2007 McGraw-Hill Higher Education. All rights reserved. Anatomy
of the Spine http://youtu.be/aDvbAvBLQuM
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Ligaments and Vertebral Discs
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Muscular Anatomy
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Neurological Anatomy
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Prevention of Injuries to the Spine Cervical Spine Muscle
Strengthening Muscles of the neck resist hyperflexion,
hyperextension and rotational forces Prior to impact the athlete
should brace by bulling the neck (isometric contraction of neck and
shoulder muscles) Exercises can be used to strengthen the neck
Range of Motion Must have full ROM to prevent injury improved
through stretching exercises
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Prevention of Injuries to the Spine Using Correct Technique
Athletes should be taught and use correct technique to reduce the
likelihood of cervical spine injuries Avoid using head as a weapon
Spearing in football, diving into shallow water Lumbar Spine Avoid
Stress Avoid unnecessary stresses and strains of daily living Avoid
postures and positions that can cause injury Strength and
Flexibility Basic conditioning should emphasize trunk flexibility
Spinal and Core strength should be stressed in order to maintain
proper alignment
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2007 McGraw-Hill Higher Education. All rights reserved.
Prevention of Injuries to the Spine Using Correct Lifting
Techniques Weight lifters can minimize injury of the lumbar spine
by using proper technique Incorporation of appropriate breathing
techniques can also help to stabilize the spine Weight belts can be
useful in providing stabilization Use spotters when lifting Core
Stabilization Core stabilization, dynamic abdominal bracing and
maintaining neutral position can be used to increase
lumbo-pelvic-hip stability Increased stability helps the athlete
maintain the spine and pelvis in a comfortable and acceptable
mechanical position (prevents microtrauma)
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Assessment of the Spine History Mechanism of injury (rule out
spinal cord injury) What happened? Did you hit someone or did
someone hit you? Did you lose consciousness Pain in your neck?
Numbness, tingling, burning? Can you move your ankles and toes? Do
you have equal strength in both hands Positive responses to any of
these questions will necessitate extreme caution when the athlete
is moved
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Assessment of the Spine Other general questions Where is the pain
and what kind of pain are you experiencing? What were you doing
when the pain started? Did the pain begin immediately and how long
have you had it? Positions or movements that increase/decrease
pain? Past history of back pain Sleep position and patterns, seated
positions and postures
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Assessment of the Spine Observations Body type Postural alignments
and asymmetries should be observed from all views Assess height
differences between anatomical landmarks
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Assessment of the Spine Palpation Should be performed with athlete
prone Head and neck should be slightly flexed, pillow under hips if
suffering from low back pain Spinous and transverse processes of
each vertebrae should be palpated along with sacrum and coccyx
Muscles should be palpated bilaterally Be aware of the possibility
of referred pain
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2007 McGraw-Hill Higher Education. All rights reserved.
Assessment of the Spine Special Tests Test for lumbar spine should
be performed standing, sitting, supine, side-lying and prone Assess
levels of pain and motion restriction during the following tests
Forward and backward bending Side-bending and rotation
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Test Straight Leg Raises Applies pressure to SI joint and may
indicate problems with sciatic nerve, SI joint or lumbar spine
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Compression and Distraction Tests Used for pathologies involving
the SI joint Distraction Compression
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Brachial Plexus Traction/Compression Test
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Test Athlete Position: Supine Athletic Trainer Position: Supporting
the ankle of each leg while standing at athletes feet. Procedure:
Athlete is asked to perform a unilateral straight leg raise
actively on the involved extremity. Test is positive if: The
athlete does not push down on the uninvolved leg or athlete does
not attempt this maneuver. Implications: The athlete is
malingering.
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2007 McGraw-Hill Higher Education. All rights reserved. Fabers
Test FABERS : Flexion Abduction External Rotation Assess SI joint
pathology
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Recognition and Management of Specific Injuries and Conditions
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Cervical Spine Injuries Cervical Fractures Cause of Injury
Generally an axial load w/ some degree of cervical flexion Addition
of rotation may result in dislocation Signs of Injury Neck point
tenderness, restricted motion, cervical muscle spasm, cervical
pain, pain in the chest and extremities, numbness in the trunk and
or limbs, weakness in the trunk and/or limbs, loss of bladder and
bowel control Care Treat like an unconscious athlete until
otherwise ruled out - use extreme care Spine Board and
transport
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Cervical Fracture and Dislocation
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Cervical Spine Injuries Cervical Dislocation Cause of Injury
Usually the result of violent flexion and rotation of the head
Signs of Injury Considerable pain, numbness, weakness, or paralysis
Unilateral dislocation causes the head to be tilted toward the
dislocated side with extreme muscle tightness on the elongated side
Care Extreme care must be used - more likely to cause spinal cord
injury than a fracture
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2007 McGraw-Hill Higher Education. All rights reserved.
