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Chapter 10
Injuries to the Spine
Back and Spine
Bones of the Spine
Cervical Spine
• The cervical spine is
made up of 7 separate
vertebrae that support
the base of the skull
and make up the neck
Thoracic Spine/Ribs
• The thoracic spine is
made up of 12
vertebrae.
• Each vertebrae
corresponds with a pair
of ribs and the sternum
to form the thoracic
cage (rib cage).
• 10 pair of true ribs
• 2 pair of floating ribs
Lumbar Spine
• The lumbar spine is
made up of 5 separate
vertebra that support
the majority of motion,
weight, and stress
created by everyday
activities and sport.
Sacrum and Coccyx
• The Sacrum consists of
five fused vertebrae.
• The Sacrum connects the
spinal column to the
pelvis.
• Right and left sacroiliac
(SI) joints are formed by
the union of the sacrum
and pelvis.
• The Coccyx (tailbone) is
most distal portion of the
vertebral column.
The Vertebrae
Pars
Interarticularis
Intervertebral Disc
• The intervetebral disc
is located between
majority of the
vertebrae.
• The discs are made
up of a thick cartilage
that act as a shock
absorber for the spine.
Intervertebral Disc
• The intervertebral disc has 2
sections.
• Nucleus
• Inner section of
intervertebral disc that
is jelly like and consist
of approximatley 80%
water and 20%
cartilage
• Annulus
• Outer section of
intervertebral disc that
is made up of primarily
cartilage
Ligaments of the Back
• There are 2 primary
ligaments of the spine
• Anterior Longitudinal
Ligament
• Posterior Longitudinal
Ligament
Motions of the Back
Superficial Muscles of the Back
The 2 largest muscles that act
on the back are the:
• Trapezius
• Fans along neck,
shoulders and midback
• Latissimus Dorsi
• Fans along mid and
lower back while
connecting on the ribs
They help perform all back
motions except back flexion
Deep Muscles of the Back
There are 2 primary muscle
groups that make up the deep
muscles of the back:
• Paraspinals
• Very small group of muscles
that run along the spinous
and transverse processes of
the spine
• Erector Spinae
• Small group of muscles that
run along the spine and ribs
These muscles perform back extension
Muscles of the Abdomen
The abdomen is made up of
3 primary muscles:
•
•
•
Rectus Abdominus
• 6-pack muscle
• Helps perform back flexion
Transverse Abdominus
• Muscle that wraps around the
torso like a belt to provide
support
• Helps in stability of core
• Helps to perform back rotation
and lateral flexion
Obliques
• Diagonal running muscles that
originate from the spine and
ribs
• Helps to perform back rotation
and lateral flexion
Core Muscles
• The core is a group of
muscles that create a
foundation of support from
all sides of the body in
order to generate power
and protect from injury
• Includes:
• Paraspinals
• Erector spinae
• Obliques
• Rectus abdominus
• Glutes
Spinal Fractures
Skeletal Injuries of the vertebrae
• Compression fractures of the
vertebral body are most
common injury.
• Such fractures usually occur at
junction of thoracic and lumbar
spine.
• Athlete with recent history of
trauma to the region in
conjunction with pain or
numbness should be referred to
a physician.
Spinal Fractures Cont.
• External blows may result in internal injury.
• Deep abdominal pain, hematuria, and shock
are signs and symptoms of internal injury.
• Immobilize on spine board and transport to
medical facility.
• Blows to the coccyx can result from landing on
the buttocks.
• Fractures of the coccyx result in severe pain,
point tenderness, swelling, and bruising. Refer
athlete to physician for evaluation.
Rib Fractures
• Such fractures are associated with direct
blows to lateral or posterior thorax and can
occur anywhere along the rib.
• The ribs commonly fracture near the
anatomic angle, which is the weakest point.
• Posterior rib fractures can potentially result in
a pneumothorax or hemothorax.
Rib Fractures (cont.)
Signs and symptoms include:
• Painful respiration.
• Deformity in the region of the injury,
including a protruding rib or depression
where the normal contour of the rib should
be.
• Swelling and discoloration.
• Pain when rib cage is gently compressed.
Rib Fractures (cont.)
First Aid
• Immediate application of RICE.
• Treat for shock.
• Refer athlete to physician.
Spondylolysis and
Spondylolisthesis
• Spondylolysis is a defect in
the neural arch (pars
interarticularis). Such
defects compromise the
articulation between two
vertebrae.
• If the condition is bilateraI,
the affected vertebra can
slip forward resulting in
spondylolisthesis.
Spondylolysis and
Spondylolisthesis
• Symptoms include
(cont.)
lower back pain that
worsens during
hyperextension, and
radiating pain to the
buttocks and upper
thighs.
• Treatment includes
rest, drug therapy,
lumbar bracing,
exclusion from certain
sports, and surgery.
Sprains
Sprains occur whenever a joint is forced beyond
its normal ROM resulting in damage to
ligaments and joint capsules.
• Evaluation of a sprain to the thoracic spine
is difficult.
• A consistent symptom is painful
respiration.
First Aid
• Apply RICE.
• If dyspnea persists for more than 24 hours,
refer the athlete to a physician.
Strains
• Involve contractile tissue and their
support structures, such as the erector
spinae and intercostals.
• Are related to maximal exertions.
• Result in muscle spasm and point
tenderness.
• First Aid
• Application of RICE to the injured area.
Strains & Sprains
Sprains occur whenever a joint is forced
beyond its normal ROM resulting in
damage to ligaments and joint
capsules.
• Evaluation of a sprain is difficult.
• A consistent symptom is painful
respiration.
Strains involve contractile tissue and
their support structures, such as the
erector spinae and paraspinals.
• Are related to maximal exertions.
• Result in muscle spasm and point
tenderness.
Strains & Sprains (cont.)
Signs and symptoms include:
• Localized muscle spasm.
• Pain that does not radiate into buttocks or lower
extremity.
• Acute postural abnormalities associated with
recent trauma.
First Aid
• Have athlete maintain a supine position with soft
support for lumbar region and application of ice.
• If not improved or if dyspnea persists for more than
24 hours, refer the athlete to a physician.
Disk Injuries
A serious form of soft tissue
injury is a herniated disk,
aka; slipped, protruding,
bulging disk.
• Most commonly occurs
at L4 or L5.
Four stages:
• Degeneration, prolapse,
extrusion, sequestration.
Disk Injuries (cont.)
• Herniation results from a weakened annulus
that allows nucleus pulposus to protrude
through the wall of the annulus.
• Protrusion may put pressure directly on spinal
nerves resulting in:
• Intense local or radiating pain.
• Sensory loss or burning/tingling sensation
in lower extremity.
• Muscle spasm and postural abnormalities.
Disk Injuries (cont.)
First Aid
• Place athlete in supine or most comfortable
position. Support lumbar region with rolled
towel or other soft material.
• Apply crushed ice to lumbar region.
• Arrange for transport to medical facility.