Week 4 - Spine Flashcards
Briefly describe spinal anatomy (bone)
The spine consists of 26 vertebrae – 7 cervical, 12 thoracic, 5 lumbar, 1 sacral (5 modified fused vertebrae), and a coccyx (tail bone)
The main functions of the cervical vertebrae are to support the weight of the skull and brain and allow movement of the head and neck in all directions
From top to bottom the shape of the cervical vertebra and the movement potential change considerably
Thoracic vertebrae provide rib attachments therefore forms a bony, flexible and protective cage around the internal organs
The main movement potential is rotation
Thoracic spine function and shoulder girdle function are strongly related
Lumbar vertebrae Provide a stable trunk and allow the lower limbs to move and to bear weight.The largest of the vertebral bodies. A large space for nerve roots to exit the spinal column – intervertebral foramina
The main movement potential is flexion / extension.
Spinal joints - Fibrocartilaginous joints between intervertebral discs and vertebral bodies. Synovial paired facet joints between one vertebra and the one above and below. Movement is determined by joint orientation.
Briefly describe spinal anatomy (muscles and ligaments)
Ligaments join vertebra to vertebra. There are numerous spinal ligaments with almost no ability to stretch or contract
If over lengthened through injury or dysfunction they can render the joint unstable
Muscles are largely stabilisers or mobilisers.
Iliopsoas involved in both mobility and stability and often a very dominant muscle.
Arises from the bodies of the lumbar vertebra and the discs and runs down inside the abdominal cavity and joints onto the femur. Flexes and laterally rotates the hip joint and assists in side flexion of the spine.
Discuss fractures
Vertebral end plate fracture – an audible pop is usually heard – likely to be caused by a strong compression force
Rib – usually a traumatic fracture but occasionally stress fractures occur
Vertebral bodies – wedge fractures seen in, for example, power lifters (trabeculae damage)
Osteoporosis – compression fractures
Management:
Non surgical – relative rest, possible restriction of movement, exercise regime.
Surgical – kyphoplasty - a balloon tamp is inserted and inflated, restoring the height and shape of the vertebra then a bone cement is added to the space, vertebroplasty – cement is injected directly into the narrowed vertebra
Osteoporotic considerations – 1 in 3 women and 1 in 5 men over 50 will experience osteoporotic fractures. Strong evidence to suggest that higher levels of activity and fitness can reduce the risk of fractures.
Discuss lumbar disc prolapse
Usually between the ages of 20 and 50
Male more common than female
Usually occur in previously damaged discs (discussed later)
Typical signs include acute LBP with or without leg pain, pins and needles, numbness, weakness
Pain usually increased with sitting, bending, lifting, coughing and decreased with lying
Easily confused with vertebral end plate fractures and the two often co-exist
Management - surgical and conservative treatment for treatment of radiculopathy caused by lumbar disc herniation
Discuss spondylosis
Stress fracture of the pars interarticularis (bridge of bone between inferior and superior articular process of vertebra, spondylosis is separation in the pars interarticularis of the posterior elements of the spine
Occur in young athletes whose sport involves hyperextension especially if combined with rotation – common in gymnasts, throwers, tennis, weightlifting, pole vault, high jump
Usually the opposite side i.e., left in a right-handed tennis player
Examination - stork test, faith test
Management - evidence to support conservative management although no consensus on best regiment, but flexion based exercises and work involving deep spine stabilisers produces symptom reduction.
Surgery indicated if stabilisation of spondylolisthesis needed for persistent pain
Discuss spondylolosthesis
Slipping of one vertebra forward on another
Most common in children aged 9 – 14
Often associated with bilateral pars defects that develop in childhood
Often asymptomatic but can be painful with extension activities
Treatment involves relative rest and stability exercises performed initially in neutral spine and graded exposure to extension movements
Surgery is an option if the slip is significant
Management - evidence to support conservative management although no consensus on best regiment, but flexion based exercises and work involving deep spine stabilisers produces symptom reduction
Discuss spinal stenosis
Rare but occasionally seen in older athletes
Characterised by pain aggravated by walking and relieved by rest
Often more leg pain than spinal pain
Management - Surgery is associated with high complication and reoperation rates, while no side effects are reported for any of the conservative treatment options including physiotherapy, exercise, mobilisation and manipulation, steroid injections and cognitive behavioural treatments
Discuss fact joint degeneration
Facet joints are subject to normal wear and tear / degeneration associated with aging (sometimes called spondylosis)
Believed to be one of the most common causes of spinal pain
Different pain provoking activities compared to disc problem - flexion with disc, extension with joint?
More tender centrally with disc and unilaterally with joint?
Frequently the 2 conditions co-exist
Discuss cervicogenic headaches
Pain referred from the neck to the head
Usually secondary due to a primary physical or neurologic primary condition.
Can be traumatic – fracture, dislocation or whiplash type injury
Or due to a medical condition - RA, cancer, infection
The symptoms can also mimic primary headaches like migraine or tension headaches
Discuss thoracic pain
Very commonly seen in conjunction with shoulder, neck and lumbar conditions due to the biomechanical connections of the spine – the thoracic region is generally the “stiff” segment with compensation happening in the areas above or below
Often a problem in overhead sport where full range shoulder flexion is adopted – e.g. swimmers, badminton, throwers – any shoulder flexion “restriction” is commonly linked with a thoracic extension “restriction” and a lumbar spine extension “give”
Conservative treatment and rehab is usually highly effective
Discuss stress fractures
Describe assessment of lumbar spine
Pain referral, length of time seated, sleeping pattern, gait problems, neuro symptoms
Describe assessment of thoracic spine
Breathing, laughing, coughing, pain referral, chest pain, stress levels, neuro symptoms
Describe assessment of cervical spine
Pain referral, headaches, visual problems, dizziness, nausea, last eye test, stress levels, neuro symptoms
Describe rehab of cervical spine