Cervical Spine Injuries Acute Strains of the Neck and Upper Back
Cause of Injury Sudden turn of the head, forced flexion, extension
or rotation Generally involves upper trapezius Signs of Injury
Localized pain and point tenderness, restricted motion, reluctance
to move the neck in any direction Care RICE and application of a
cervical collar in severe cases Follow-up care will involve ROM
exercises, isometrics which progress to a full isotonic
strengthening program, cryotherapy and superficial thermotherapy,
analgesic medications
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2007 McGraw-Hill Higher Education. All rights reserved.
Cervical Spine Injuries Cervical Sprain (Whiplash) Cause of Injury
Generally the same mechanism as a strain, just move violent
Involves a snapping of the head and neck Signs of Injury Similar
signs and symptoms to a strain - however, they last longer
Tenderness over the transverse and spinous processes Pain will
usually arise the day after the trauma (result of muscle spasm)
Management Rule out fracture, dislocation, disk injury or cord
injury RICE for first 48-72 hours, possibly bed rest if severe
enough Analgesics and NSAIDs, mechanical traction
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2007 McGraw-Hill Higher Education. All rights reserved.
Cervical Spine Injuries Acute Torticollis Cause of Injury Pain on
one side of the neck upon wakening Result of synovial capsule
impingement w/in a facet Signs of Injury Palpable point tenderness
and muscle spasm, restricted ROM, muscle guarding, Care Variety of
techniques including traction, superficial heat and cold
treatments, NSAIDs Use of a soft collar can be helpful as well May
last 2-3 days Gradual strengthening and stretching exercises should
be utilized for neck and shoulders for prevention
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2007 McGraw-Hill Higher Education. All rights reserved.
Cervical Spine Injuries Pinched Nerve (Brachial Plexus Injury)
Cause of Injury Result of stretching or compression of the brachial
plexus Referred to as stinger or burner Signs of Injury Burning
sensation, numbness and tingling as well as pain extending from the
shoulder into the hand Some loss of function of the arm and hand
for several minutes Symptoms rarely persist for several days
Repeated injury can result in neuritis, muscular atrophy, and
permanent damage Care Return to activity once S&S have returned
to normal Strengthening and stretching program Padding to limit
neck ROM during impact
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Lumbar Spine Conditions
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Spine Conditions Low Back Pain Cause of Injury
Congenital/biomechanical anomalies Mechanical defects of the spine
(posture, obesity and body mechanics) Back trauma Recurrent and
chronic low back pain Signs of Injury Pain, possible weakness,
antalgic gait, ligament sprain, muscle strains and bony defects
Neurological signs and symptoms if it becomes disk related Care
Correct alignments and body mechanics (better posture, lifting
techniques, lose weight, etc) Strengthening and stretching avoid
unnecessary stresses and strains associated with daily living
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2007 McGraw-Hill Higher Education. All rights reserved. Lumbar
Spine Conditions Lumbar Vertebrae Fracture and Dislocation Cause
Compression fractures or fracture of the spinous or transverse
processes Compression fractures are usually the result of trunk
hyperflexion or falling from a height Fractures of the processes
are generally the result of a direct blow Stress from improper
lifting or too much weight Dislocations tend to be rare
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2007 McGraw-Hill Higher Education. All rights reserved. Lumbar
Fractures
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2007 McGraw-Hill Higher Education. All rights reserved. Lumbar
Spine Conditions Signs of Injury Compression fractures will require
X-rays for detection Point tenderness over the affected area
Palpable defects over the spinous and transverse processes
Localized swelling and guarding Care X-ray and physician referral
Transport with extreme caution and care to minimize movement of the
segments Utilize a spine board
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2007 McGraw-Hill Higher Education. All rights reserved. Lumbar
Spine Conditions Low Back Muscle Strain Cause of Injury Sudden
extension contraction overload generally in conjunction w/ some
type of rotation Chronic strain associated with posture and
mechanics Signs of Injury Pain may be diffuse or localized; pain w/
active extension and passive flexion Care RICE to decrease spasm;
followed by a graduated stretching and strengthening program
Elastic wrap/back brace may be useful for support and compression
Complete bed rest may be necessary if it is severe enough
NSAIDs
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2007 McGraw-Hill Higher Education. All rights reserved. Lumbar
Spine Conditions Lumbar Strains Cause of Injury Forward bending and
