Spine Flashcards
What percent of CSI come from sports?
8%
What is axial loading?
Spearing, which occurs when the head and the neck is flexed between 20-30 degrees and serves as the point of contact
What order is the assessment listed?
Assess breathing, circulation, pulse, LOC, symptoms, palpate c-spine and perform extremity CMS assessment
What indicators warrant activation of CSI management protocol?
Unconsciousness, bilateral neurological complaints obvious deformity and significant c-spine pain
C1
None
C2
Neck flexion
C3
neck lateral flexion and extension
C4
Shoulder shrug
C5
Shoulder abduction
C6
Elbow flexion/wrist extension
C7
Elbow extension/wrist flexion
C8
Ulnar deviation/thumb extension
T1
Finger intrinsics (abd, add, opposition)
L1
None
L2
Hip flexion
L3
Knee extension
L4
Ankle dorsiflexion
L5
Hallux extension
S1
Plantar flexion, eversion, knee flexion, hip extension (gastrocs and hammy’s)
S2
Plantar flexion, knee flexion, hip extension
What root level is for the diaphragm and how do you sensory test it?
C4 and you test the shoulder tops
What is the most common neurological cervical injury?
Unilateral neurapraxia of the cervical nerve roots and brachial plexus “burner” or “stinger”
List 2 techniques to get an athlete on a spine board
Prone log roll or 6 person lift
How many vertebrae?
33
How many vertebrae are movable (true)?
24
Which vertebrae are movable?
Cervical, thoracic lumbar
How many vertebrae are immovable and what are they?
9 are false and they are the sacrum and coccyx
Cervical spine has how many vertebrae?
7
C1 has no _____ or ______
Body or spinous processes
C2 allows for
Rotation (no duh)
Movements of C1
Flexion, extension, lateral
How many vertebrae in the thoracic spine?
12 and they articulate with ribs
Largest and thickest vertebrae
Lumbar spine
How many vertebrae in lumbar spine?
5
Fusion of 5 vertebrae in adults
Sacrum
Also known as tailbone
Coccyx
While sitting weight is transmitted through these joints
Sacrum/SI joint
Between each of the cervical, thoracic, and lumbar is an
Intervertebral disk
Each intervertebral disk is composed of _______ and the _________
Annulus fibrosis and nucleus pulposus
Forms the periphery of the disk Composed of strong, firbrous tissue
Annulus fibrosus
In the center of the annulus fibrosus, shock absorption
Nucleus pulposus
Wide strong band extends the full length of the anterior surface of vertebrae
Anterior longitudinal ligament
Inside the canal and extends the full length of the posterior aspect
Posterior longitudinal ligament
Connects spinous processes
Supraspinous
Extends the spine
Superficial
Erector spinae
Deep muscles of the spine
Go from vertebrae to vertebrae
Extend and rotate the spine
Multifidus, quadratus
lumborum
How many pairs of spinal nerves are there?
31
Specific area of sensory in a spinal nerve is called
Dermatomes
Nerves form a
Plexus
Movements of the vertebral column
Flexion
Extension
Right and left lateral flexion
Rotation to the left and right
Can be life threatening Strengthening is critical Bull the neck Isometric, isotonic, isokinetic contractions can be used Watch for spearing
Preventing c-spine injuries
What back pain is the most common?
Lower back pain with
How do you prevent a lumbar injury
Avoid unnecessary strain
Be aware of posture anomalies of the athlete
Abdominal strength is essential
Cervical neck MOI
Axial Load Flexion Hyperextension Rotation and Flexion Rotation and Hyperflexion Lateral Flexion
Gymnasts, hockey, diving, football, rugby
Relatively uncommon in athletics but must be prepared.
MOI: Axial loading and flexion, rotation, hyperextension
S/S:
common in C4-C6
Point tenderness
Muscle spasms = decrease ROM
Numbness & pain in extremities, loss of bladder/bowel cont
Cervical fracture
MOI: Violent flexion, extension or rotation, affects anterior and posterior ligaments
S/S: Persistent, tender over transverse and spinous processes, pain occurs a day later
Cervical sprain (whiplash)
MOI: Pain on one side of the neck upon waking up, synovial lining or capsule is pinched
S/S: Palpable pt. tenderness and muscle spasm, limited side flexion, and rotation
Acute torticolis (wry neck)
Athlete lies supine. Examiner grasps the patient’s head under the occiput and chin and gradually applies traction.
Cervical distraction
Cervical distraction positive test
reduction or elimination of symptoms caused by cervical radiculopathy
Athlete seated with neck bent to affected side. Carefully compress straight through the head. Repeat on opposite side.
Spurling compression test
Spurling compression positive test
pain in the upper extremity on the side the head is flexed = pressure on the nerve root
Kyphosis resulting from wedged fx of 3 or more vertebrae, causes nucleous pulposis to enter into vertebrae
S/S: Kyphosis and lumbar lordosis but no pain, point tender over spinous processes and back ache at end of day
Scheuremens disease
athlete is seated or standing. The examiner pushes the hands together to compress the ribcage and then releases the pressure.
Rib compression
Rib compression positive test
Pain with compression or release of pressure indicates the possibility of a rib fracture, rib contusion, or costochondral separation.
