Chapter 25: The Spine

Anatomy of the Spine

Lumbar reclining

Spinal Curvitures

Functional Anatomy of the Spine

ÄMovements of the spine include flexion, extension, right and left lateral flexion and right and left lateral rotation

–Minimal movement w/in the thoracic region

ÄMovement of the spine and muscle contributions

ÄSuperficial and deep musculature functioning and abdominal muscular functioning

–Flexion and extension

–Trunk rotation and lateral flexion

Prevention of Injuries to the Spine

ÄCervical Spine

–Muscle Strengthening

ÄMuscles of the neck resist hyperflexion, hyperextension and rotational forces

ÄPrior to impact the athlete should brace by ≥bulling≤ the neck (isometric contraction of neck and shoulder muscles)

ÄVaried of exercises can be used to strengthen the neck

–Range of Motion

ÄMust have full ROM to prevent injury

ÄCan be improved through stretching

–Using Correct Technique

ÄAthletes should be taught and use correct technique to reduce the likelihood of cervical spine injuries

ÄAvoid using head as a weapon, diving into shallow water

Lumbar Spine

–Avoid Stress

ÄAvoid unnecessary stresses and strains of daily living

ÄAvoid postures and positions that can cause injury

–Correction of Biomechanical Abnormalities

ÄATC should establish corrective programs based on athleteπs anomalies

ÄBasic conditioning should emphasize trunk flexibility

ÄSpinal extensor and abdominal musculature strength should be stressed in order to maintain proper alignment

Using Correct Lifting Techniques

ÄWeight lifters can minimize injury of the lumbar spine by using proper technique

ÄIncorporation of appropriate breathing techniques can also help to stabilize the spine

ÄWeight belts can also be useful in providing added stabilization

ÄUse of spotters when lifting

–Core Stabilization

ÄCore stabilization, dynamic abdominal bracing and maintaining neutral position can be used to increase lumbopelvic-hip stability

ÄIncreased stability helps the athlete maintain the spine and pelvis in a comfortable and acceptable mechanical position (prevents microtrauma)

ÄObservations

–Body type

–Postural alignments and asymmetries should be observed from all views

–Assess height differences between anatomical landmarks

Postural Malalignments

ÄCervical Spine Evaluation

Lumbar Spine and Sacroiliac Joint Observations

–Coordinated movement of the low back involves the pelvis, lumbar spine and sacrum

–Equal levels (shoulders and hip)

–Symmetrical soft tissue structures bilaterally

–Observe athlete seated, standing, supine, side-lying, and prone (leg position - contractures)

–75% of the back flexion occurs at L5-S1.

Special Tests - Cervical Spine

–Brachial Plexus Test

ÄApplication of pressure to head, neck and shoulders to re-create MOI

ÄLateral flexion of the neck w/ same side pain indicates a compression injury

ÄLateral flexion of the neck w/ opposite side pain indicates stretch or traction injury

–Cervical Compression and Spurlingπs Test

ÄCompression of cervical spine compresses facets and spinal roots

ÄLevel of pain determines specific nerve root impingement

ÄSpurlingπs adds a rotational component to the cervical compression

Shoulder Abduction Test

Test Done in Standing Position

–Forward bending

ÄObserve movement of PSIS, test posterior spinal ligaments

–Backward bending

ÄAnterior ligaments of the spine

ÄDisk problem

–Side bending

ÄLumbar lesion or sacroiliac dysfunction

–Standing Trunk Rotation

ÄAssessment of symmetrical motions w/out pelvic movement

Test Done in Sitting Position

–Forward bending - PSIS motions and restrictions

–Rotation - lumbar spine motion symmetry

–Hip Rotation - IR and ER to assess integrity and status of the piriformis muscle

–≥Sign of the Butt≤ - used to assess potentially serious hip pathology

ÄPain w/ passive ROM, straight leg raise, and hip flexion w/ knee flexion

ÄCapsular pattern= limitation of flexion, abduction, internal rotation w/ slight limitations in hip extension and no limitation of external rotation

ÄNon-capsular pattern of limitation - gross limitation in all ranges

ÄExternal rotation limitation is the key motion lost in this test

Slump Test: detects neural tension as a result of spinal stenosis.

Well Straight Leg Raising Test

Milgram and Hoover Straight Leg Raising Test

Knee to Chest

Pelvic Tilt Test

Tests Done in Prone Position

Prone Knee Flexion Test

Iliotibial Band Stretch Test

Neurological Exam

Sensation Testing

ÄIf there is nerve root compression, sensation can be disrupted

Reflex Testing

ÄThree reflexes in the upper extremity include the biceps, brachioradialis and triceps reflexes

–Tests C5, C6, and C7 nerve roots respectively

ÄThe two reflexes to be tested in the lower extremity are the patellar tendon and Achilles tendon reflexes

–Used to assess the L4 and S1 nerve root respectively

Recognition and Management of Specific Injuries and Conditions

ÄCervical Spine Conditions

–Mechanisms of Injury

ÄCervical Fractures

ÄCervical Dislocation

ÄCervical Sprain (Whiplash)

ÄCervical Cord and Nerve Root Injuries

ÄBrachial Plexus Neurapraxia (Burner)

ÄCervical Disk Injuries

Thoracic Spine Conditions

ÄDorsolumbar Kyphosis

ÄKyphosis of the thoracic spine and lumbar lordosis w/out back pain

ÄProgresses to point tenderness of the spinous processes; young athlete may complain of backache at the end of a very physically active day

ÄHamstring muscles are characteristically tight

Lumbar Spine Conditions

ÄLow Back Pain

ÄLumbar Vertebrae Fracture and Dislocation

ÄManagement

–X-ray and physician referral

–Transport with extreme caution and care to minimize movement of the segments

ÄLow Back Muscle Strain

ÄLumbar Strains

ÄBack Contusions

Sciatica

ÄArises abruptly or gradually; produces sharp shooting pain, tingling and numbness

ÄSensitive to palpation while straight leg raises intensify the pain

–Management

ÄRest is essential acutely

ÄTreat the cause of inflammation; traction if disk protrusion is suspected; NSAIDπs

Herniated Disk

–Etiology

ÄCaused by abnormal stresses and degeneration due to use (forward bending and twisting)

Management of disk herniation

Spondylolysis and Spondylolisthesis

Sacroiliac Joint Dysfunction

Sacroiliac Sprain

Management

–Modalities can be used to reduce pain

–Bracing can be helpful in acute sprains

–SI joint must be mobilized to correct positioning

–Strengthening exercises should be used to stabilize the joints

Coccyx Injuries

Rehabilitation Techniques for the Neck

Joint Mobilizations

Strengthening Exercises

Progressive relaxation techniques

Traction

Flexibility

Flexion Exercise

Neuromuscular Control

Functional Progressions

ÄProgression of stabilization exercises should move from supine activities, to prone activities, to kneeling and eventually to weight-bearing activities

ÄStabilization exercises must be the foundation and should be incorporated into each drill

Return to Activity

ÄAcute sprains and strains of the back take the same amount of time to heal as most extremity injuries

ÄWith chronic or recurrent injuries, return to full activity can be frustrating and time consuming

ÄExtensive amounts of time and education concerning skills and techniques of the athlete will be required to achieve a full return to activity