twisting can cause injury Chronic or repetitive in nature Improper
lifting techniques Signs of Injury Localized pain lateral to the
spinous process Pain becomes sharper w/ certain movements or
postures Care RICE, joint mobes, strengthening for abdominals,
stretching in all directions Trunk stabilization exercises Braces
should be worn early to provide support Will require time for
healing
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2007 McGraw-Hill Higher Education. All rights reserved. Lumbar
Spine Conditions Back Contusions Cause of Injury Significant impact
or direct blow to the back Signs of Injury Pain, swelling,
discoloration, muscle spasm and point tenderness Management RICE
for the first 72 hours Ice massage combined with gradual stretching
Recovery generally last 2 days to 2 weeks
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2007 McGraw-Hill Higher Education. All rights reserved. Lumbar
Spine Conditions Sciatica Cause of Injury Inflammatory condition of
the sciatic nerve Nerve is vulnerable to torsion or direct blows
that place abnormal amounts of stretching or pressure on nerve
Signs of Injury Arises abruptly or gradually; produces sharp
shooting pain, tingling and numbness Sensitive to palpation with
straight leg raises intensifying the pain Care Rest is essential
acutely recovery = 2-3 weeks Treat the cause of inflammation;
traction if disk protrusion is suspected; NSAIDs
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Sciatica / Sciatica Nerves
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2007 McGraw-Hill Higher Education. All rights reserved. Lumbar
Spine Conditions Herniated Disk Cause of Injury Caused by abnormal
stresses and degeneration due to use (forward bending and twisting)
Improper lifting techiques Over weight
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2007 McGraw-Hill Higher Education. All rights reserved. Lumbar
Spine Conditions Signs of Injury Centrally located pain that
radiate unilaterally in dermatomal pattern Symptoms are worse in
the morning Onset is sudden or gradual, pain may increase after the
athlete sits and then tries to resume activity Forward bending and
sitting increase pain, while back extension reduces pain Straight
leg raise to 30 degrees is painful Care Rest and ice for pain
management Extension exercises may be comfortable Core
stabilization exercises should be integrated as athlete
improves
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2007 McGraw-Hill Higher Education. All rights reserved. Lumbar
Spine Conditions Spondylolysis and Spondylolisthesis Cause of
Injury Spondylolysis refers to degeneration of the vertebrae due to
congenital weakness (stress fracture results) Slipping of one
vertebrae above or below another is referred to as
spondylolisthesis and is often associated with a spondylolysis
Signs of Injury Pain and persistent aching, low back stiffness with
increased pain after activity Frequent need to change position or
pop back to reduce pain Localized tenderness to one segment
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Spondylolysis
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Spondylolisthesis
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2007 McGraw-Hill Higher Education. All rights reserved. Lumbar
Spine Conditions Care Bracing and occasionally bed rest for 1-3
days will help to reduce pain Major focus should be on exercises
directed as controlling or stabilizing hypermobile segments
Progressive trunk strengthening, dynamic core strengthening,
concentration on abdominal work Braces can also be helpful during
high level activities Increased susceptibility to lumbar strains
and sprains and thus vigorous activity may need to be limited
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2007 McGraw-Hill Higher Education. All rights reserved.
Sacroiliac and Coccyx Injuries Sacroiliac Sprain Cause of Injury
Result of twisting with both feet on the ground, stumbles forward,
falls backward, steps too far down, heavy landings on one leg,
bends forward with knees locked during lifting Signs of Injury
Palpable pain and tenderness over the joint, medial to the PSIS w/
some muscle guarding Pelvic asymmetries are possible
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2007 McGraw-Hill Higher Education. All rights reserved.
Sacroiliac and Coccyx Injuries Care Ice can be used to reduce pain
Bracing can be helpful in acute sprains Strengthening exercises
should be used to stabilize the joints
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2007 McGraw-Hill Higher Education. All rights reserved.
Sacroiliac and Coccyx Injuries Coccyx Injuries Cause of Injury
Generally the result of a direct impact which may be caused by
forcibly sitting down, falling, or being kicked by an opponent
Signs of Injury Pain is often prolonged and at times chronic
Tenderness over the bone and pain with sitting Care Analgesics and
a ring seat to relieve pressure while sitting Pain from a fractured
coccyx could last months May require protective padding to prevent
further injury