1. Anatomy and Injuries to the Spine Spain Park Sports Medicine

2. Function of anatomy  Protects spinal cord  Holds body upright  Site for muscle & ligament attachment (support spine)  Discs provide shock absorption  Nerves provide sensation and motor function

3. Bony anatomy  Vertebrae 7 cervical (flexion, extension, lateral flexion, rotation)  1 st -atlas  2 nd -axis 12 thoracic (little movement) 5 lumbar (less flexion than extension, some rotation 5 sacral (fused) 3-4 coccyx (fused)

4. Anatomy of spine  Parts of vertebrae Spinous process Transverse process Body

5. Cervical vertebrae

6. First 2 cervical vertebrae

7. Thoracic vertebra

8. Lumbar Vertebrae

9. Sacrum and coccyx

10. Vertebrae and ribs

11. Posture  Neutral spine Normal alignment  Thoracic curve Excessive--kyphosis  Lumbar curve Excessive--lordosis

12. Discs  Fibrocartilaginous  Shock absorbers  Resist compression  Keep vertebrae separated  Allows movement & flexibility  Provides space for nerves to exit  No blood supply

13. Discs Nucleus pulposus  Jelly-like core Annulous fibrosus  Cartilaginous outer rings

14. Muscles  Provide movement & stability  Superficial—erector spinae Attach to vertebrae, ribs, pelvis 3 groups  Spinalis, iliocostalis, longissimus In 3 areas  Cervicis, thoracicis, lumborum

15. Muscles  Abdominal muscles play big role in stabilizing back  Trunk flexion, lateral flexion, rotation Rectus abdominus External oblique Internal oblique Transverse abdominus

17. Muscles  Trapezius Upper portion aids in cervical extension  Sternomastoid Lateral flexion, rotation  Scaleneus Flexion of cervical area  Multifidis Rotation of spine

18. Muscles

21. Nerves  Each vertebrae has a nerve that exits either below or above it  31 pairs of spinal nerves 8 cervical nerves 12 thoracic nerves 5 lumbar 5 sacral 1 coccygeal

22. Spinal Cord  Part of the CNS along with brain  Contained within vertebral canal  Extends from cranium to 1 st -2 nd lumbar vertebrae  Lumbar roots & sacral nerves for a “horse-like tail” called cauda equina  2 plexuses Brachial, lumbosacral

23. Brachial Plexus

25. Lumbosacral plexus

29. CNS

30. Dermatomes  Area of body that has nerve sensation for each nerve root

31. Dermatomes  Cervical C4-shoulder C5-lateral arm C6-lateral forearm C7-middle finger C8-medial half of ring finger & forearm T1-medial arm

32. Dermatomes  Thoracic At the level of the respective thoracic vertebrae

33. Dermatomes  Lumbar/Sacral L1-upper anterior thigh L2-middle anterior thigh L3-lower anterior thigh L4-medial side of leg L5-lateral side of leg, dorsum of foot S1,2-lateral malleolus, plantar surface of foot S2,3,4-nerve supply for bladder, intrinsic muscles of toes

36. Myotomes  Area of the body that has motor function

37. Myotomes  C5-deltoid—shoulder abduction  C5-6-biceps—elbow Flexion  C6-wrist extensors—extension  C7-triceps & wrist/finger flexors— elbow extension, wrist/finger flexion  C8-finger flexors—finger flexion  T1-finger Abductors--abduction

38. Myotomes  L1,2,3-iliopsoas—hip flexion  L2,3,4-Quads—knee extension  L4-tibialis anterior— dorsiflexion/inversion at ankle  L5-Extensor hallicus longus, extensor digitorum longus/brevis, extension/inversion at ankle  S1-peroneus longus/brevis-eversion  S1,2-gastroc/soleus—plantar flexion

39. Posture  Normal Slight curve at thoracic and lumbar areas, ears in line w/ shoulders

40. Posture  Problems Forward head position-ears in front of line with shoulder Kyphosis-excessive curve of thoracic spine Lordosis-excessive curve of lumbar spine Scoliosis-lateral curve of spine

41. Posture  Preventing poor posture Don’t be lazy Walk and stand as if something is pulling you up straight Carry bags/backpacks on both shoulders/alternate Carry bags at small of back (lumbar area)

42. Posture

46. Prevention of Injuries  Most injuries to cervical/lumbar area  Maintain adequate strength and flexibility of hip flexors and back  Maintain strong abdominals/core strength  Work on proper posture

47. Prevention  Learn to lift properly Maintain slight curve in lumbar spine Lift with knees and hips (legs)  Keep head up  Keep your butt behind you!!!

