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Spinal Injuries Introduction • Spine consists of __________________ bones, supported by muscles and ligaments • Also includes other structures like __________________ and __________________ • Injuries to the spine can be life __________________ because the spine __________________ the spinal cord. • Most spinal cord injuries in the __________________ and __________________ regions. Anatomy of the Spine • Complex structure of bones with four segments 1. __________________ (tailbone area) 2. __________________ (lower spine) 3. __________________ (middle spine) 4. __________________ (upper spine) **__________________-spinal curves of lumbar, thoracic, and cervical region are curved neither too much nor too little. Bones • Bones in the spine are __________________ by disks and held __________________ by ligaments. • Called __________________ • ______ cervical • ______ thoracic • ______ lumbar • ______ sacral • All vertebrae have a __________________, __________________ process, and a __________________ through which the spinal cord passes • Bony spinal column has several functions: – __________________ the spinal cord – Holding the body __________________ for walking – Serving as a __________________ for muscular attachments Disks • • Aka __________________ Lie __________________ the vertebrae to __________________ shock and resist __________________ during activity • Keep vertebrae __________________, which allows movement and __________________ and provides space for nerves to exit the spinal cord to the rest of the body. • Two distinct parts 1. __________________-jellylike core 2. __________________-layers of cartilage *disks do not receive any __________________ supply *do not have the same __________________ potential as some other body tissues *__________________ Muscles • Muscles of trunk and neck are __________________ to spine • Provide wide range of __________________ and s__________________ • __________________ muscles help support __________________ movement – Especially rectus abdominis and the internal and external obliques – Work with spinal extensors to keep the body upright • __________________extends cervical spine • Cervical flexion accomplished by the __________________ muscles – Attach to cervical vertebrae and run down to the first and second ribs (3 muscles in all) – Also help with __________________ • Cervical side bending and rotation accomplished by the _______________________________ muscle – Rotates the head to the direction opposite the attachment Normal Posture • ATC can determine if someone has normal posture by viewing him from the __________________ • Imagine a straight line dropping from the ceiling…the line would pass… – just __________________ the ear – Through the __________________ of the shoulder – Down through the __________________ of the greater trochanter of the hip – Just behind the __________________ – Down to just in __________________ of the lateral malleolus Abnormal Posture • _______________________________________-ear projected in front of the line – Puts great deal of stress at the back of the neck • __________________-thoracic spine somewhat curved – Line passes through back of shoulders instead of middle • __________________-lumbar spine has too much forward curve • If athlete cannot maintain proper posture, the ability of the spine to absorb shock is __________________ – Eventually results in injury • __________________-side to side curvature of the spine Preventing Postural Problems • Imagine a balloon attached to your head pulling it __________________ up • • • __________________ carrying book bag, sports bag, purse, etc. on opposite shoulders Stay __________________ Exercise __________________ to prevent stiffness Preventing Spinal Injuries • Preventing injuries to cervical and lumbar spinal regions is __________________ process – Participate in exercise and __________________ programs – Maintain proper __________________ – Learn to __________________ properly – Use back __________________ when lifting Lumbar Ligament Injuries • __________________ commonly occur when athletes are forced into __________________ trunk flexion or attempt to __________________ the spine and __________________ at the same time – Posterior aspect of the vertebral joints can separate and stretch over the ligaments • Characteristics: pain to one side of spine, __________________ movement due to pain, muscle __________________ • ATC test: stress test where you gently __________________ on each vertebrae – __________________ if joint is sprained, not painful if __________________ is present • Treatment: __________________ – Heat can be used after 48 hours Lumbar Muscle and Tendon Injuries • Rarely see ruptured muscle at lumbar spine • Mild to moderate strains are c__________________ • Characteristics: pain to one side of spine, __________________, lack of movement – Pain will be on __________________ side from the direction in which she bends • Pain associated with __________________ is __________________; pain associated with s__________________ usually __________________ up and down the length of the muscle • Treatment: apply ice, gentle __________________ using knees to chest routine • Once pain is decreased, flexibility and strength can be restored using normal strengthening and flexibility routines Lumbar Bone Injuries • Fractures hard to determine without an __________________ – Can be __________________ if ATC knows mechanism of injury, finds a great deal of back pain, muscle spasm, and tenderness • If ATC suspects lumbar fracture, athlete should be treated __________________ – Placed on a backboard with help of appropriate emergency medical personnel and taken to nearest hospital • __________________-stress fracture or bone degeneration of the vertebrae • __________________ of bone degeneration is important because if fracture fails to heal, it can separate, causing the spine to become unstable – Allows vertebrae to __________________ (slip forward) on the vertebrae below it (called __________________) – most common location: __________________slipping forward on the 1st sacral Bulging Disk • Aka __________________ • Jellylike nucleus pulpous (at center of disk) __________________ through the rings of cartilage • Disks __________________ bulge forward – Front of spine covered with very thick _______________________________________ – Most individuals have postures that __________________ the spine, which puts more pressure on the front of the disk and this pushes the nucleus pulpous to the back • Can be disabling, cause __________________, tingling, pain can occur down the leg, and pain in lower back that __________________ with sitting • Treatment: understand the cause, active rest, __________________ poor posture, help athlete move into spinal extension Cervical Ligament Injuries • Subject to sprains when __________________ moved beyond its normal range • Usually result of __________________ or __________________ • Symptoms: neck and arm pain • Treatment: __________________ …no compression with elastic bandage…the “C” should really be support • Rehab: strengthening exercises to regain __________________ and full ROM needs to be established • Before returning to participation, athlete must have the following: – __________________ – __________________ – __________________ – __________________ – __________________ Cervical Muscle and Tendon Injuries • Most common: __________________ • Characteristics: muscle __________________, restricted ROM, weakness against resistance, pain, __________________ • Treatment: same as ligament sprain • Return to play: same as ligament sprain Cervical Bone Injuries • Fractures and dislocations • • • • • Fractures often result of an __________________ load – Imagine pressing on the end of a drinking straw until it bends Dislocations often result of combination of excessive __________________ and __________________ Symptoms: pain around cervical spine, __________________, numbness, __________________ down arms Dislocations: often visible __________________ Treatment: emergency care procedures, neck immobilized, athlete placed on backboard. Helmet should be left in place Cervical Disk Bulge • Not as common as lumbar • Report more neck pain with __________________ and while flexing the neck __________________, discomfort down back and between shoulder blades • Treatment: improving neck posture and then progressing to cervical extension exercises • Cervical traction can be used • Full neck mobility and strength should gradually be regained Brachial Plexus Injuries • _________________________ -network of nerves that exit cervical spine and run a course through the shoulder and down the arm • Athlete who f__________________, runs into, or attempts to t__________________ another player can stretch the brachial plexus • Results in __________________, tingling, numbness, and __________________ sensations of the arm and shoulder – Aka “__________________ “or “__________________” – May last matter of seconds or minutes • Treatment: neck strengthening, ROM stretching • Before returning to play, athlete must have the following: – __________________ – __________________ – __________________ – Problem-free neck and shoulder evaluation by ATC and team physician