SM2 Unit 8 - Back -Spine Injuries Student Lecture PDF

UNIT 8 BACK & SPINAL INJURIES What are the bones of the spine called? ANATOMY OF THE SPINE What are the four (4) segments of the spine? Cervical Thoracic Lumbar Sacral How many of each type of vertebrae are there? □ cervical (7) □ thoracic (12) □ lumbar (5) □ sacral (5...

UNIT 8 BACK & SPINAL INJURIES What are the bones of the spine called? ANATOMY OF THE SPINE What are the four (4) segments of the spine? Cervical Thoracic Lumbar Sacral How many of each type of vertebrae are there? □ cervical (7) □ thoracic (12) □ lumbar (5) □ sacral (5 fused) Cervical Vertebrae Thoracic Vertebrae Lumbar Vertebrae Sacral Vertebrae Sacroiliac Joint What is NEUTRAL Spine? □ The spinal curves of the cervical, thoracic, and lumbar regions are curved neither too much nor too little □ This position is anatomically the STRONGEST Neutral Spine What is necessary to keep the spine aligned? Normal anatomical alignment combined with BALANCED muscular strength CURVES OF THE SPINE 1) Cervical LORDOSIS 2) Thoracic KYPHOSIS 3) Lumbar LORDOSIS 4) Sacral KYPHOSIS Kyphosis □ Excessive posterior/backward curve □ Seen in THORACIC & SACRAL curve Lordosis □ Excessive forward curve □ Can be in LUMBAR spine or CERVICAL spine VERTEBRAL ANATOMY What are the functions of the vertebrae? □ Protect spinal cord □ Hold body upright for walking □ Site for muscular attachments What are the different parts of each vertebrae? Each vertebra is composed of a: 1. Body 2. Transverse process 3. Spinous process 4. Vertebral Foramen/canal (for spinal cord to pass through) 5. Facets  Anatomy of the Vertebrae Spinous Process Body Vertebral Transverse foramen Process Transverse Process Spinous Process What are the facet joints? □ Joints in your spine that make your back flexible and enable you to bend and twist. □ Nerves exit your spinal cord through these joints on their way to other parts of your body. □ □ Healthy facet joints have cartilage, which allow your vertebrae to move smoothly against each other without grinding □ Facet joints are synovial joints □ Each joint is surrounded by a capsule of that contains SYNOVIAL fluid to nourish and lubricate the joint. □ When your back “pops” it is usually the facet joints that are doing this Why does your back crack? □ occurs due to the release of gas bubbles (called cavitation) within the joints of your spine □ often caused by tight muscles, joint misalignment, or worn down cartilage □ is generally considered normal unless accompanied by significant pain or other concerning symptoms. What factors contribute to your back cracking? Tight muscles: can pull on the joints causing them to shift slightly and create a cracking sound when you move. Joint misalignment: If your spinal joints are slightly misaligned, movement can cause them to "snap" back into place, producing a cracking noise. Degenerative joint disease (osteoarthritis): As cartilage in your joints wears down due to age or overuse, bones can rub against each other, causing a cracking or grinding sound. Poor posture: Sitting for long periods with poor posture can put stress on your spine and contribute to joint cracking Back Cracking Explained DISKS What are the functions of the intervertebral disks? 1. serve as shock absorbers and resist compression during activity 2. Keep vertebrae separated (increasing movement/flexibility 3. Provide space for nerves to exit the spinal cord What are the two parts of the disks? □ the annulus fibrosus is the tough, dense outer layer of the disk □ the nucleus pulposus is the flexible inner layer of the disk Spinal Cord Annulus Fibrosus Nucleus Pulposus  What are the shortcomings (i.e. problems) with the disks? □ Do not have a good blood supply □ This results in poor healing capability □ The disks compress over time □ (This is why we shrink as we age)  MUSCLES of the Upper & Lower Back □ Trapezius □ Latissimus dorsi □ Erector spinae □ Rhomboids Trapezius The Trapezius has three parts □ Upper □ Middle □ Lower Upper Trapezius FUNCTIONS □ Shoulder elevation □ Helps extend, laterally flex, and rotate the neck Shoulder Elevation Middle Trapezius FUNCTIONS □ Horizontal abduction □ Shoulder stabilization Horizontal Abduction of Shoulder Lower Trapezius FUNCTIONS □ Depresses, rotates, and retracts the scapula □ The trapezius is also an important postural muscle Scapular depression Y Raise (Prone) Latissimus Dorsi FUNCTIONS? □ Shoulder adduction □ Shoulder extension □ Medial rotation of shoulder Shoulder Extension Shoulder Adduction Shoulder Medial Rotation Erector spinae FUNCTIONS? □ Trunk Extension □ Lateral Trunk flexion □ Controls the rate of trunk flexion □ Maintains trunk posture Rhomboids (Major & Minor) Rhomboid Major Rhomboid Minor FUNCTIONS? □ Scapular retraction Serratus Anterior Responsible for protraction of the scapula Serratus anterior Shoulder Protraction What muscles are also