ATC 222ATC 222The SpineThe SpineChapter 25Chapter 25

Natasha Tibbetts, ATCNatasha Tibbetts, ATC

QuizQuiz

1.1. What is the medical or technical What is the medical or technical term for spearing?term for spearing?

2.2. List 3 signs of a serious cervical List 3 signs of a serious cervical spine injury.spine injury.

3.3. What is the name given to the first What is the name given to the first cervical vertebra?cervical vertebra?

4.4. Define hypoesthesia.Define hypoesthesia.

AnatomyAnatomy

Vertebral columnVertebral column 7 cervical vertebra7 cervical vertebra

C1=AtlasC1=Atlas C2=AxisC2=Axis

12 thoracic vertebra12 thoracic vertebra 5 lumbar vertebra5 lumbar vertebra 5 sacral vertebra5 sacral vertebra

Intervertebral disksIntervertebral disks Annulus pulposusAnnulus pulposus Nucleus pulposusNucleus pulposus

Anatomy (Cont’d)Anatomy (Cont’d)

LigamentsLigaments Anterior longitudinalAnterior longitudinal Posterior longitudinalPosterior longitudinal SupraspinousSupraspinous InterspinousInterspinous

Spinal cord and Spinal nervesSpinal cord and Spinal nerves

Anatomy ExamplesAnatomy Examples

Spinal AnatomySpinal Anatomy

Anatomy (Cont’d)Anatomy (Cont’d)

LigamentsLigaments

Motion of the SpineMotion of the Spine Vertebral Column General MotionsVertebral Column General Motions

Flexion/ExtensionFlexion/Extension Right/Left lateral flexionRight/Left lateral flexion Right/Left rotationRight/Left rotation

Specific Cervical MotionSpecific Cervical Motion Rotation occurs at C1-C2Rotation occurs at C1-C2 Flexion/Extension=atlanto-occipital jointFlexion/Extension=atlanto-occipital joint

Specific Thoracic MotionSpecific Thoracic Motion Flexion/Extension is 20-30 degrees MAX!Flexion/Extension is 20-30 degrees MAX!

Specific Lumbar MotionSpecific Lumbar Motion 90% of Flexion/Extension occurs at L4-L5-S190% of Flexion/Extension occurs at L4-L5-S1

Cervical InjuryCervical Injury Catastrophic injuryCatastrophic injury

DefinitionDefinition Warning signsWarning signs

UnconsciousnessUnconsciousness DeformityDeformity Loss of strength/movement in extremitiesLoss of strength/movement in extremities Anesthesia/paresthesia/hypoesthesia in Anesthesia/paresthesia/hypoesthesia in

extremitiesextremities AssessmentAssessment

Stabilize and calm athleteStabilize and calm athlete Call EMSCall EMS ABC’sABC’s

Mechanisms of InjuryMechanisms of Injury Axial loadingAxial loading

SpearingSpearing Straight columnStraight column

Hyper-flexionHyper-flexion Hyper-extensionHyper-extension Lateral hyperflexionLateral hyperflexion RotationRotation CombinationCombination

WhiplashWhiplash

Specific InjuriesSpecific Injuries FracturesFractures DislocationsDislocations StrainStrain

Pain in muscle primarily (localized)Pain in muscle primarily (localized) Point tendernessPoint tenderness Pain with AROM (restricted motion)Pain with AROM (restricted motion) Pain with passive stretch of musclePain with passive stretch of muscle Pain/weakness with strength testingPain/weakness with strength testing

Injuries (Cont’d)Injuries (Cont’d)

Brachial Plexus SyndromeBrachial Plexus Syndrome C5-T1C5-T1 Can be caused by traction or Can be caused by traction or

compressioncompression Paresthesia and weaknessParesthesia and weakness Burning/TinglingBurning/Tingling Return to play criteriaReturn to play criteria TreatmentTreatment

Thoracic and Lumbar Thoracic and Lumbar InjuriesInjuries

Postural deviationsPostural deviations KyphosisKyphosis LordosisLordosis ScoliosisScoliosis

Normal postureNormal posture Pages 645-648Pages 645-648 Ear-shoulder-hip-knee-ankleEar-shoulder-hip-knee-ankle Level knees, hips, and shouldersLevel knees, hips, and shoulders Normal vertebral curvesNormal vertebral curves

Postural ExamplesPostural Examples

Injuries (Cont’d)Injuries (Cont’d)

Congenital abnormalitiesCongenital abnormalities May also be mechanicalMay also be mechanical Spondylolysis vs. SpondylolysisthesisSpondylolysis vs. Spondylolysisthesis Causes and treatmentCauses and treatment

SciaticaSciatica DefinitionDefinition Signs and symptomsSigns and symptoms CausesCauses

MechanicalMechanical StructuralStructural CompressionCompression

SwellingSwelling Disc HerniationDisc Herniation TumorTumor

Herniated Lumbar DiskHerniated Lumbar Disk Lumbar disks are under constant stressLumbar disks are under constant stress

DegenerationDegeneration TearsTears CracksCracks

Most often injured between L4-L5, 2Most often injured between L4-L5, 2ndnd most most common is between L5-S1common is between L5-S1

MechanismMechanism Forward bending and twisting places abnormal strain on Forward bending and twisting places abnormal strain on

lumbar regionlumbar region Signs and SymptomsSigns and Symptoms

Centrally located pain that radiates unilaterallyCentrally located pain that radiates unilaterally Symptoms worse in morningSymptoms worse in morning Forward bending/sitting increases painForward bending/sitting increases pain

TreatmentTreatment Pain reducing modalitiesPain reducing modalities Postural self-correction exercisesPostural self-correction exercises Back and abdominal strengtheningBack and abdominal strengthening

BulgingBulging

ProlapsedProlapsed

ExtrusionExtrusion

Prevention of Spinal InjuriesPrevention of Spinal Injuries Cervical SpineCervical Spine

Muscle StrengtheningMuscle Strengthening Cervical regionCervical region

Range of MotionRange of Motion C-spine should have full ROMC-spine should have full ROM Can be increased through stretchingCan be increased through stretching

Using correct techniquesUsing correct techniques Rules and regulationsRules and regulations

Head should not be used as a weapon!Head should not be used as a weapon!

Prevention (Cont’d)Prevention (Cont’d) Lumbar SpineLumbar Spine

Correction of Biomechanical AbnormalitiesCorrection of Biomechanical Abnormalities Emphasis on trunk flexibilityEmphasis on trunk flexibility Maximum ROMMaximum ROM Abdominal strengthAbdominal strength

Correct lifting techniquesCorrect lifting techniques Appropriate breathingAppropriate breathing ““Lift with your legs, not your back”Lift with your legs, not your back”

Core StabilizationCore Stabilization Increase stability of trunkIncrease stability of trunk Helps athlete maintain spine and pelvis in Helps athlete maintain spine and pelvis in

comfortable and acceptable mechanical positioncomfortable and acceptable mechanical position