48. Lumbar spine injuries  Sprain  Strains  Fractures  Dislocation  Disc injury

49. Lumbar Sprain  Mxn: forced into excessive trunk flexion and rotation at some time  Posterior aspect of vertebral joints separate and stretch ligaments

50. Lumbar Sprains  S/S: localized pain to one side of spine  Limited ROM  Pain  Spasms  Push each vertebra anteriorly to attempt to reproduce pain

51. Lumbar Sprains  TX: RICE After 48 hours—heat Active rest Maintain comfortable neutral spine Stretching Strengthening and stability exercises

52. Lumbar Strain  Mild/moderate strains very common  Mxn: same as for sprains  S/S: pain on one side spasms decreased ROM pain moves up and down length of muscles

53. Lumbar Strains  TX: RICE Gentle stretch Heat Strengthening Flexibility

54. Fractures  Mxn: Severe compression type force Direct blow Extreme flexion

55. Fractures  S/S: Severe pain POT over vertebra, especially spinous process Muscle spasm LOM Possible tingling, numbness, etc.

56. Fractures  TX: Be conservative Call 911 Neurological exam Don’t move athlete Spineboard prior to transport

57. Fractures

60. Disc Injury  Common in older people but not so much in younger athletes.  Referred to as “slipped” disc  Nucleus pulposus pushes through rings of annulous fibrosus causing a “bulge” which can lead to herniation  Most are posterior to one side  Pressure exerted on nerve root

61. Disc Injury  Mxn: Improper lifting Poor posture Poor body mechanics (excessive flexion over prolonged time frame) Trauma due to direct fall

62. Disc  S/S: Pain radiating down leg Numbness Tingling down leg Increased pain with sitting/flexion motion “list” Decreased/absence of reflex

63. Disc  TX: Active rest Work on posture Extension exercises Proper mechanics Core stability—especially lumbar area Traction Surgery if PT doesn’t work

64. Herniated disc

66. Disc injury

67. Lumbar traction

68. Cervical Injuries  Similar to those in lumbar area  May have to treat differently due to the increased mobility in that area

69. Cervical Sprains  Mxn: move beyond normal ROM Hyperextension or hyperflexion of neck Whiplash type mxn  Body forced forward by the blow while the head moves backwards, placing the cervical spine into extension stretching the ligaments & muscles at front of neck. When body stops head snaps forward stretching the posterior ligaments & muscles of neck

70. Cervical Sprain

71. Sprains  S/S: Neck and arm pain Pain between scapula Possible numbness or tingling Decreased ROM due to Pain POT over the cervical area, usually localized

72. Cervical Sprain

73. Sprains  TX: Check for nerve injury Ice Soft neck collar Medical referral if severe Traction Stretching strengthening

74. Cervical Strains  Mxn: Whiplash type –same as for sprains  S/S: Muscle spasms, Decreased ROM, Muscle weakness, pain along the muscle, POT over muscles  TX: same as for sprains  Return to Activity: No symptoms, full ROM & strength, Dr. release

75. Cervical Strain

76. Cervical sprains/strains

77. Cervical Traction

78. Cervical Fractures/Dislocations  Can result in permanent disability/death  Mxn: axial loading—neck flexion with force to top of head (fracture) or flexion w/ rotation (dislocation)

79. Cervical Fx

80. Cerivcal Fx

81. Cervical FX/Dislocations  S/S: Pain & POT over cervical spine Numbness and/or tingling down arms Muscle weakness Loss of motion Visible deformity possible (esp. w/ dislocation) but may not see it due to equipment worn

82. Cervical Fx/Dislocation

83. Cervical Fx

84. Cervical fx

85. Cervical Fx/dislocation

86. Cervical Fx/Dislocations  TX: Rule out life-threatening situations Call 911 Stabilize/immobilize head/neck If in helmet/shoulder pads, leave those in place Monitor athlete/treat for shock

87. Cervical Fx Surgery

88. Disc injury  Not as common as in lumbar area  Mxn: overuse/previous injury  S/S: pain with sitting/flexing neck down back between scapulae, weakness in arms, tingling, numbness  TX: Improve neck posture, traction, strengthening, stretching, possible surgery

89. Cervical disc injury

90. Brachial Plexus Nerve Injury  Also called Burner Stinger

91. Brachial Plexus Nerve Injury  Mxn: head forced to one side & shoulder depressed (they are spread apart) stretching brachial plexus  S/S: tingling, burning, numbness down arm that lasts for a few seconds to minutes, muscle weakness in any/all muscles of upper extremity

92. Brachial Plexus Nerve injury  TX: Ice Neck collar Physician referral if necessary Strengthening ROM exercises Return to activity when symptom free, full strength, full ROM of neck and shoulders

93. Brachial Plexus Nerve injury