THE THE SPINESPINE

Chris A. Gillespie, MEd, ATC, LATDirector, Athletic Training Education

Samford University

SKELETAL ANATOMY OF THE SPINE

• CERVICAL SPINE• THORACIC SPINE• LUMBAR SPINE• SACRUM• COCCYX

ADDITIONAL ANATOMY• ARTICULATIONS &

LIGAMENTS• INTERVERTEBRAL

DISKS• MUSCULATURE• NEUROANATOMY• THE LINKAGE SYSTEM• SUM OF THE PARTS IS

GREATER THAN THE INDIVIDUAL PARTS

NEUROANATOMY OF THE SPINE

• Sensory• Motor• Reflexes• Extremely

Important• Make a mistake

here and someone could die or….

NEUROANATOMY OF THE SPINE

“A CLOSER LOOK”

MOVEMENTS OF THE SPINE• FLEXION• EXTENSION• LATERAL FLEXION

(RIGHT & LEFT)• ROTATION (RIGHT

& LEFT)• CIRCUMDUCTION• INTERVERTEBRAL

MOTION SEGMENTS

ANATOMICAL VARIATIONS

• LORDOSIS• KYPHOSIS• SCOLIOSIS• PARS DEFECTS• SPINAL

STENOSIS

INJURIES OF THE SPINEINJURIES OF THE SPINE

Most of the injuries of the spine that we deal

with on a daily basis are minor, yet the

significant injuries are the ones that we

remember the most.

MECHANISMS OF INJURY

• AXIAL LOADING• HYPEREXTENSION• FLEXION• ROTATIONAL STRESS• LATERAL BENDING• DYNAMIC OVERLOAD• DIRECT BLOW• MECHANICAL

CERVICAL INJURIES

• CONTUSIONS• SPRAINS• STRAINS• SPINAL STENOSIS• SPINAL CORD INJURY• FRACTURES• DISLOCATIONS• DISK PROBLEMS• CERVICAL PLEXUS INJURY• BRACHIAL PLEXUS INJURY

CERVICAL STENOSIS

CERVICAL FRACTURES, etc. C1 FRACTURE C4 WEDGE FRACTURE C5-6 FACET SUBLUXATION

BRACIAL PLEXUS INJURIES

BRACHIAL PLEXUS INJURIES

BRACHIAL PLEXUS INJURIES

THORACIC INJURIES

• CONTUSTIONS• SPRAINS• STRAINS• FRACTURES• NERVE INJURIES

LUMBAR INJURIES

• CONTUSIONS• SPRAINS• STRAINS• FRACTURES• DISLOCATIONS• DISK PROBLEMS• LUMBAR PLEXUS

INJURIES• SPONDYLOLYSIS• SPONDYLOLISTHESIS

DISK HERNIATION

SACRUM & COCCYX INJURIES

• CONTUSIONS• SPRAINS• STRAINS• FRACTURES• NERVE INJURIES

EVALUATION OF THE EVALUATION OF THE SPINESPINE

MEDICAL EMERGENCYMEDICAL EMERGENCY

A condition wherebywithout

prompt medical care,death will occur ---

ATHLETIC TRAUMAASSESSMENT & MANAGEMENT

• Scene Size-up• Initial Assessment• Focused Physical

Exam and History / Rapid Trauma Assessment

• Detailed Physical Examination

DETAILED PHYSICAL EXAM• Assess Head• Assess Neck• Assess Chest• Assess

Abdomen/Pelvis• Assess Extremities• Assess Posterior• Manage Secondary

Injuries• Reassess Vitals

PRIMARY SURVEY

• RESPONSIVENESS• AIRWAY• BREATHING• CIRCULATION• SHOCK

SECONDARY SURVEY

• History• Observation• Palpation• Functional tests• Neurological tests• Special tests• Referral & Plan

HISTORY

• Areas of pain• Onset of injury• Mechanism of injury• Nature of pain• Activities that cause pain• Bowel and/or bladder problems• Previous history of injury related to

area

INSPECTION

• Curves of the spinal column• Gait• Position of the other parts of the

body• Alignment and symmetry • Breathing patterns• Posture• Swelling and discoloration

PALPATION

• Cervical spine• Thoracic spine• Lumbar spine• Sacrum• Coccyx • Pelvis• Palpate of tenderness, swelling,

deformity, etc.

FUNCTIONAL TESTS

• Range of Motion of the Spine– Active range of motion– Passive range of motion– Resistive range of motion

• Do not check if there is any doubt regarding severity of the injury to the spinal column.

NEUROLOGICAL TESTS

• SENSORY• MOTOR • REFLEX• Check all areas:

– Cervical– Thoracic– Lumbar– Sacral

SPECIAL TESTS• Babinski Test• Oppenheim’s Test• Brachial Plexus Traction

Test• Cervical Axial Load• Cervical Distraction• Shoulder Abduction• Spurling’s Test• Single Leg Stance Test• Straight Leg Raise

• Well Straight Leg Raise

• Valsalva Test• Beevor’s Sign• Milgram Test• Kernig’s Test• Femoral Nerve Stretch• Hoover Test• Lasegue’s Test• Sacroiliac Tests

REFER THE ATHLETE IF:

• You have a doubt• There is paralysis• Pain or tenderness• Deformity• Weakness• Unusual sensations• Head injury

involvement

A 13-year-old female gymnast comes to you complaining of low

back pain. The pain increases when she extends the spine. Like most gymnasts, she is hypermobile in most of her joints. Describe you assessment plan for this athlete. What condition(s) do you suspect

and what are the potential mechanisms of injury? What about

competition? Can she continue?

A 13-year-old female gymnast comes to you complaining of low

back pain. The pain increases when she extends the spine. Like most gymnasts, she is hypermobile in most of her joints. Describe you assessment plan for this athlete. What condition(s) do you suspect

and what are the potential mechanisms of injury? What about

competition? Can she continue?

Questions

• Age?• Chronic?• Repetitive Stress?• Radiating pain?• Special Tests?• Impression?• Referral and Plan?

A 30-year-old recreational athlete comes to you complaining of a chronic backache for 6 months duration. The pain has been

gradually increasing in severity and is worse at rest and in the morning on

arising from bed. When present, the pain is centered in the low back and radiates

into her buttocks and posterior left thigh. Describe your assessment plan for this individual. What condition(s) do you

suspect? What are the possible mechanisms of injury?

A 30-year-old recreational athlete comes to you complaining of a chronic backache for 6 months duration. The pain has been

gradually increasing in severity and is worse at rest and in the morning on

arising from bed. When present, the pain is centered in the low back and radiates

into her buttocks and posterior left thigh. Describe your assessment plan for this individual. What condition(s) do you

suspect? What are the possible mechanisms of injury?

Questions

• Age?• Chronic?• Radiating pain?• Special Tests?• Impression?• Referral and Plan?

L4 REFLEX

SENSORY AREAS FOR L4-S2

WELL LEG STRAIGHT LEG TESTVS.

STRAIGHT LEG TEST

GAENSLEN’S TEST

SINGLE LEG STANCE TEST

HOOVER TEST

SI COMPRESSION&

DISTRACTION TESTS

SPONDYLOLISTEHSISVS.

SPONDYLOLYSIS

MOTOR TESTS FOR L4-S2