MOI: Sudden extension and rotation, faulty posture, excessive lumbar lordosis
S/S: Pain with active extension and passive flexion
Lumbar strain
Inflammatory condition of the sciatic nerve
MOI: Nerve compression, irregularities in
vertebrae, tight piriformis muscle
S/S: Acute or chronic, sharp shooting pain that follows the nerve pathway
Sciatica
Athlete is supine. Examiner slowly raises the legs until tightness or pain is noted
Straight leg raise
Straight leg raise positive test
Pn @ 30 degrees = hip problem or inflamed nerve
Pn. @ 30-60 = sciatic nerve
Pn. @ 70-90 = SI joint
MOI: Congenital degeneration of the vertebrae, appears as a stress fx, most common in boys
S/S: Asymptomatic until hyperextension or disk
herniation
Spondylolysis
MOI: One vertebrae slipping on one below it, a complication of spondy higher in girls
S/S: hyperlordosis
Spondylolisthesis
Procedure:
subject stands on one foot and extend their back, repeat on opposite side.
Stork test
Stork positive test
Lumbar pain= possible fracture of pars of vertebrae
Subject is sitting
ask subject to take a deep breath and blow against closed fist (bowel movement)
This increases intrathecal pressure
Valsalva maneuver
Valsalva maneuver positive test
Pain or neurologic symptoms in buttox and thigh = Herniated disc
Athlete is lying prone. Athlete uses hands to push up upper body and extend spine
Press ups
Press ups positive test
pain radiating into the buttocks/thigh = herniated disc
MOI: Twisting with both feet on the ground, falling backward, landing heavily on one leg
S/S: Point tender on SI joint, ASIS and PSIS may be asymmetrical, side bending toward the injury side increases pain
Sacroiliac pain
Athlete is supine or side lying. Examiner has both hands over the lateral aspect of the pelvis.
Examiner applies downward pressure through the anterior portion of the ilium, spreading the SI joints
SI compression
SI compression positive test
SI pain
Athlete is supine
Examiner applies pressure to spread the ASIS
SI distraction
SI distraction positive test
SI joint pain
Athlete is supine with the foot of the
involved side crossed over the opposite thigh (figure–4 position) & the leg resting in the full external rotation
Examiner has one hand on the opposite ASIS & the other hand on the medial apsect of the flexed knee
Examiner applies overpressure at the knee & ASIS
Fabers (Patrick’s) test
Faber’s positive test
SI joint pain
History questions to ask
Did you land on top of, or hit someone with your head?
Did you lose consciousness?
Do you have pain in your neck?
Any tingling, numbness, or burning in your shoulders, arms or hands?
Equal muscle strength in both hands?
Able to move your ankles and toes?
After you’ve ruled out a spinal injury what history questions should you ask?
Were you standing, twisting, sitting, bending?
Did the pain begin immediately?
How long has it been going on?
What motions/movements hurt your back?
Tingling or pain in your buttocks or down the back of your leg?
General observation
Head is tilted to one side Shoulder is lower on one side, or carried forward Scapular imbalance One hip is prominent Hips are tilted One arm hangs lower One patella is lower than the other
Increased thoracic curve
Kyphosis
Compensatory change in the position of the head and neck
Forward head posture
Decreased lumbar curve
Flatback posture
Anterior shifting of entire pelvis
Swayback posture
Increased curve in lumbar spine
Lordosis
Lateral curvature of the spine
Scoliosis
Cervical observations
Look at the position of the head and neck Symmetrical shoulders Is the patient willing to move head and neck Check active ROM
Lumbar observations
Pelvis and shoulders should be level
Soft tissues symmetrical
Unusual curve in lower back noticed
Thoracic observations
Check active ROM
Flex forward and laterally/extend and rotate the trunk
What if there is pain when you flex forward and laterally/extend and rotate the thoracic trunk
nerve root irritation to the lower thoracic region
What if there is pain when you check ROM of thoracic
cervical disk or trigger
point
What does most common thoracic pain have to do with?
Facet joints
Spine palpation
Athlete lying prone Head and neck should be slightly flexed Pillow under the hips Musculature on both sides of spine Spinous processes Sacroiliac joint
General rule of thumb for spine rehab
Any movement that causes the back pain to radiate or spread over a larger area should not be included during this early phase of treatment
Flexibility exercises for rehab
Flexion
Extension
Lateral bending
Rotation
When should you do lumbar extension exercises
When back pain is diminished with lying down and
increased with sitting
Forward bending is limited and increase the pain
Rehab cervical strengthening exercise for rotation
Put one palm on side of forehead and the other at back of head. Push with each hand, attempting to rotate head
Rehab cervical strengthening exercise for lateral flexion
Place palm on side of head and press head into palm
Rehab cervical strengthening exercise for extension
Lace fingers behind head, press head against hands
Rehab cervical strengthening exercise for flexion
Press forehead against the palm of hand
Why use extension exercises?
Reduction in the neural tension
Reduction of the lead on the disk which decreases disk pressure
Increases in the strength of extensor muscles
Examples of lumbar extension exercises
Prone extension on elbows
Prone extension on hands
Alternate arm and leg extension (dead bug)
Supine hip extension-butt lift or bridge
-Double leg support
-Single leg support
Indications for lumbar flexion exercises
- Back pain is diminished with sitting and increased with lying down or standing
- Forward bending eases the pain
- Abdominal tone and strength are poor
Why use flexion exercises?
Reduction in the articular stresses
Opening of the intervertebral foramen
Examples of lumbar flexion exercises
Single knee to chest Double knee to chest Posterior pelvic tilt Partial sit up Rotation partial sit up Pelvic tilt down (dog) Pelvic tilt, tail tuck (cat) Kneeling – dog tail wags Kneeling Alternate arm and leg (bird dog)
Core stabilization exercises
Quadriped
Triped
Biped (alternating)
Thera ball
