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Chapter 9Chapter 9
Spinal InjuriesSpinal Injuries
ObjectivesObjectives
Describe the basic anatomy of the spine. Describe the basic anatomy of the spine. Explain common spinal injuries that occur Explain common spinal injuries that occur
with athletic participation. with athletic participation. Identify common signs and symptoms of Identify common signs and symptoms of
spinal injuries. spinal injuries. Explain the treatments performed by an Explain the treatments performed by an
ATC for specific spinal injuries. ATC for specific spinal injuries. Describe common postural problems. Describe common postural problems.
AnatomyAnatomy
Four segmentsFour segments Sacrum (tailbone)Sacrum (tailbone) Lumbar (lower spine)Lumbar (lower spine) Thoracic (middle Thoracic (middle
spine)spine) Cervical (upper/neck Cervical (upper/neck
spine)spine)
AnatomyAnatomy
Normal anatomical Normal anatomical alignment and alignment and muscular strength muscular strength keep the spine keep the spine alignedaligned
Normal alignment and Normal alignment and curvature is called curvature is called neutral spineneutral spine
BonesBones
Separated by disksSeparated by disks Held together by Held together by
ligamentsligaments Muscles also permit Muscles also permit
many movements and many movements and stabilize the spinestabilize the spine
7 cervical vertebrae7 cervical vertebrae 12 thoracic vertebrae12 thoracic vertebrae 5 lumbar vertebrae5 lumbar vertebrae 5 sacral (fused) vertebrae5 sacral (fused) vertebrae 4 coccyx (fused)4 coccyx (fused)
BonesBones
All vertebrae have a All vertebrae have a body, a spinous body, a spinous process, and a canal process, and a canal through which the through which the spinal cord passesspinal cord passes
FunctionsFunctions Protecting the spinal cordProtecting the spinal cord Hold body upright when Hold body upright when
walkingwalking Sight for muscle Sight for muscle
attachmentattachment
BonesBones
CervicalCervical C1= atlasC1= atlas C2= axisC2= axis C7= very prominent C7= very prominent
spinespine ThoracicThoracic
Large spinous Large spinous processesprocesses
LumbarLumbar Most chronic injuries Most chronic injuries
occur to this regionoccur to this region SacralSacral
Thoracic vertebraeThoracic vertebrae
Lumbar vertebraeLumbar vertebrae
Sacrum and coccyxSacrum and coccyx
Intervertebral DisksIntervertebral Disks
FunctionFunction Absorb shockAbsorb shock Resist compression Resist compression
during activityduring activity Keep vertebrae Keep vertebrae
separateseparate Allow for movement Allow for movement
and flexibilityand flexibility Provide space for Provide space for
nerves to exit the nerves to exit the spinal cord spinal cord
Intervertebral disksIntervertebral disks
Two specific partsTwo specific parts Nucleus pulposus (jelly-like core)Nucleus pulposus (jelly-like core) Annulus fibrosus ( layer rings of cartilage that Annulus fibrosus ( layer rings of cartilage that
surround the nucleus pulposus)surround the nucleus pulposus) Disks receive no blood supply, therefore Disks receive no blood supply, therefore
do not heal well when injureddo not heal well when injured Disks are compressibleDisks are compressible
Possible to be taller first thing in the morningPossible to be taller first thing in the morning Shorter with ageShorter with age
Nucleus pulposus and annulus Nucleus pulposus and annulus fibrosisfibrosis
MusclesMuscles
Numerous muscles Numerous muscles that provide a wide that provide a wide range of movements range of movements and stabilityand stability
Spine=mast on a shipSpine=mast on a ship
MastMast SpineSpine
Many cables that Many cables that attach at various attach at various pointspoints
Many muscles Many muscles attach to different attach to different places like pelvis, places like pelvis, legs, and armslegs, and arms
Cables Cables stabilize stabilize the sailsthe sails
Muscles stabilize Muscles stabilize spine while body spine while body performs performs functions like functions like throwing, throwing, catching, and catching, and kickingkicking
Provides stability Provides stability to ensure sails to ensure sails catch in the windcatch in the wind
Provides stability Provides stability to body so it can to body so it can function correctlyfunction correctly
