1. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 10 Spinal Conditions

2. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Anatomy of the Spine Vertebral Column –Cervical (7) convex anteriorly –Thoracic (12) concave anteriorly –Lumbar (5) convex anteriorly –Sacral (5 fused) concave anteriorly –Coccyx (4 fused) Vertebral spine

3. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Anatomy of the Spine (cont’d) Vertebral structure –Body –Vertebral arch –Superior and inferior articular processes Facet joints –Pedicles Intervertebral foramina –Spinous process –Transverse processes

4. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Anatomy of the Spine (cont’d) The structure of a typical vertebra

5. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Anatomy of the Spine (cont’d) Cervical –7 vertebrae form curve – convex anteriorly –Atlas 1st vertebra No body – filled with odontoid process Function: support the head

6. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Anatomy of the Spine (cont’d) Cervical (cont’d) –Axis 2nd vertebra Odontoid process – tooth-like Allows head to rotate Skeletal features of the cervical spine

7. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Anatomy of the Spine (cont’d) Thoracic –12 vertebrae form curve –Concave anteriorly –Extra facets for articulation with ribs

8. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Anatomy of the Spine (cont’d) Lumbar spine –Forms convex curve anteriorly –5 lumbar, 5 fused sacral, and 4 small, fused coccygeal vertebrae –Progressive increase in vertebral size –Change in angulation Sacrum articulates with ilium – sacroiliac joint

9. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Anatomy of the Spine (cont’d)

10. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Anatomy of the Spine (cont’d) Motion segment –Functional unit –Any 2 adjacent vertebrae and soft tissues between them Motion segment of the spine

11. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Anatomy of the Spine (cont’d) Intervertebral discs –Components Annulus fibrosus Thick fibrous ring Nucleus pulposus Gelatinous interior

12. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Anatomy of the Spine (cont’d) Intervertebral discs (cont’d) –Function Shock absorption Allow spine to bend

13. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Anatomy of the Spine (cont’d) Ligaments –Length of the spine –Vertebra to vertebra A superior view of the ligaments of the vertebral column

14. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Anatomy of the Spine (cont’d) Spinal Cord –Extends from the brainstem to the level of the 1st or 2nd lumbar vertebrae –Sensory and motor impulses Enables reflex activity –31 pairs of spinal nerves (8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal)

15. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Anatomy of the Spine (cont’d) Nerve Plexus –Cervical (C1–C4) –Brachial (C5–T1) Brachial plexus

16. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Anatomy of the Spine (cont’d) Nerve Plexus (cont’d) –Lumbar (T12 – L5) –Sacral (L4 – L5) Lumbar plexus

17. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Kinematics and Major Muscle Actions Movements in all planes –Flexion/extension/hyperextension –Lateral flexion –Rotation Motion allowed between any two adjacent vertebrae is small. ….spinal movements always involve a number of motion segments

18. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Kinematics and Major Muscle Actions (cont’d) Muscles of the neck: Lateral view

19. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Kinematics and Major Muscle Actions (cont’d) Muscles of the neck: Posterior view

20. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Kinematics and Major Muscle Actions (cont’d) MusclePrimary Action – Cervical Spine SpleniusExtension, lateral flexion, rotation to same side Erector spinaeExtension, lateral flexion, rotation to opposite side SemispinalisExtension, lateral flexion, rotation to opposite side SternocleidomastoidFlexion of the neck, extension of the head, lateral flexion, rotation to opposite side Levator scapulaeLateral flexion ScalenesFlexion, lateral flexion TrapeziusExtension

21. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Kinematics and Major Muscle Actions (cont’d) Muscles of the low back

22. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Kinematics and Major Muscle Actions (cont’d) MusclePrimary Action – Lumbar Spine Rectus abdominisFlexion, lateral flexion External obliqueFlexion, lateral flexion, rotation to opposite side Internal obliqueFlexion, lateral flexion, rotation to same side Erector spinaeExtension, lateral flexion, rotation to opposite side Quadratus lumborumLateral flexion Psoas majorFlexion

23. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Anatomical Variations – Injury Potential Kyphosis –Excessive curve of thoracic spine –Congenital – deficits in vertebral bodies –Idiopathic Scheuermann’s disease –Secondary to osteoporosis

24. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Anatomical Variations – Injury Potential (cont’d) Scoliosis –Lateral curvature of spine; “C” or “S” curve –Structural Inflexible curve, persists with lateral bending –Nonstructural Flexible, corrected with lateral bending –Commonly idiopathic

25. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Anatomical Variations – Injury Potential (cont’d) Lordosis –Abnormal exaggeration of lumbar curve –Causes include: Weak abdominal musculature Congenital deformities Poor posture Activities with excessive hyperextension

26. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Anatomical Variations – Injury Potential (cont’d) Spinal anomalies. A. Thoracic kyphosis. B. Scoliosis. C. Lordosis

27. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Prevention of Spinal Conditions Physical Conditioning –Strength and flexibility Protective equipment –Neck roll –Rib protectors –Weight belts/abdominal binders

28. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Prevention of Spinal Conditions (cont’d) Proper Technique –Avoid axial loading (e.g., spearing) –Posture –Lifting

29. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Cervical Spine Conditions Cervical flexion combined with axial loading = danger Axial loading

30. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Cervical Spine Conditions (cont’d) Angular deformation and buckling occurs as load continues and maximum compression deformation is reached Continued force results in an anterior compression fracture, subluxation, or dislocation Results of cervical spinal compression deformation

31. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Cervical Spine Conditions (cont’d) Acute torticollis (“wry neck”) Due to muscle strain S&S Often awakens with deformity Presents with the head tilted to one side with the chin pointed to the opposite shoulder ROM is limited

32. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Cervical Spine Conditions (cont’d) Acute torticollis (“wry neck”) (cont’d) Management Heat or cold to reduce spasm Because ROM is limited, the individual should not be permitted to participate in sport or physical activity If the condition does not resolve in 2-3 days, physician approval prior to return to activity

33. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Cervical Spine Conditions (cont’d) Cervical strain –Usually, sternocleidomastoid or upper trapezius –MOI: direct or indirect trauma involving tension force –S&S Pain, stiffness, spasm, restricted ROM  pain with active contraction or passive stretch of involved muscle

34. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Cervical Spine Conditions (cont’d) Cervical strain (cont’d) –Management: Application of cold to reduce spasm No return to activity until pain free and ROM and strength is normal If the condition does not resolve in 2-3 days, physician approval prior to return to activity

35. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Cervical Spine Conditions (cont’d) Cervical sprain –Extreme motions or violent mechanism –S&S Pain, stiffness, restricted ROM Pain can persist for several days

36. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Cervical Spine Conditions (cont’d) Cervical sprain (cont’d) –Management: Application of cold If condition doesn’t improve rapidly, physician referral

37. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Cervical Spine Conditions (cont’d) Cervical fracture and dislocation –MOI: axial loading with violent flexion of neck –Dislocation: add rotation Cervical fracture/dislocation

38. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Cervical Spine Conditions (cont’d) Cervical fracture and dislocation (cont’d) –S&S Pain over the spinous process, with or without deformity Unrelenting neck pain or muscle spasm Abnormal sensations in the head, neck, trunk, or extremities Muscular weakness in the extremities Loss of coordinated movement

39. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Cervical Spine Conditions (cont’d) Cervical fracture and dislocation (cont’d) –S&S (cont’d) Paralysis or inability to move a body part Absent or weak reflexes Loss of bladder or bowel control Mechanism of injury involving violent axial loading, flexion, or rotation of the neck

40. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Cervical Spine Conditions (cont’d) Cervical fracture and dislocation (cont’d) –An unstable neck injury should be suspected In an unconscious individual An individual who is awake but has numbness and/or paralysis iIn a neurologically intact individual who has neck pain or pain with neck movement

41. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Cervical Spine Conditions (cont’d) Cervical fracture and dislocation (cont’d) –A cervical fracture or dislocation could be present even if there are no apparent neurological deficits –An individual with a cervical fracture or dislocation could still be able to walk off a playing field/court

42. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Cervical Spine Conditions (cont’d) Cervical fracture and dislocation (cont’d) –Management Activate emergency plan, including summoning EMS Do not move the individual While waiting for EMS, without moving head or neck, assess and manage life-threatening conditions

43. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Brachial Plexus Injuries MOI –Stretch Head is forced laterally away from the shoulder while the shoulder is simultaneously forced downward Arm is forced into excessive external rotation, abduction, and extension

44. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Brachial Plexus Injuries (cont’d) MOI (cont’d) –Compression (pinch) Head is rotated, laterally flexed, and compressed or extended to the same side of the shoulder

45. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Brachial Plexus Injuries (cont’d) Common mechanisms of a brachial plexus stretch

46. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Brachial Plexus Injuries (cont’d) Acute S&S –Immediate, severe, burning pain radiates down arm into hand –Pain transient; subsides in 5–10 minutes –Weakness in abduction and external rotation –Symptoms are unilateral

47. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Brachial Plexus Injuries (cont’d)

48. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Brachial Plexus Injuries (cont’d) Management –Weakness is present- remove from activity –Strength & function return 1-2 minutes, permit individual to return to activity –If symptoms persist >2 min, do not allow to return to play until seen by a physician

49. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Thoracic Spine Conditions Contusions –MOI: direct blow –S&S: pain, ecchymosis, spasm, & limited swelling –Management Application of cold If symptoms persist > 2-3 days or mod-severe injury, physician approval prior to return to activity

50. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Thoracic Spine Conditions (cont’d) Sprains/strains –MOI: overload; overstretch –S&S Painful spasms of back muscles May develop as a sympathetic response to sprains Presence of spasms makes it difficult to determine sprain or strain

51. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Thoracic Spine Conditions (cont’d) Sprains/strains (cont’d) –Management Application of cold Physician referral for definitive diagnosis and treatment

52. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Thoracic Spine Conditions (cont’d) Thoracic spinal fractures and apophysitis –Wedge fracture Fracture of vertebral end plates Mechanism Large compressive loads or landing on the buttock area Compressive stress during small, repetitive loads S&S: standard fracture; pain and muscle guarding

53. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Thoracic Spine Conditions (cont’d) Thoracic spinal fractures and apophysitis

54. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Thoracic Spine Conditions (cont’d) Thoracic spinal fractures and apophysitis (cont’d) –Scheuermann’s disease Leading cause of fractures among adolescents Osteochondrosis of the spine Related to mechanical stress Abnormal epiphyseal plate behavior allows herniation of disc into vertebral body

55. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Thoracic Spine Conditions (cont’d) Thoracic spinal fractures and apophysitis (cont’d) –Apophysitis Repeated flexion–extension of thoracic spine Progressive condition characterized by local pain and tenderness –Management: immediate physician referral –Treatment: eliminate flexion-extension stress; strengthening of abdominal and other trunk muscles

56. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Thoracic Spine Conditions (cont’d) Thoracic fracture and apophysitis

57. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Lumbar Spine Conditions Strains and Sprains –Estimated 75% of population has low back pain (LBP) at some time Stems from mechanical injury to muscles, ligaments, or connective tissue –Chronic LBP: associated with LBP, reduced spinal flexibility, repeated stress, and activities that require maximal extension of the lumbar spine –Acute and chronic strains

58. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Lumbar Spine Conditions (cont’d) Strains and Sprains (cont’d) –S&S Pain and discomfort can range (local or diffuse) No radiating pain No signs of neural involvement –Management: Standard acute; stretching Moderate to severe cases, physician referral

59. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Lumbar Spine Conditions (cont’d) LBP in runners –Associated with tightness in hip flexors and hamstrings –S&S Localized pain, ↑ with active and resisted back extension No radiating pain No signs of neural involvement Possible anterior pelvic tilt and hyperlordosis

60. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Lumbar Spine Conditions (cont’d) LBP in runners (cont’d) –Management: Standard acute If symptoms persist > 2-3 days or mod-severe injury, physician approval prior to return to activity –Avoiding excessive flexion activities and a sedentary posture

61. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Lumber Spine Conditions (cont’d) Sciatica –Set of symptoms attributed to a condition –Possible conditions: a herniated disc, annular tear, muscle-related disease, spinal stenosis, facet joint disease, and piriformis syndrome

62. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Lumbar Spine Conditions (cont’d) Sciatica (cont’d) –S&S depend on condition; common general symptoms Pain that follows a path from low back, through buttocks, through posterior thigh and posterior lower leg Burning or tingling sensation radiates down leg

63. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Lumbar Spine Conditions (cont’d) Sciatica (cont’d) –S&S (cont’d) Weakness of the muscles in the lower extremity Coughing, sneezing, straining, and prolonged sitting aggravate symptoms Loss of bladder or bowel control

64. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Lumbar Spine Conditions (cont’d) Sciatica (cont’d) –Management Referral to a physician is necessary to check for a potentially serious underlying condition and treatment options.

65. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Lumbar Spine Conditions (cont’d) Disc Injuries –Prolonged mechanical loading → microruptures in annulus fibrosus → disc degeneration Protruded Prolapsed Extruded Sequestered

66. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Lumbar Spine Conditions (cont’d) Herniated Discs

67. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Lumbar Spine Conditions (cont’d) Disc Injuries –S&S Sharp pain and spasm at site of herniation; pain shoots down extremity Walk in slightly crouched position, leaning away from side of lesion Muscle weakness, sensory changes, and diminished reflexes in the lower extremity Abnormal bladder or bowel function

68. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Lumbar Spine Conditions (cont’d) Disc Injuries (cont’d) –Management Physician referral Do not permit to continue activity Application of cold to decrease pain and spasm

69. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Lumbar Spine Conditions (cont’d) Lumbar fractures and dislocations –Transverse or spinous process fracture MOI Extreme tension from attached muscles Direct blow Additional injury to surrounding soft tissues

70. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Lumbar Spine Conditions (cont’d) Lumbar fractures and dislocations (cont’d) –Compression fracture Hyperflexion crushes anterior aspect of vertebral body Primary danger—possibility of bony fragments moving into spinal canal, damaging cord or spinal nerves

71. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Lumbar Spine Injuries (cont’d) Lumbar fractures and dislocations (cont’d) –Dislocations Occur only when a fracture is present Rare in sports

72. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Lumbar Spine Conditions (cont’d) Lumbar fractures and dislocations (cont’d) –S&S Localized, palpable pain may radiate down the nerve root if a bony fragment compresses a spinal nerve –Management Activate the emergency plan, including summoning EMS

73. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Sacrum and Coccyx Conditions Sacroiliac sprain –MOI Single traumatic episode involving bending and/or twisting Repetitive stress from lifting Fall on buttocks Excessive side-to-side or up-and-down motion during running

74. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Sacrum and Coccyx Conditions (cont’d) Sacroiliac sprain (cont’d) –MOI (cont’d) Running on uneven terrain Suddenly slipping or stumbling forward Wearing new shoes or orthoses

75. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Sacrum and Coccyx Conditions (cont’d) Sacroiliac sprain (cont’d) –S&S Unilateral, dull pain that extends into buttock and posterior thigh ASIS or PSIS may appear asymmetric bilaterally Leg length discrepancy

76. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Sacrum and Coccyx Conditions (cont’d) Sacroiliac sprain (cont’d) –S&S (cont’d) ↑ pain with standing on one leg and stair climbing Forward bending reveals block to normal movement with the PSIS on injured side moving sooner than uninjured side ↑ pain with lateral flexion toward injured side ↑ pain with straight leg raises beyond 45°

77. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Sacrum and Coccyx Conditions (cont’d) Sacroiliac sprain (cont’d) –Management Standard acute with gentle stretching If symptoms do not resolve in 2-3 days, physician referral

78. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Sacrum and Coccyx Conditions (cont’d) Coccygeal conditions –Direct blow → contusion or fracture –S&S Localized pain and tenderness Pain increases with prolonged sitting or direct pressure –Management Physician referral to ensure accurate diagnosis and treatment options

79. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins The Coach and On-site Assessment of an Acute Spinal Condition Control any scene around the individual – instruct others to not touch the person Observation while approaching injured individual –Overall presentation and attitude, with a particular focus on their willingness or ability to move

80. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins The Coach and On-site Assessment of an Acute Spinal Condition (cont’d) Initial contact with individual –Calm and reassure – must have their attention during assessment –Assess level of consciousness – MOI for cervical injury could also produce head trauma If individual is not alert and attentive, activate emergency plan, including summoning EMS; do not move the individual

81. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins The Coach and On-site Assessment of an Acute Spinal Condition (cont’d) Conduct a neuromuscular assessment by asking the following –What happened? (attempt to determine MOI) –Where is your pain? –Are you experiencing any neck or back pain? –Are you having any difficulty breathing or swallowing? –Are you experiencing any unusual sensations in your arms or legs?

82. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins The Coach and On-site Assessment of an Acute Spinal Condition (cont’d) Conduct a neuromuscular assessment by asking the following (cont’d) –Can you wiggle your fingers? Can you wiggle your toes? –(The coach should place 2-3 fingers in the individual’s palm of the hand.) Can you gently squeeze my hand? (perform on both hands) –(The coach should place their hands in a position to resist ankle dorsiflexion.) Can you gently push your foot against my hand? (perform on both feet)

83. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins The Coach and On-site Assessment of an Acute Spinal Condition (cont’d) In performing neuromuscular assessment, the coach must be prepared to hear a positive response to a question and remain calm.

84. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins The Coach and On-site Assessment of an Acute Spinal Condition (cont’d) Determination based on neuromuscular assessment –If MOI suggests severe injury, individual reports unusual sensations in the arms and/or legs, was unable to wiggle the fingers and/or toes, and/or was unable to squeeze the hand or push with the foot –Treat as a potentially serious spinal injury –If no problems or difficulties related to neuromuscular assessment, could elect to continue assessment

85. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins The Coach and On-site Assessment of an Acute Spinal Condition (cont’d) Treatment of potentially serious spinal injury –The individual should not be moved! –If equipment is being worn, it should not be removed. –Stabilize the head & neck in the position in which they are found.

86. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins The Coach and On-site Assessment of an Acute Spinal Condition (cont’d) Treatment of potentially serious spinal injury (cont’d) –Activate the emergency plan, including summoning EMS –Monitor vital signs while waiting for EMS to arrive –Manage any life-threatening conditions (e.g., respiratory arrest; cardiac arrest; shock)

87. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins The Coach and On-site Assessment of an Acute Spinal Condition (cont’d) Continued assessment –Assess sensation Upper extremities Positive responses: treat as a potentially serious spinal injury Negative responses: continue assessment

88. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins The Coach and On-site Assessment of an Acute Spinal Condition (cont’d) Continued assessment (cont’d) –Assess sensation Lower extremities Positive responses: treat as a potentially serious spinal injury Negative responses: continue assessment

89. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins The Coach and On-site Assessment of an Acute Spinal Condition (cont’d) Continued assessment (cont’d) –The coach should once again ask the individual about the location and intensity of their pain If the individual reports that the neck or back pain: Has not decreased or Has diminished, but is still significant or Has increased Manage the situation as a potentially serious spinal injury!

90. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins The Coach and On-site Assessment of an Acute Spinal Injury (cont’d) Continued assessment (cont’d) –If the pain is diminished and not significant, the coach could opt to continue assessment – using HOPS format

91. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Always err on the side of caution! If uncertain, activate emergency plan! Summon EMS!