The Spine

1
The Spine

• Chapter 25

2
Anatomy of the Spine

• 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

3
(No Transcript)
4
(No Transcript)
5

• 1. Disc
• 2. Body
• 3. Dura mater
• 4. Epidural space
• 5. Spinal cord
• 6. Subarchnoid space

6
Preventing Injuries to the Spine

• 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

7
Assessment of the Spine

• History very important R/O cord injury
• Observation
• posture and movement evaluation
• Fatback decrease lumbar curve with increase
  pelvic
• Swaybackhip exten. at hip, flex of thoracic on
  lumbar spine lumbar in lordosis, thoracic in
  kyphosis
• Lordosisincrease in lumbar curve
• Scoliosis lateral curvature of spine
• Kyphosis increase in thoracic curve

8

• Palpation proximal to distal muscles and bony
  prominence
• Special Tests
• stress tests
• Range of Motion
• Neurological Exam
• reflex

9
Injuries to the Spine

• Cervical Sprain (whiplash) cervical sprain
• Etiologysudden 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

10
Spine Injuries

• Acute Toticollis (Wryneck)
• Etiology cold draft of air or head in unusual
  position for extended period of time
• Signs and Symptomspoint tender, muscle spasm
• Management r/o more serious injury break pain
  spasm cycle
• Cervical Cord and Nerve Root Injuries
• Etiology
• 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

11
Injuries to the Spine

• 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
• 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

12
Injuries to the Spine

• 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

13
Injuries to the Spine

• Herniated Lumbar Disk usually L4-L5 or L5-S1
• Etiology forward bending and twisting
• Signs and SymptomsRadiating pain unilaterally
• Management pain control if persists, surgery
  may be indicated
• 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

14
Injuries to the Spine

• Coccyx Injuries sprain, subluxations, fractures
• Etiology direct impact
• Signs and Symptoms refer for x-ray, pain
• Management ring seat, analgesics
• 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

15
Rehabilitation Principles for the Spine

• Joint Mobilization (decrease pain, increase
  mobility, increase ROM)
• Flexibility Exercises
• Strengthening Exercises
• Techniques for the Low Back
• Pain Control (mobs, traction, modalities, etc)
• General Body Conditioning
• Joint Mobilization ? Traction
• Flexibility Exercises
• Strengthening Exercises