral of the spinous process
Pain becomes sharper with certain movements
Any anteroposterior or rotational movement increases pain

36. Lumbar Sprain: Rx R.I.C.E Athlete may have to wear a supported brace
Stretching in all directions, (ROM) should be limited to a pain free range
Once appropriate, strengthening exercises for abdominals and back extensors should be initiated
Doctor referral may be indicated

37. Fractures & dislocations of neck & Spine
Fractures & dislocations of neck & Spine

38. Terminology
Spearing: Athlete uses top of the helmet to hit another athlete
Axial Loading: a force delivered to the top of a straight column of vertebrae

40. Cervical Spine Fracture/Dislocation: MOI
Often the result of combination of excessive neck flexion and rotation
Axial loading of the cervical vertebrae from a force to the top of the head combined with flexion of the neck can result in a fracture or dislocation

42. Hyperrotation laterally
Hyperflexion
with axial load
Hyperrotation laterally

43. Cervical Spine: S/S Athlete reports pain around cervical spine
Weakness
Numbness
Tingling down the arms
With a dislocation, there is often a visible deformity
Pain in the chest
Numbness in the trunk or limbs
Sometimes loss of bladder and/or bowel control

44. Cervical Spine: Rx
If signs and symptoms present possibility of a fracture or dislocation call 911 for assistance
For both a fracture and dislocation often care for both injuries as identical
After ruling out life-threatening conditions the neck should be immobilize and athlete should be put on a spine board

46. http://www. nj. com/rutgersfootball/index

47. http://www. nj. com/rutgersfootball/index

48. FRACTUREE

49. Chronic injuries of the neck & spine

50. TERMINOLOGY
Ostephytes: outgrowth on a bone Disk bulge: disk moves out between the two vertebrae causing pinching of the disk Impinge: to come into contact with a nerve or disk causing a pinching action Transitory: not lasting, temporary Posterolateral: in the combined direction of posterior and later movements Extrudes: to thrust out Idiopathic: unknown cause

51. Spinal Stenosis
Characterized by a narrowing of the spinal canal in the cervical region that can impinge the spinal cord

52. Spinal Stenosis MOI: S/S:
Either a congenital defect or development of bone spurs osteophytes or disc bulges
S/S:
Transient quadriplegia may occur from axial loading, hyperextension, or hyperflexion
Neck pain my be absent initially
Symptoms may be burning and tingling or associated motor weakness in the arms and legs
Complete recovery normally occurs within minutes

53. Spinal Stenosis: Rx
If athlete demonstrates transient quadriplegia the athletic trainer should use extreme caution initially
Athlete must have diagnostic test including x-rays or MRI
If identified as having cervical spinal stenosis, athlete should be advised of the potential risks of continued participation
Physicians release is required to return to participation

54. Cervical Disk Injury MOI: S/S:
Sustained, repetitive cervical loading during contact sports. The disk extrudes posterolaterally
S/S:
Neck pain with some restriction in neck motion
Pain in upper extremity with associated functional weakness or sensory changes
Possible activation of EMS

55. Cervical Disk Injury: Rx
Rest and immobilization of the neck to decrease discomfort
Physician referral recommended
Cervical traction may also help reduce symptoms

56. http://www. greatriverspineclinic

57. Low Back Pain MOI: Either caused by a congenital or idiopathic defect.
S/S: Localized or diffused pain in the low back
Low back muscles may be weak
Range of motion for back may be painful
Athlete may become discouraged with symptoms because they may last a long time

58. Low Back Pain: Rx
Dependent on athlete’s pain tolerance, he/she may continue with regular practice or be in complete rest
Alternating ice pack and heat pack (20 minutes)
Low back muscular stretching with athletic trainer
Athletic trainer teaches and demonstrates exercises the athlete should do at home

59. Herniated Disk: MOI
Develops from extruded posterolateral disk fragment or from degeneration of the disk
Primary mechanism involves sustained, repetitive cervical loading during contact sports

60. Herniated Disk: S/S Neck or back pain
Pain may be restricted or diffused
Restriction in neck movement
At some point in the range of motion of the back and neck the herniated disk may become impinged causing extreme pain

61. Herniated Disk: Rx
Initial treatment involves rest and immobilization of the neck to decrease discomfort
If discomfort is in the lumbar area, rest and an immobilization brace may be helpful
Cervical traction may help reduce symptoms
If this conservative treatment does not help surgical intervention may be necessary

63. Injury Evaluation for the neck & spine

64. HOPS/SOAP REVIEW
History: questions to determine nature location of injury
Observation: Visual examination of injury
Palpation: A hands-on exam
Stress tests: Tests to check range of motion and degree or injury
Subjective: detailed information about patient history, complains
Objective: information that is record of test measurements; data gained from inspection
Assessment: Identify problem
Plan of Action: Treatment

65. TERMINOLOGY Assessment: Identification of problem
Plan of Action: Treatment; rehabilitation

66. Objective is Hands-On! Completing the S & O
Subjective = Oral Objective = Visual
Objective is Hands-On!

67. Objective- Hands-On! Taking a Closer Look……. Perform Palpation
Check anatomical structures to determine points of pain
Check for abnormalities
Perform special test or stress test to assess severity
Objective-
Hands-On!
Click animation to bring in points

68. Plan of Action: Treatment
Subjective
Objective
Assessment: Identification of problem; determine injury; severity of injury
Plan of Action: Treatment
Yesterday we learned about Subjective and Objective.
Click to fly in A and P part of slide

69. Injury rehabilitation of the spine & neck

70. Terminology
Range of Motion: the available pain-free movement at a joint
Flexibility: the ability to move a joint through a full range of motion without restriction
Strength: using higher resistance and lower repetitions
Endurance: using low resistance and higher repetitions.
Return to Play: sport specific exercises for the athlete to safely return to play.
Therapeutic: Healing action
Continuously during the rehabilitation process gradual cardiovascular exercises would be utilized.

71. PHASE I
PAIN MANAGEMENT
What are you going to use on an injured neck or spine to manage pain and why?

72. PHASE II How are you going to limit ROM on the neck and spine and why?

73. PHASE III
PROPRIOCEPTION
What are you going to do for proprioception on an injured neck or spine?

74. PHASE IV
STRENGTH
What could you do to build strength in a person who has a neck or spine injury?

75. PHASE V
ENDURANCE
What could you do to build endurance in a person who has injured their neck and spine?

76. PHASE VI
SPORTS SPECIFIC
What could you do to help a person who has a head or neck injury continue in their sport?