Download The Spine

The Spine
Chapter 25
Anatomy of the Spine
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Bones of the vertebral column
• Cervical (7), thoracic (12), lumbar (5), sacral (5
fused), coccyx (4+ fused)
– Intervertebral Disks - shock absorbers
• Ligamentous Structures (anterior and posterior
longitudinal and supraspinous)
Muscles of the Spine (superficial and deep)
• Erector spinae muscle group: superficial portion
• Interspinalis, multifidus, rotatores, and
semispinalis : Deep portion
Spinal Cord, Nerves and Peripheral Branches
1. Disc
 2. Body
 3. Dura mater
 4. Epidural
space
 5. Spinal cord
 6. Subarchnoid
space
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Preventing Injuries to the Spine
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Cervical Spine
• Strengthening – protect by resisting excessive
motion
• Range of Motion – flexibility
• Using correct techniques
Lumbar Spine
• Avoid Stresses – completing ADLs properly
• Correct Biomechanical Abnormalities – strength
and flexibility in the core
• Correct techniques when lifting
Assessment of the Spine
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History “very important” – R/O cord injury
Observation
• posture and movement evaluation
– Fatback: decrease lumbar curve with increase pelvic
– Swayback:hip exten. at hip, flex of thoracic on lumbar
spine; lumbar in lordosis, thoracic in kyphosis
– Lordosis:increase in lumbar curve
– Scoliosis: lateral curvature of spine
– Kyphosis: increase in thoracic curve
– proximal to distal; muscles
and bony prominence
 Special Tests
• stress tests
• Range of Motion
 Neurological Exam
• reflex
 Palpation
Injuries to the Spine
Cervical Sprain (whiplash) –cervical sprain
• Etiology:sudden snap of the head
• Signs and Symptoms: similar to sprain but last
longer
• Management: Referral to r/o fracture an
neurological problems; collar, RICE, NSAIDs, etc
Spine Injuries
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Acute Toticollis (Wryneck)
• Etiology: cold draft of air or head in unusual position for
extended period of time
• Signs and Symptoms:point tender, muscle spasm
• Management: r/o more serious injury; break pain spasm cycle
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Cervical Cord and Nerve Root Injuries
• Etiology
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Laceration : dislocation or fracture
Hemorrhage: dislocation, fx, sprain and strains
Contusion: violent force to neck that does not cause dislocation
Spinal Shock: severe twist or snap; transient signs of spinal cord
injury
• Signs and Symptoms: paralysis, motor and sensory systems
affected
• Management
Injuries to the Spine
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Brachial Plexus Neurapraxia (Burner)
• Etiology: stretch or compression of brachial plexus
• Signs and Symptoms: burning sensation, numbness, tingling,
weakness
• Management: once symptoms resolve, athlete can return
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Cervical Spine Stenosis
• Etiology: narrowing of spinal canal; congential or developed
• Signs and Symptoms: transient quadriplegia; persistent
burners; weakness
• Management: referral for diagnosis; advise to D/C
participation
Injuries to the Spine
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Mechanisms
• Congenital: spondylolisthesis (forward subluxation
of 5th vertebrae); abnormal bony structure )length,
width of vertebrae), etc
• Idiopathic (mechanical or traumatic)
– Mechanical: faulty posture, bad mechanics
– Back Trauma: injuries occuring in competition; WATCH
OUT FOR MIS-MANAGEMENT
– Recurrent or chronic low back pain: malalignment, nerve
rot compressions, muscle weakness
Injuries to the Spine
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Herniated Lumbar Disk: usually L4-L5 or L5-S1
• Etiology: forward bending and twisting
• Signs and Symptoms:Radiating pain unilaterally
• Management: pain control; if persists, surgery may be
indicated
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Spondylolysis (degeneration of vertebrae) and
Spondylolisthesis (slipping of the vertebral disk)
• Etiology: hyperextension, direct blow, sudden twist
• Signs and Symptoms: aching pain, change positions often,
possibly some neurological symptoms
• Management: bracing, rest, rehab focuses on trunk
strengthening
Injuries to the Spine
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Coccyx Injuries: sprain, subluxations, fractures
• Etiology: direct impact
• Signs and Symptoms: refer for x-ray, pain
• Management: ring seat, analgesics
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Sacroiliac Joint Dysfunction(sprain, inflammation,
hypermobility, hypomobility)
• Etiology: twisting, falling, landing heavy on one leg, etc
• Signs and Symptoms: tenderness over site, guarding, pain,
ASIS or PSIS asymmetrical
• Management: manage pain, mobilizations, exercises to
strengthen and re-align
Rehabilitation Principles for the
Spine
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Joint Mobilization (decrease pain, increase mobility,
increase ROM)
Flexibility Exercises
 Strengthening Exercises
 Techniques for the Low Back
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Pain Control (mobs, traction, modalities, etc)
General Body Conditioning
Joint Mobilization  Traction
Flexibility Exercises
Strengthening Exercises