Injuries To Spine PDF

SPORTS REHABILITATION
Annually15,000 permanent spinal injuries

Commonly men 16-30 years old
Cause of Injury
Motor Vehicle Accidents (MVA): 50%
Falls: 20%
Penetrating Trauma: 15%
Sport Injuries: 15%
About 9% of all new cases of spinal injuries in
U.S. are related to sports
Approximately 1000 spinal cord injuries per year in
athletic events
Most not related to team sports—diving, surfing,
skiing
Football most common team sport for cervical
injury
Extremes of motion
Hyperextension
Hyperflexion: “Kiss the Chest”
Excessive Rotation
Lateral bending
Axial Stress
Axial loading
Compression common between T12 and L1
Distraction
Combination
Distraction/Rotation or compression/flexion
Other MOI
Direct, Blunt or Penetrating trauma
Electrocution
Most
common mechanism leading to
quadriplegia:
Axial compression force to the top of the head
while the neck is slightly flexed
C spine compression fractures typically:
C4-C7
Soft tissue injuries
Sprains
Ligamentous injuries with instability
Intervertebral disc lesions
Spinal cord injury without fracture/dislocation
Stinger/burner syndrome
Fracture/dislocation
Think about the
significance of the
injury to the area
of the spinal cord
Paralysis,
paraplegia,
quadraplegia, and
death can result
dependent upon
the injury location
The signs and symptoms of a spinal cord injury
depend on two factors:
1. The location of the injury.
2. The severity of the injury.
Spinal cord injuries are classified as partial or
complete, depending on how much of the
cord width is damaged.
1. A partial spinal cord injury, which may also be
called an incomplete injury, the spinal cord is able
to convey some messages to or from the brain.
2. A complete injury is defined by complete loss of
motor function and sensation below the area of
injury.
Paralysis of extremities Priapism
(The most reliable sign Posturing
in conscious patient)
Loss of bowel or
Pain with/without bladder control
movement Nerve impairment to
Tenderness anywhere the extremities
along the spine Severe spinal shock
Impaired breathing
Soft tissue injury
Deformity associated with
trauma
X-rays.
Computerized tomography (CT) scan: is
beginning to become the study of choice in
many trauma centers and emergency
departments
Magnetic resonance imaging (MRI).
Myelography.
Strains
usually the stenocleidomastoid or upper trapezius
usually the result of extreme motions, violent
contractions or external force, turning head
suddenly, or forced flexion, extension, or rotation
pain stiffness, restricted ROM, muscle spasm ,
local tenderness
RICE, cervical collar, ROM exercises, followed by
isometric exercises, progressing to full range
isotonic strengthening, heat
Sprains (whiplash)
can occur to major ligaments in spine
same mechanism of strains, but more violent,
frequently muscle strains occur with ligament
sprains producing tears of the supporting
ligamentous tissue
same as strains but persist longer, may have
tenderness over transverse and spinous processes;
may not have pain until 24 hrs after injury
rule out fracture, dislocations, or disk injury. RICE for
first 72 hrs, cervical collar, NSAID’s, heat, massage
Can Occur when
there is enough
pressure from the
vertebrae above
and below
This can force some
or all of the nucleus
pulposus through a
weakened or torn
part of the annulus
fibrosus.
The ruptured nucleus
will often come
incontact with and
press on nerves near
the disc.
This can result in severe
pain
About 90% of herniated
discs occur in the
lumbar region. The
discs in the cervical
region are affected
about 8%, those of the
thoracic region only
about 1-2%
Herniated disks are one
of the most common
causes of back pain
Thereare 3 main ways discs can become
herniated of ruptured
Many older people get herniated disks because the
disks have worn down over time
The extremely overweight are very susceptible because
they are carrying around excess weight which puts
extra pressure on the intervertebral disks
Improper lifting form, usually associated with bending
with back and not with knees. Which can cause a
sudden strain. This can be everyday lifting of objects or
actual weight training
Twisting violently can also cause a sudden strain that
could possible herniate a disk
Sharp and shooting pain the runs down
athletes low back, buttocks and down the
thigh
If the athlete complains of numbness or
tingling anywhere in lower back, buttocks or
leg
If athlete complains pain gets worse after any
kind of strain to the body
Sometimes, the disk can pinch the nerve
controlling bladder functioning
The first thing a coach should ask his athlete,
would be the history of the injury; if the
athlete felt the pain immediately after
performing a heavy deadlift at the gym that
would be a good indicator of a herniated disk
The coach should also ask athlete where the
pain is, sciatica is very typical with herniated
disks
A coach can never be 100% sure, so the
athlete must be sent to a doctor to perform
an MRI (magnetic resonance imaging) or a
CT (computerized tomography)
An MRI is the best choice because it can
clearly show the bones nerves and disks that
might be damaged
The first thing that
should be done is to
rest and stay away
from activity the
agitate the
symptoms
Then the application
of ice and heat
This acts to relax the
muscles in the back
which can calm pain
and any muscle spasms
Physical Therapy
Although performing
physical Therapy does
not directly help the
disks, it does
strengthen the
muscles around it, so
as to increase stability,
which can help
prevent herniated
disks in the future
Pain relievers are
often given to
patient to alleviate
pain
Anti-inflammatory
drugs are given to
reduce swelling
Although not all
patients report
having back pain
Exercise #1 while lying
on your back bend your
left knee up. Clench
abs and butt, keeping
back in neutral position.
Raise your other leg
about 12in off floor,
while knee is straight
Hold the position for 3
seconds