EXTREMELY important for supporting trunk movement? □ Rectus Abdominis □ Transverse abdominis □ Obliques Rectus abdominis □ Flexes trunk/spine Transverse Abdominis □ Supports the abdominal wall □ Assists with breathing Obliques □ Trunk/spine rotation Muscles of the Neck □ Scalenes □ Sternocleidomastoid □ Levator scapulae Scalenes FUNCTIONS □ Cervical flexion □ Assists with breathing Sternocleidomastoid □ Lateral flexion and rotation of the neck Levator Scapulae □ Elevation of the scapula Evaluation, Diagnosis, & Treatment of Back/Spine Injuries  ACUTE INJURIES OF THE BACK/SPINE Acute injuries can include: Ligament sprains Muscle strains Intervertebral disk injuries Sprains & Strains of the Spine Ligament Injuries (SPRAINS) □ Mechanism? Usually trunk flexion w/ some rotation  S/S? □ Pain directly over spine □ Limited movement due to muscle spasm □ Rotation will be VERY painful □ Pain will be local Muscle & Tendon Injuries (Strains) □ Mild & moderate strains are common □ Pain will be lateral to the spine, often on side opposite the injury Mechanism(s)? □ Extension under stress □ Sudden twisting S/S? □ Pain LATERAL of the spine □ Muscle spasm □ Stiffness □ Guarded movement Treatment? □ Initially Ice, rest, NSAIDS □ ROM/flexibility exercises when tolerable □ Physician referral IF neurological symptoms are present NEUROLOGICAL SYMPTOMS? □ Numbness □ Tingling □ Muscle weakness □ Burning, referred/radiating pain Intervertebral Disc Injuries INTERVERTEBRAL DISK INJURIES What is another name for this injury? □ “Slipped Disc” □ Bulging disc □ Herniated disc □ Degenerative Disc Disease is injury to the disk as the result of CHRONIC mechanisms WHAT PART OF THE SPINE DO THE MAJORITY OF DISC INJURIES OCCUR IN? Lumbar What are possible Mechanism(s) for this condition? □ Poor posture over time □ Forced flexion/extension under weight □ Poor biomechanics during an activity □ Obesity □ Rarely will a traumatic event (e.g. fall or a blow to the back) cause a herniated disc □ Congenital Defects Signs and Symptoms □ Burning pain □ Numbness/tingling □ Weakness of the lower extremities □ Symptoms tend to be aggravated by sitting How are disc injuries diagnosed? □ X-rays □ MRI (Magnetic resonance imaging) □ Electromyogram (EMG) is used to test for nerve and/or muscle damage □ Functional Tests (e.g. myotomes) □ Note the spacing between the vertebrae Initial Treatment 1. Ice 2. Heat 3. NSAIDS 4. Rest 5. Corticosteroids can also be used Long Term Treatment □ Physical therapy can relieve symptoms □ Addressing poor posture/obesity is critical □ 90-95% of people with a herniated disc can be treated without surgery. □ Surgical intervention is sometimes needed □  When is surgery recommended? □ Conservative treatment fails to improve symptoms after 6-8 weeks □ There are persistent neurological symptoms □ Patient cannot perform basic activities such as standing or walking What Surgeries Can Be performed correct disk injury? □ Discectomy □ Spinal Fusion □ Artificial Disc Replacement Discectomy Spinal Fusion Surgery □ A surgeon removes the disc and the herniated disc fragment. □ The the vertebrae are permanently joined above and below the disc space. Spinal Fusion Surgery Spine Surgery Video Artificial Disc Replacement □ Artificial disc is a prosthetic “spacer” inserted in place of the removed disc. □ It is placed between two vertebrae, preserving spinal flexibility and stability. □ Recommended as an alternative to spinal fusion for people younger than 65 with a herniated disc in the neck What increases the risk of disk injuries? □ Age: Herniated disks are most common in middle age, especially between 35 and 45, due to aging-related degeneration of the disks. □ Obesity: Excess body weight causes extra stress on the disks in your lower back. □ Occupation: Physically demanding jobs have a greater risk of back problems. Repetitive lifting, pulling, pushing, bending sideways and twisting also may increase your risk of a herniated disk. □ http://www.mayoclinic.com/health/herniated-disk/DS00893/DSECTION=risk-factors  What percentage (%) of people recover from intervertebral disc injury WITHOUT surgery? □ Approximately 90%  CHRONIC BACK/SPINE CONDITIONS Scoliosis Chronic back pain Spondylolisthesis/Spondylolysis Piriformis Syndrome Ankylosing Spondylitis Degenerative Disk Disease What is Scoliosis?  