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Spinal Injuries Describe the basic anatomy of the spine Explain common spinal injuries that occur with athletic participation. Identify common signs and symptoms of spinal injuries Explain the treatments performed by an ATC for specific spinal injuries. Describe common postural problems. Objectives Spine consists of articulated bones, supported by muscles and ligaments Also includes other structures like disks and nerves Injuries to the spine can be life threatening because the spine protects the spinal cord. Most spinal cord injuries in the lumbar and cervical regions. Introduction Complex structure of bones with four segments 1. Sacrum (tailbone area) 2. Lumbar (lower spine) 3. Thoracic (middle spine) 4. Cervical (upper spine) **neutral spine-spinal curves of lumbar, thoracic, and cervical region are curved neither too much nor too little. Anatomy of the Spine Bones in the spine are separated by disks and held together by ligaments. Called vertebrae 7 cervical 12 thoracic 5 lumbar 5 sacral Bones All vertebrae have a body, spinous process, and a canal through which the spinal cord passes Bony spinal column has several functions: ◦ Protecting the spinal cord ◦ Holding the body upright for walking ◦ Serving as a site for muscular attachments Bones Aka intervertebral Lie between the vertebrae to absorb shock and resist compression during activity Keep vertebrae separated, which allows movement and flexibility and provides space for nerves to exit the spinal cord to the rest of the body. Disks Two distinct parts 1. Nucleus pulposus-jellylike core 2. Annulus fibrosus-layers of cartilage *disks do not receive any blood supply *do not have the same healing potential as some other body tissues *compressible Disks Muscles of trunk and neck are connected to spine Provide wide range of movement and stability Abdominal muscles help support trunk movement ◦ Especially rectus abdominis and the internal and external obliques ◦ Work with spinal extensors to keep the body upright Upper trapezius extends cervical spine Muscles Cervical flexion accomplished by the scalenius muscles ◦ Attach to cervical vertebrae and run down to the first and second ribs (3 muscles in all) ◦ Also help with breathing Cervical side bending and rotation accomplished by the sternocleidomastoid muscle ◦ Rotates the head to the direction opposite the attachment Muscles ATC can determine if someone has normal posture by viewing him from the side Imagine a straight line dropping from the ceiling…the line would pass… ◦ just behind the ear ◦ Through the center of the shoulder ◦ Down through the middle of the greater trochanter of the hip ◦ Just behind the patella ◦ Down to just in front of the lateral malleolus Normal Posture Forward head posture-ear projected in front of the line ◦ Puts great deal of stress at the back of the neck Kyphosis-thoracic spine somewhat curved ◦ Line passes through back of shoulders instead of middle Lordosis-lumbar spine has too much forward curve Abnormal Posture If athlete cannot maintain proper posture, the ability of the spine to absorb shock is diminished ◦ Eventually results in injury Scoliosis-side to side curvature of the spine Abnormal Posture Imagine a balloon attached to your head pulling it straight up Alternate carrying book bag, sports bag, purse, etc. on opposite shoulders Stay fit Exercise regularly to prevent stiffness Preventing Postural Problems Preventing injuries to cervical and lumbar spinal regions is active process ◦ ◦ ◦ ◦ Participate in exercise and flexibility programs Maintain proper posture Learn to lift properly Use back supports when lifting Preventing Spinal Injuries Sprains commonly occur when athletes are forced into excessive trunk flexion or attempt to flex the spine and rotate at the same time ◦ Posterior aspect of the vertebral joints can separate and stretch over the ligaments Characteristics: pain to one side of spine, limited movement due to pain, muscle spasm ATC test: stress test where you gently press on each vertebrae ◦ painful if joint is sprained, not painful if strain is present Treatment: PRICE ◦ Heat can be used after 48 hours Lumbar Ligament Injuries Rarely see ruptured muscle at lumbar spine Mild to moderate strains are common Characteristics: pain to one side of spine, spasm, lack of movement ◦ Pain will be on opposite side from the direction in which she bends Pain associated with sprains is localized; pain associated with strains usually moves up and down the length of the muscle Lumbar Muscle and Tendon Injuries Treatment: apply ice, gentle stretching using knees to chest routine Once pain is decreased, flexibility and strength can be restored using normal strengthening and flexibility routines Lumbar Muscle and Tendon Injuries Fractures hard to determine without an Xray ◦ Can be suspected 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 conservatively ◦ Placed on a backboard with help of appropriate emergency medical personnel and taken to nearest hospital Lumbar Bone Injuries Spondylolysis-stress fracture or bone degeneration of the vertebrae Location of bone degeneration is important because if fracture fails to heal, it can separate, causing the spine to become unstable ◦ Allows vertebrae to shunt (slip forward) on the vertebrae below it (called spondylolisthesis) ◦ most common location: 5th lumbar vertebra slipping forward on the 1st sacral Lumbar Bone Injuries Aka slipped disk Jellylike nucleus pulpous (at center of disk) pushes through the rings of cartilage Disks rarely bulge forward ◦ Front of spine covered with very thick anterior longitudinal ligament ◦ Most individuals have postures that flex the spine, which puts more pressure on the front of the disk and this pushes the nucleus pulpous to the back Bulging Disk Can be disabling, cause numbness, tingling, pain can occur down the leg, and pain in lower back that increases with sitting Treatment: understand the cause, active rest, correct poor posture, help athlete move into spinal extension Bulging Disk Subject to sprains when forcefully moved beyond its normal range Usually result of hyperextension or hyperflexion Symptoms: neck and arm pain Treatment: PRICE…no compression with elastic bandage…the “C” should really be support Cervical Ligament Injuries Rehab: strengthening exercises to regain stability and full ROM needs to be established Before returning to participation, athlete must have the following: ◦ ◦ ◦ ◦ ◦ Full strength Full ROM Full confidence No symptoms Physician clearance Cervical Ligament Injuries Most common: whiplash Characteristics: muscle spasm, restricted ROM, weakness against resistance, pain, tenderness Treatment: same as ligament sprain Return to play: same as ligament sprain Cervical Muscle and Tendon Injuries Fractures and dislocations Fractures often result of an axial load ◦ Imagine pressing on the end of a drinking straw until it bends Dislocations often result of combination of excessive neck flexion and rotation Symptoms: pain around cervical spine, weakness, numbness, tingling down arms Cervical Bone Injuries Dislocations: often visible deformity Treatment: emergency care procedures, neck immobilized, athlete placed on backboard. Helmet should be left in place Cervical Bone Injuries Not as common as lumbar Report more neck pain with sitting and while flexing the neck forward, 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 Cervical Disk Bulge Brachial plexus-network of nerves that exit cervical spine and run a course through the shoulder and down the arm Athlete who falls, runs into, or attempts to tackle another player can stretch the brachial plexus Results in burning, tingling, numbness, and stinging sensations of the arm and shoulder ◦ Aka “burner” or “stinger” ◦ May last matter of seconds or minutes Brachial Plexus Injuries Treatment: neck strengthening, ROM stretching Before returning to play, athlete must have the following: ◦ ◦ ◦ ◦ No symptoms Full strength Full ROM of neck and shoulder Problem-free neck and shoulder evaluation by ATC and team physician Brachial Plexus Injuries