Then lower leg, do for 10
reps
Repeat the same with
your other leg
Exercise #2 Start with both
knees on floor, clench abs
and butt, back is straight
Put your hands on your hips.
Pickup your right foot and
place on floor in front of
you, while your left knee is
still on floor
Lunge forward,.
Hold your position for 3-5
seconds
Return your right knee to
floor
Do for 10 reps
Then repeat with the other
leg
Surgery is very rarely required for herniated
disks
The treatment previously described is almost
always done prior to surgery
Generally if symptoms, such as pain and
numbness grow worse over time surgery is
required
If herniated disk interferes with bladder and
bowl movements, surgery is also required
Herniated disks can vary in severity and the
rehabilitation plan can vary depending on
the severity of the symptoms;
Phase # 1 Rest- This can last from 2 days up to
2 months depending on the nature of the
injury, typically the older the patient the
longer the rest period. As stated before, rest
should include immobilization of spinal column
as well as icing and heating of the lower back
Phase # 2 After symptoms have subsided,
anywhere from 10days to a few months
exercises should be done to strengthen
muscles around spinal column to help prevent
another hernia. Doctors clearance is
preferred so as not to begin exercises to early,
which could cause a re injury. These exercises
may be done with some slight lower back
pain
Hamstring stretch
Lay down face up
with one leg in
door way other leg
on wall
This stretches out
ligaments and
tendons that
connect from leg
to lower back
Cat and Camel
On your hand and
knees, allow your
back to sag for 5
seconds, then arch
your back for 5
seconds
Repeat for 10 reps
Arm/Leg Raise
On your hands and
knees
Tighten abs so spinal
column is stiff
Raise right arm and
left leg as shown to
the right
Do 10 reps and
switch arm/leg
After all pain has gone
the following exercise
may be performed
Partial curl-lying on your
back with knees bent
and feet on floor
Tuck the chin into the
chest
Curl upper body
forward intill your
shoulder blades are off
the floor
Hold the position for 3
seconds and repeat for
10 reps
In order for an athlete
that has sustained a
herniated disk to
return to play he/she
must have clearance
from their doctor
This will not usually
happen until all pain,
and numbness has
gone completely
The stretches and
exercises listed
previously can
strengthen the
muscles around the
discs, which can
increase the stability
of the discs
Teaching and
practicing proper
lifting form is
essential in
preventing these
injuries
CervicalNerve Stretch Syndrome
(“Burner”/”Stinger”)
When the head is hit and forcefully bent sideways,
a nerve in the neck can be pinched near the
bones, muscles, or other neck tissues
Symptoms:
Numbness, tingling, or burning in the neck,
shoulder, or arm
Stinging or shocking sensation in the back of the
neck and shoulder
Slight weakness &/or loss of sensation in the arm or
hand on the injured side
What you can do?
If sensation and strength do not return within 5
minutes, or the injury becomes recurrent, seek
medical attention.
return to activity once symptoms resolve;
strengthening and stretching of neck musculature
Mechanisms of injury:
C-spine forced into hyperextension, hyperflexion,
or axial load
Stenosis – esp. at C3-C4 level
Neural arch abnormalities, esp. posteriorly
Signs &Symptons:
Initially
– resemble catastrophic injury
Clear within 15 min. to 48 hours
Mechanisms of injury
hyperflexion i.e. diving
in shallow water
axial compression i.e.
landing directly on
head
Hyperextension i.e.
hitting dashboard in
MVC
Classified as stable or unstable
Stability of cervical spine is provided by
two functional vertical columns
Anterior column: vertebral bodies, the disc
spaces, the anterior and posterior longitudinal
ligaments and annulus fibrosus
Posterior column: pedicles, facets and
apophyseal joints, laminar spinous processes
and the posterior ligament complex
Aslong as one column is intact the injury is
stable.
Signs of spinal cord injury:
Bradycardia
Hypotension
Diaphragmatic breathing
Neurological deficit
Jefferson Fracture
Compression fracture of
C1 ring
Most common C1
fracture
Unstable
Commonly see increase
in predental space on
lateral if transverse
ligament is damaged
and displacement of C1
lateral masses on
odontoid.
Obtain CT
Burst Fracture
Fracture of C3-C7
from axial loadinng
Spinal cord injury is
common from
posterior
displacement of
fragments
Stable if ligaments
intact
ClayShoveler’s
Fracture
Flexion fracture of
spinous process
C7>C6>T1
stable
FlexionTeardrop
fracture
Flexion injury
causing a fracture
of the
anteroinferior
portion of the
vertebral body
Unstable because
usually associated
with ligamentous
injury
Bilateral Facet
Dislocation
Flexion injury
Subluxation of
dislocated vertebra of
greater than ½ the AP
diameter of the
vertebral body below it
High incidence of
spinal cord injury
Extremely unstable
Hangman’s
Fracture
Extension injury
Bilateral fractures of
C2 pedicles (white
arrow)
Anterior dislocation
of C2 vertebral body
secondary to ALL
tear (red arrow)
Unstable
Odontoid
Complex mechanism of injury
Generally unstable
Type 1 fracture through the tip
rare
Type 2 fracture through the base
Most common
Type 3 fracture through the base and body of
axis
Best prognosis
Significant trauma and Significant injury above
use of intoxicating clavicle
substances Fall more than three
Seizure activity
times patient's height
Fall and fracture of both
Pain or paresthesia in
heels
neck or arms
Injury from a high-speed
Neck tenderness motor vehicle crash
Unconsciousness
because of head injury
Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
Damage further complicated by:
Patient's age
Preexisting bone diseases
Congenital spinal cord anomalies
Spinal
cord neurons do not regenerate to any
great extent
Most frequently injured spinal regions
C5-C7
C1-C2
T12-L2
Wedge-shaped compression fractures and

