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The spine

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by

Lindsey Pugh

on 22 April 2014

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Transcript of The spine

The Spine
Warm Up
1) What are the 5 sections on the spine?
2) How many MOVEABLE vertebra are there in the spine?
3)How many ribs are there on each side?
4)Which section of the spine do the ribs connect to?
5) What are the first two vertebra called?
Anatomy
Head
Vertebral Disk
(Jelly Donut)
Functional Anatomy
Movements
Flexion
Extension
Lateral Flexion
Lateral Extension
Injury Prevention
Muscle Strengthening
Avoid activities that put the neck in an abnormal position.
Have good ROM
Use correct technique (lifting)
Avoid using the neck as a weapon
Maintain a strong core
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
If the athlete has a positive response to any of these questions use extreme caution when moving the athlete.
History
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
Observation
Body type
Postural alignments and asymmetries should be observed from all views
Assess height differences between anatomical landmarks
Injuries
Cervical Fractures
MOI
Generally an axial load w/ some degree of cervical flexion
Signs and Symptoms
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
Treatment
Treat like an unconscious athlete until otherwise rule out - use extreme care
Cervical Dislocation
MOI
Usually the result of violent flexion and rotation of the head
Signs and Symptoms
Unilateral dislocation causes the head to be tilted toward the dislocated side with extreme muscle tightness on the elongated side
Treatment
Extreme care must be used - more likely to cause spinal cord injury than a fracture
Warm Up
1) What is the most common MOI for
a cervical fracture.
2) What is the difference between a quadriplegic and a paraplegic? Where would each injury likely occur?
3)What is more likely to cause paralysis, a cervical dislocation or fracture? why?
4) What are three questions you might ask to rule out a spinal cord injury?
Upper Back
&
Neck Strains
Moi - Sudden turn of the head, forced flexion, extension or rotation
Generally involves upper traps, scalenes, splenius capitis and cervicis
Signs and Symptoms - Localized pain and point tenderness, restricted motion, reluctance to move the neck in any direction
Treatment -
RICE and application of a cervical collar
Follow-up care will involve ROM exercises, isometrics which progress to a full isotonic strengthening program, cryotherapy and superficial thermotherapy, analgesic medications
Cervical Strain
(whiplash)
MOI
Generally the same mechanism as a strain, just move violent.
Involves a snapping of the head and neck.
Signs and Symptoms
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)
Treatment
Rule out fracture, dislocation, disk injury or cord injury RICE for first 48-72 hours, possibly bed rest if severe enough, analgesics and NSAID’s, mechanical traction
Disk Injuries
MOI
Herniation that develops usually from degeneration of the disk
MOI involves sustained repetitive cervical loading and abnormal stresses such as side bending and twisting.
Signs and Symptoms
Neck pain w/ some restricted ROM
Radicular pain in the upper extremity and associated motor weakness
Forward bending and sitting increase pain, while back extension reduces pain
Decreased muscle strength and tendon reflexes; Valsalva maneuver increases pain
Treatment
Rest and immobilization to decrease discomfort
Mobilization and traction to help reduce symptoms and regain motion
If conservative treatment is unsuccessful or neurological deficits increase surgery may be needed
Spondylolysis
&
Spondylolisthesis
Spondylolysis
Spondylolisthesis
Spondylolisthesis

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
MOI
Signs and Symptoms
Pain and persistent aching, low back stiffness with increased pain after activity
Full ROM w/ some hesitation in regards to flexion
Localized tenderness and some possible segmental hypermobility
Step off deformity may be present
Treatment
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
Scoliosis
MOI
In the case of the most common form of scoliosis, adolescent idiopathic scoliosis, there is no clear causal agent.
Scoliosis is more often diagnosed in females and is often seen in patients with cerebral palsy or spina bifida.
Signs and Symptoms
Uneven musculature on one side of the spine
A rib "hump" (Pectus carinatum) and/or a prominent shoulder blade, caused by rotation of the ribcage in thoracic scoliosis
Uneven hip, rib cage, and shoulder levels
Unequal distance between arms and body
Slow nerve action (in some cases)
Different heights of the shoulders
Treatment
Observation (with physical therapy)
Bracing
Surgery
30 degrees
53 degrees
15 degrees
15 degrees
Spina Bifida
developmental birth defect involving the neural tube: incomplete closure of the embryonic neural tube results in an incompletely formed spinal cord.
the vertebrae overlying the open portion of the spinal cord may not fully form and remain unfused and open.
The abnormal portion of the spinal cord may stick out through the unformed vertebrae.
MOI
S/S
most common location of the malformations is the lumbar and sacral areas of the spinal cord.
varying degrees of paralysis, absence of skin sensation, and poor or absent bowel and/or bladder control as well as curvature of the spine
Fauns Beard
Tx
There is no known cure for nerve damage due to spina bifida.
Surgery to close opening in back.
Most affected individuals will require braces, crutches, walkers or wheelchairs to maximize their mobility.
The higher the level of the spina bifida defect the more severe the paralysis.
Sciatica
Inflammation of the sciatic nerve
Often incorrectly used as a general term for low back pain.
Usually caused from nerve root compression due to an intervertebral disk protrusion that presses on the sciatic nerve.
Also can be caused from a tight piriformis muscle.
MOI
S/S
Can either begin abruptly or gradually
Sharp shooting pain
Radiating pain down the posterior and medial thigh.
Straight leg raises usually intensify the pain.
Tx
Rest
Treat the cause of the inflammation (lumbar traction?)
Stretch tight piriformis muscle
Oral anti inflammatory medications.
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