MusclesMuscles Spinal extensorsSpinal extensors
Run entire length of spine Run entire length of spine posteriorlyposteriorly
Attach to ribs, pelvis, and Attach to ribs, pelvis, and vertebraevertebrae
Keep body uprightKeep body upright Upper trapezius Upper trapezius
Extends the cervical spineExtends the cervical spine Attaches to occipital bone and Attaches to occipital bone and
fans out to each side of neck and fans out to each side of neck and attaches on acromion process of attaches on acromion process of scapulascapula
MusclesMuscles
Scalene muscles ( 3 Scalene muscles ( 3 total each side)total each side) Cervical flexionCervical flexion Attach to cervical Attach to cervical
vertebrae and run vertebrae and run down to the first and down to the first and second ribssecond ribs
Help with breathing Help with breathing processprocess
MusclesMuscles
SternocleidomastoidSternocleidomastoid Cervical side bending Cervical side bending
and rotationand rotation Attaches to top of Attaches to top of
sternum and attaches sternum and attaches to mastoid process to mastoid process just behind earjust behind ear
MusclesMuscles
AbdominalsAbdominals Rectus abdominus and Rectus abdominus and
internal and external internal and external obliquesobliques
Support trunk Support trunk movementmovement
PosturePosture NormalNormal
Plumb line- imaginary vertical line that helps Plumb line- imaginary vertical line that helps determine posturedetermine posture
View from sideView from side Correct posture, plumb line should pass Correct posture, plumb line should pass
through these anatomical landmarksthrough these anatomical landmarks• Just behind earJust behind ear• Through center of shoulderThrough center of shoulder• Down through middle of the greater trochanter of Down through middle of the greater trochanter of
hiphip• Behind the patellaBehind the patella• Just in front of lateral malleolusJust in front of lateral malleolus
PosturePosture
AbnormalAbnormal Forward head postureForward head posture
• Ear projects in front of Ear projects in front of plumb lineplumb line
• Stresses back of neckStresses back of neck Rounded shouldersRounded shoulders
• Line passes through Line passes through back of shoulders back of shoulders instead of middleinstead of middle
PosturePosture
KyphosisKyphosis Excessive Excessive
rounding of the rounding of the thoracic spinethoracic spine
Decreases ability Decreases ability of spine to absorb of spine to absorb shock effectivelyshock effectively
More prone to More prone to injuryinjury
PosturePosture
LordosisLordosis Excessive forward Excessive forward
curve of the lumbar curve of the lumbar spinespine
Decreases ability of Decreases ability of spine to absorb shock spine to absorb shock effectivelyeffectively
More prone to injuryMore prone to injury
PosturePosture
ScoliosisScoliosis Side bend to spineSide bend to spine Looks crooked from a Looks crooked from a
posterior viewposterior view If undiagnosed and If undiagnosed and
suspect, should refer suspect, should refer for further assessmentfor further assessment
PosturePosture
Improving postureImproving posture Keep top of head as Keep top of head as
high as possiblehigh as possible Don’t always carry bag Don’t always carry bag
on same shoulderon same shoulder Regular exerciseRegular exercise Focus on good Focus on good
posture and it will posture and it will become habitbecome habit
Preventing spinal injuriesPreventing spinal injuries
Active processActive process Exercise Exercise Concentrate on flexibilityConcentrate on flexibility Maintain proper postureMaintain proper posture Use correct lifting techniquesUse correct lifting techniques Use back support if necessary when liftingUse back support if necessary when lifting
Injury prevention Injury prevention
Proper balance of muscles strength and flexibilityProper balance of muscles strength and flexibility Strong abs decrease stress on lumbar regionStrong abs decrease stress on lumbar region Hip strength also has effect on spineHip strength also has effect on spine Need to be strong and flexible Need to be strong and flexible
Injury preventionInjury prevention
