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The Spine

The Spine. Chapter 25. 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)

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The Spine

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

  4. 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

  5. Assessment of the Spine • History “very important” – R/O cord injury • Observation • posture and movement evaluation • Fatback: decrease lumbar curve with increase pelvic • Swayback:hip exten. at hip, flex of thoracic on lumbar spine; lumbar in lordosis, thoracic in kyphosis • Lordosis:increase in lumbar curve • Scoliosis: lateral curvature of spine • Kyphosis: increase in thoracic curve

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

  7. Injuries to the Spine Cervical Sprain (whiplash) –cervical sprain • Etiology:sudden 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

  8. Spine Injuries • Acute Toticollis (Wryneck) • Etiology: cold draft of air or head in unusual position for extended period of time • Signs and Symptoms:point 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

  9. 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

  10. 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

  11. Injuries to the Spine • Herniated Lumbar Disk: usually L4-L5 or L5-S1 • Etiology: forward bending and twisting • Signs and Symptoms:Radiating 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

  12. 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

  13. 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

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