Download The Spine

Chapter 24
THE SPINE
THE NERVOUS SYSTEM

Consists of the brain and spinal cord
 Collects
information about external and internal
conditions
 Analyzes the information
 Initiates appropriate responses aimed primarily
toward survival needs

2 parts of the CNS
 Peripheral
 Autonomic
THE PERIPHERAL NERVOUS SYSTEM


Consists of all the nerves and ganglia
located outside the brain and spinal
cord (CNS)
Nerves carry impulses to the brain



Sensory (afferent) nerves
Motor (efferent) nerves
Cranial/Spinal nerves make up the
entire peripheral nervous system



Cranial nerves provide communication
pathways between the head and neck
and the brain
The spinal nerves provide
communication pathways between the
rest of the body and spinal cord, which
also provides links to the brain
The spinal nerves form a network,
called a plexus
THE AUTONOMIC NERVOUS SYSTEM

Divided into 2
systems
 Sympathetic
 Prepares
action

the body for
“fight or flight”
 Parasympathetic
 Counteracts
the
sympathetic system
to prepare the body
for more restful
activities
 The
2 systems
operate as a pair
REFLEXES

The simplest type of
nervous response
They are unconscious and
involuntary
 As few as 2 neurons are
necessary for a reflex,
though many involve 3
neurons
 Every reflex act is preceded
by a change in the
environment, called a
stimulus
 Special structures called
receptors pick up the stimuli

REFLEXES (CONT’D)



If two nerves are involved, all that is necessary is a
sensory receptor, which is the distal end of the sensory
neuron that carries the sensation to the CNS
The sensory neuron communicates to a motor neuron
through a neurotransmitting chemical diffusing across a
synapse
The motor neuron then sends a signal to an effector,
which provides the response (usually a muscle
contraction or glandular secretion)
THE VERTEBRAL COLUMN

Vertebral column is divided into 5
sections

Cervical
7

vertebrae including the atlas and axis
Thoracic
 12

vertebrae that articulate with ribs
Lumbar
5
vertebrae that bears most of the body’s
weight

Sacrum
5
fused vertebrae that serve as an
articulation point for the hips

Coccyx
4
fused vertebrae that form the tailbone
SPINAL CORD

Begins at the base of the skull
and continues to the second
lumbar vertebrae
It is surrounded by the 3 meninges
and cerebrospinal fluid for
protection
 The spinal cord consists of gray
matter internally, which is
surrounded by white matter
 For reflex action and
communication with the brain,
neuron connections are made
within the gray matter, while the
white matter consists of neuron
fibers.

INJURIES TO THE SPINE

Cervical Spine Injuries
 Can
lead to serious problems
or death
 Most serious injuries are the
result of axial loading or
cervical compression,
 may
cause vertebral fracture
or the articular facets to slide
away from each other
 Symptoms
 Unconsciousness,
numbness,
paralysis and neck pain with
movement
TREATMENT OF CERVICAL SPINE INJURY
Manage airway using jawthrust technique
 If helmet is work, do no
remove


Head movements may
increase the severity of the
injury
Check for carotid pulse
 If absent, begin chest
compressions
 Immobilize until EMS
arrives

CERVICAL SPRAINS & STRAINS

Symptoms



Tenderness and pain at the injury
site
Neck motion not affected
Moderate strains/sprains will
present with limited motion


Severe injuries will have localized
pain and muscle spasm


But without radiation of
pain/parathesia
Athlete may complain of an insecure
feeling about the neck
Treatment

Protect the area, exclude from
further activity, refer to a physician
CERVICAL NECK SYNDROME


Caused by forced lateral flexion
Causes nerve roots to be stretched
or impinged


Commonly called a pinched nerve,
burner or stinger
Symptoms



Sharp, burning, radiating pain
If brachial plexus is involved, there
may be radiating pain, numbness
and loss of function of the arm and
possible hand
Symptoms usually subside in
minutes, though it may leave
residual soreness and paresthetic
(numbness, tingling) areas
CERVICAL FRACTURES AND SUBLUXATIONS
Not common athletic
injuries
 Can occur in football,
diving, and gymnastics
 Most fatal or
paralyzing injuries
occur when an
athlete’s neck is in
flexion and the athlete
receives a blow to the
head

CERVICAL FX/SUBLUXATION SYMPTOMS










Swelling within the spinal cord
Transitory paralysis
Neck pain
Muscle spasms
Numbness
Loss of sensation
Weakness
Paresthesia
Partial or complete limb paralysis
Athletes may experience transient quadriparesis or
quadriplegia, also called neuropraxia


Recovery can occur within a few minutes, but can last 1-2 days.
Referral to a physician for further medical attention is
necessary
CAUSES OF NEUROPRAXIA AND TRANSIENT
QUADRIPARESIS
Spinal stenosis
 Congenital abnormality
 Cervical instability
 Interverterbal disk herniation
 Because most mechanisms causing cervical
spine injury involve forces to the head, injuries
to the head and neck must be considered
together

THORACIC SPINE INJURIES

Include the following
Contusions
 Sprains
 Strains


Symptoms include
Tenderness
 Spasms
 Increased pain with active
contraction or stretching
 Stiff back


Athlete should be referred to a
physician for further evaluation
LUMBAR SPINE INJURIES



Can be aggravated by
inadequate or inappropriate
conditioning, inflexibility,
congenital anomalies, and
poor postural habits
Contusions are more
common in the paraspinal
muscles, but may also occur
over the subcutaneous
spinous process
Severe injuries are extremely
rare in athletics.
SPONDYLOLYSIS




A defect in the pars interarticularis of the vertebrae; if
bilateral
It can allow the vertebrae to slip forward on the vertebrae of
the sacrum
Known as spondylolisthesis
Symptoms



Complaint of low back pain associated with increased activity
Pain radiating into the buttocks and upper thighs
Refer athletes to a physician for diagnosis
INTERVERTEBRAL DISC HERNIATION








Occurs when the nucleus pulposus
herniates, or protudes, through the
annulus fibrosus and presses against
the spinal cord or spinal nerve
Symptoms
Extreme pain and stiffness in the lower
back
Pain in the buttocks
Radiating leg pain
Pain is usually unilateral and follows the
route of the sciatic nerve
Possible unilateral weakness, sensory
loss, or reflex loss in the affected leg
Refer to a physician for further
evaluation
SACROILIAC INJURIES

Usually sprains to the SI
joint
 Occurs
as a result of acute
or chronic trauma

Symptoms
 Sacroiliac
pain
 Stiffness
 Soreness
of the SI joint
that diminishes during
activity
 Returns
down
as the athlete cools