Proper lifting proceduresProper lifting procedures Maintaining slight curve in lumbar spine while Maintaining slight curve in lumbar spine while
lifting with knees and hips…not backlifting with knees and hips…not back Keep head upKeep head up Injury most often occurs when spine is too Injury most often occurs when spine is too
rounded or flexed and causes a strain or disk rounded or flexed and causes a strain or disk injuryinjury
Back supports common in many work Back supports common in many work environmentsenvironments
Treatment of lumbar spine injuries Treatment of lumbar spine injuries and conditionsand conditions
Ligament injuriesLigament injuries
Often occur from Often occur from forced excessive forced excessive trunk flexion or flexion trunk flexion or flexion and rotation at the and rotation at the same timesame time Example: a football Example: a football
player tackled and player tackled and forced forwardforced forward
• Posterior aspect of the Posterior aspect of the vertebral joints can vertebral joints can separate and stretch separate and stretch ligamentsligaments
Ligament injuriesLigament injuries
Characteristics of a lumbar sprainCharacteristics of a lumbar sprain Pain to one side of the spinePain to one side of the spine Limited movement due to pain and muscle Limited movement due to pain and muscle
spasmspasm Often difficult to differentiate a sprain from a Often difficult to differentiate a sprain from a
strainstrain Can test by pushing each of the vertebrae Can test by pushing each of the vertebrae
anteriorly, should not be painfulanteriorly, should not be painful Do not perform if signs/symptoms of a fracture Do not perform if signs/symptoms of a fracture
are presentare present
Ligament injuriesLigament injuries
Treat like any other Treat like any other acute injuryacute injury PRICEPRICE Always use ice in first Always use ice in first
48 hours of an acute 48 hours of an acute injuryinjury
Return to activity Return to activity includesincludes Proper flexibilityProper flexibility Proper strengtheningProper strengthening Pain free motionPain free motion
Muscle and tendon injuriesMuscle and tendon injuries
Rare to see a ruptured muscle at the spineRare to see a ruptured muscle at the spine Characteristics of strainCharacteristics of strain
Pain to one sidePain to one side Muscle spasmMuscle spasm Lack of movementLack of movement Pain on the opposite side from the direction the Pain on the opposite side from the direction the
athlete bends (bend to right, pain on left)athlete bends (bend to right, pain on left) Pain from sprain usually localized (small area), pain Pain from sprain usually localized (small area), pain
from strain usually travels length of musclefrom strain usually travels length of muscle
Muscle and tendon injuriesMuscle and tendon injuries
Treat with PRICETreat with PRICE Return to activityReturn to activity
Proper stretchingProper stretching Proper strengtheningProper strengthening Pain free activityPain free activity
Observe athlete for proper posture and Observe athlete for proper posture and lifting techniquelifting technique
Bone InjuriesBone Injuries
Caused by Caused by CompressionCompression
• Forcefully landing on buttocksForcefully landing on buttocks Direct blowDirect blow
Bone injuriesBone injuries
SpondylolysisSpondylolysis Most common in gymnastsMost common in gymnasts Stress fracture at the pars interarticularisStress fracture at the pars interarticularis Fracture that fails to heal can separate, causing spinal Fracture that fails to heal can separate, causing spinal
instabilityinstability
SpondylolysthesisSpondylolysthesis
Occurs when a Occurs when a spondylolysis slips spondylolysis slips forward on the forward on the vertebrae below itvertebrae below it
Most often occurs Most often occurs when L5 slips forward when L5 slips forward on S1 (as shown)on S1 (as shown)
Bone injuriesBone injuries
Spondylolysis and spondylolisthesis are Spondylolysis and spondylolisthesis are serious injuriesserious injuries
Need physician examNeed physician exam Require rest and possible lumbar braceRequire rest and possible lumbar brace Extensive rehab strengthening trunk Extensive rehab strengthening trunk
musclesmuscles
Bulging diskBulging disk
Not common in young Not common in young athletesathletes