When lateral curvature occurs…what happens to the posture of the body? If untreated Scoliosis can cause what TWO physical problems? What Can Cause Scoliosis? Possible Causes of Scoliosis □ Malformed vertebrae □ Unequal leg lengths □ Fused ribs □ Cerebral palsy □ Muscular Dystrophy □ Spina Bifida □ Polio What is Cerebral Palsy? □ a group of disorders that affect movement and muscle tone or posture. □ Caused by damage that occurs to the immature, developing □ brain, most often before birth. https://www.mayoclinic.org/diseases-conditions/cerebral-palsy/symptoms-causes/syc-20353999 What is Muscular Dystrophy? □ Muscular dystrophy is a group of diseases that cause progressive weakness and loss of muscle mass. □ Caused by abnormal genes (mutations) interfering with the production of proteins needed to form healthy muscle. What is Spina Bifida? □ a birth defect in which an area of the spinal column doesn't form properly, leaving a section of the spinal cord and spinal nerves exposed through an opening in the back What is polio? □ a disabling and life-threatening disease caused by the poliovirus. □ The virus spreads from person to person and can infect a person's spinal cord, causing paralysis In most cases, the cause of scoliosis is unknown. This is known medically as “idiopathic” How Is Scoliosis Determined? What is assessed first? Shoulder Height What is assessed Second? Hip height is assessed at iliac crest When the patient is bent over, what is exposed in persons with scoliosis? □ A “rib hump” □ The curve will bend towards the side of the spine with the rib hump How is scoliosis measured? □ By hand using a scoliometer □ There are numerous apps also available Signs/Symptoms of Scoliosis □ Uneven shoulders. □ One shoulder blade that appears more prominent than the other. □ Uneven waist. □ One hip higher than the other. □ One side of the rib cage jutting forward. □ A prominence on one side of the back when bending forward (i.e. “rib hump”)  What are the treatment for options for scoliosis? □ Bracing □ Physical Therapy □ Surgery Scoliosis Surgery Surgical Intervention □ What is inserted into the spine? □ Screws and metal rods along spine What is removed from the spine? The FACET joints  What does the surgeon do to make sure the scoliosis does not come back? □ The surgeon makes a bone graft from the facet joints and some of the spinous processes □ This eventually heals around the screws and rods How many teens have this surgery every year in the U.S.? THOUSANDS!!  What FOUR medical professionals work together on a scoliosis patient? 1) Surgeons 2) Anesthesiologists 3) Physical Therapists 4) Nurses Non-Surgical Treatment Back Bracing Physical Therapy What is Ankylosing Spondylitis? Ankylosing Spondylitis Explained What is the difference between Spondylolisthesis vs. Spondylolysis vs. Spodylosis? What is spondylosis? □ A condition that usually develops with age, and is the result of normal “wear and tear” on both the soft structures and bones that make up the spine. □ More frequently seen in the cervical (neck) and lumbar (low back) region □ Also called osteoarthritis of the spine S/S □ Most people experience no symptoms. □ When symptoms do occur, they typically include pain and stiffness in the affected area (neck or lower back) □ Be concerned with Neurological S/S Lack of coordination/difficulty walking Loss of bowel/bladder control What is spondylolysis? □ A stress fracture through the pars interarticularis of the lumbar vertebrae. □ The pars interarticularis is a thin bone segment joining two vertebrae. □ usually occurs in young athletes □ This disorder is essentially a stress fracture of the spine. Signs/Symptoms □ Spondylolysis doesn’t always have symptoms. □ When it does, the only symptom is usually back pain. □ The pain often gets worse with activity and sport, and is more notable when bending backward. □ The pain doesn’t usually interfere with everyday activities. □ https://www.hopkinsmedicine.org/health/conditions-and-diseases/sp ondylolysis#:~:text=Spondylolysis%20doesn't%20always%20have,t %20interfere%20with%20everyday%20activities. Spondylolisthesis Explained What is spondylolisthesis? □ occurs when one vertebra slips forward on the adjacent vertebrae after a fracture has occurred SPONDYLOLISTHESIS Signs/Symptoms of spondylolisthesis? □ Low back pain/stiffness □ Muscle Spasm □ Tightened hamstrings □ “Step-off” deformity □ Pain/weakness in thighs/buttocks □ Burning pain that radiates down leg(s) to the feet What does Conservative Treatment consist of? What are two surgical options? ASSESSING POSTURE Why is it important to Assess Posture in athletes? □ In athletes postural assessment is important, because of the inter-relationship between the trunk and core musculature and the lower and upper parts of the body □ Postural assessment as part of the screening process is relevant as there is evidence of correlations between injury and posture. □ Abnormal postures can influence muscle function. □ https://www.physio-pedia.com/Sports_Screening:_Postural_Assessment How is posture assessed? Side, rear, and front view of: □ C/T/L Spine □ Shoulders □ Pelvis □ Hips □ Knees What is considered “Normal Posture” Proper alignment would result in a straight line passing just behind the ear and through the center of the shoulder, the middle of the greater trochanter, just behind the patella, & down to the front of the lateral malleolus Forward Head Posture What are “abnormal” postures?