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Chapter 20: The Spine

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Chapter 20: The SpineCharacteristics of VertebraeCervical Spine 1 and 2Slide 4Slide 5Slide 6Slide 7Slide 8Prevention of Injuries to the SpineSlide 10Slide 11Slide 12Assessment of the SpineSlide 14Slide 15Slide 16Postural MalalignmentsSlide 18Recognition and Management of Specific Injuries and ConditionsSlide 20Slide 21Slide 22Cervical Spine InjuriesSlide 24Slide 25Slide 26Brachial Plexus InjurySlide 28Slide 29Slide 30Slide 31Slide 32Slide 33Slide 34Slide 35Slide 36Slide 37Slide 38Slide 39Slide 40Sacroiliac Joint DysfunctionSlide 42Slide 43Chapter 20: The SpineCharacteristics of VertebraeCervical Spine 1 and 2Sacrum and CoccyxCurves in the SpineLordoticKyphoticLordoticLigamentous SupportMuscles of the SpineSpinal NervesPrevention 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)•Variety of exercises can be used to strengthen the neck–Range of Motion•Must have full ROM to prevent injury•Can be improved through stretching exercises–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; 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•ATC should establish corrective programs based on athlete’s anomalies•Basic conditioning should emphasize trunk flexibility•Spinal extensor and abdominal musculature strength should be stressed in order to maintain proper alignment–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 also be useful in providing added stabilization•Use of spotters when lifting•Core Stabilization–Core stabilization, dynamic abdominal bracing and maintaining neutral position can be used to increase lumbopelvic-hip stability–Increased stability helps the athlete maintain the spine and pelvis in a comfortable and acceptable mechanical position (prevents microtrauma)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–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•Observations–Body type–Postural alignments and asymmetries should be observed from all views–Assess height differences between anatomical landmarksPostural Malalignments•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 also be palpated bilaterally–Be aware of the possibility of referred painRecognition and Management of Specific Injuries and Conditions•Cervical Spine Conditions–Mechanisms of Injury•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•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 fractureCervical Spine InjuriesDislocation Bifacet fracture•Acute Strains of the Neck and Upper Back–Cause of Injury •Sudden turn of the head, forced flexion, extension or rotation•Generally involves upper traps, scalenes, splenius capitis and cervicis –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•Follow-up care will involve ROM exercises, isometrics which progress to a full isotonic strengthening program, cryotherapy and superficial thermotherapy, analgesic medications•Cervical Sprain (Whiplash)–Cause of Injury •Generally the same mechanism as a strain, but more violent•Involves a snapping of the head and neck - compromising the anterior or posterior longitudinal ligament, the interspinous ligament and the supraspinous ligament–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 NSAID’s, mechanical traction•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


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