Some call slipped Some call slipped disk, not appropriate disk, not appropriate termterm
Nucleus pulposus Nucleus pulposus bulges through bulges through annulus fibrosisannulus fibrosis
Bulging diskBulging disk
Rarely bulges toward front of spineRarely bulges toward front of spine Covered with thick ligament (anterior longitudinal Covered with thick ligament (anterior longitudinal
ligament)ligament) Most people have postures that flex the spine forward Most people have postures that flex the spine forward
most of the time which pushes nucleus pulposus most of the time which pushes nucleus pulposus toward the posterior aspecttoward the posterior aspect
Puts pressure on the nerves exiting the spinal cordPuts pressure on the nerves exiting the spinal cord Causes numbness, tingling, and pain down the legCauses numbness, tingling, and pain down the leg Can cause low back pain that increases while sittingCan cause low back pain that increases while sitting
Bulging diskBulging disk
TreatmentTreatment Improve postureImprove posture Improve body mechanics and lifting Improve body mechanics and lifting
techniquestechniques RestRest Traction Traction StrengtheningStrengthening
Cervical spineCervical spine Ligament injuriesLigament injuries
Caused by forceful Caused by forceful movement beyond movement beyond normal rangenormal range
• HyperflexionHyperflexion• HyperextensionHyperextension
Cause neck and arm Cause neck and arm painpain
Always rule out spinal Always rule out spinal cord injurycord injury
PRICE, no CPRICE, no C Strengthen, regain full Strengthen, regain full
ROMROM
Cervical spineCervical spine
Return to activity guidelinesReturn to activity guidelines Full strengthFull strength Full ROMFull ROM Full confidenceFull confidence No symptomsNo symptoms Physician clearancePhysician clearance
Muscle and tendon injuriesMuscle and tendon injuries
Can also be caused by whiplashCan also be caused by whiplash CharacteristicsCharacteristics
Muscle spasmMuscle spasm Limited ROMLimited ROM Weakness against resistanceWeakness against resistance Pain and tendernessPain and tenderness Treat like a sprain (PRI)Treat like a sprain (PRI) Same return to activity guidelinesSame return to activity guidelines Manual resistance work well for rehabManual resistance work well for rehab
Bone injuriesBone injuries
FracturesFractures Often a result of axial Often a result of axial
loadingloading
DislocationsDislocations often result of a often result of a
combination of combination of excessive flexion and excessive flexion and rotationrotation
Fractures and dislocationsFractures and dislocations
Similar signs and Similar signs and symptomssymptoms Pain around cervical Pain around cervical
vertebraevertebrae WeaknessWeakness NumbnessNumbness Tingling down armsTingling down arms Dislocation usually has Dislocation usually has
deformitydeformity
Fractures and dislocationFractures and dislocation
Care/treatmentCare/treatment Immobilize and spineboardImmobilize and spineboard Helmet proceduresHelmet procedures Call EMSCall EMS
Disk injuriesDisk injuries
Not as common as in lumbar spineNot as common as in lumbar spine Person reports more neck pain with sitting Person reports more neck pain with sitting
and forward flexionand forward flexion Some discomfort down the back and Some discomfort down the back and
between the shouldersbetween the shoulders TreatmentTreatment
Improve postureImprove posture Cervical extension exercisesCervical extension exercises tractiontraction
Brachial plexus injuriesBrachial plexus injuries
Exit through the cervical spineExit through the cervical spine Stretching nerves causes stinger/burnerStretching nerves causes stinger/burner
Can last seconds or minutesCan last seconds or minutes Severe even longer (weeks)Severe even longer (weeks)
TreatmentTreatment StrengtheningStrengthening ROM stretchingROM stretching Neck roll (FB) to limit lateral flexionNeck roll (FB) to limit lateral flexion
Brachial plexusBrachial plexus
Return to play guidelinesReturn to play guidelines No symptomsNo symptoms Full strengthFull strength Full ROMFull ROM Problem-free neck and shoulder eval by ATC Problem-free neck and shoulder eval by ATC
and team physicianand team physician
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