"teardrop" fractures or dislocations common
Hyperflexion injury
Compressive force to
anterior vertebral body
stretches posterior
ligament complex
Industrial accidents, falls
Middle or lower cervical
segments or at T12 and L1
Generally stable
Extremely unstable
Severe hyperflexion
and compression
forces
Motor vehicle crashes
Mostserious spinal injuries in cervical, thoracic,
and lumbar regions
Patient may say, “I broke my tailbone”

Moderate pain from mobile coccyx
Fractures of S1 and S2 fairly common
May compromise sacral nerves
May result in loss of perianal sensory motor
function and in bladder and sphincter
disturbances
Sacrococcygeal joint may be injured from

direct blows and falls
Primary injuries
Occur at time of impact
Secondary injuries
Occur later due to:
Swelling
Ischemia
Movement of bony fragments
Concussed
Contused
Compressed
Lacerated
Severity of injuries depends on:

Amount and type of force
Duration of injury
Lesions (transections) of spinal cord are
classified as:
Complete
Incomplete
Usually spinal fracture or dislocation
Absence of pain, pressure, and joint sensation
Complete motor paralysis below injury
Quadriplegia
Injury at cervical level
Loss of all function below injury site
Paraplegia
Thoracic or lumbar level injury
Loss of lower trunk function
Autonomicdysfunction may occur with
complete cord lesions
Manifestations of autonomic dysfunction

Bradycardia
Hypotension
Priapism
Loss of sweating and shivering
Poikilothermy
Loss of bowel and bladder control
Central cord syndrome
Seen with hyperextension or flexion cervical
injuries
Greater motor impairment of upper than lower
extremities
Signs and symptoms

Paralysis of arms
Sacral sparing
Anterior cord syndrome
Usually flexion injuries
Pressure on anterior spinal cord by ruptured
intervertebral disk
Fragments of vertebral body extruded into spinal canal
Signs and symptoms

Decreased sensation of pain and temperature
below lesion
Intact light touch and position sensation
Paralysis
Brown-Séquard syndrome
Hemitransection of spinal cord
Ruptured intervertebral disk
Encroachment on spinal cord by a fragment of
vertebral body
Pressure on half spinal cord results in:
Weakness of upper and lower extremities on ipsilateral
side
Loss of pain and temperature on contralateral side
Use
in incomplete cord injury is very
controversial
Glucocorticoids
Naloxone
Calcium channel blockers
Methylprednisolone (Solu-Medrol)
Afterlife-threatening injuries have been
assessed and treated
Priorities:
Scene survey
Assess airway, breathing, and circulation
Preserve spinal cord function
Avoid secondary injury to spinal cord
Prevent secondary injury from:
Unnecessary movement
Hypoxemia
Edema
Shock
Neurological exam
At scene or en route
Document findings
Motor and sensory findings
Reflex responses
Seldom evaluated
prehospital
Some indicate
autonomic injury
Babinski's sign
Plantar reflex
Dorsiflexion of great toe
with or without fanning of
toes
Visual inspection
Cord transection above C3 often results in
respiratory arrest
C4 lesions may cause paralysis of diaphragm
Transections at C5-C6 spare diaphragm
Permit diaphragmatic breathing
Absence of neurological deficits does not rule
out spinal injury
Ability
to walk should not be a factor in
determining need for spinal precautions
Primary goal
Prevent further injury
Treat spine as a long bone with a joint at either

end (the head and pelvis)
Use complete spinal immobilization
Begins at initial assessment
Maintain until spine is immobilized on a long

backboard
When a possible or
potential spine injury
recognized, manually
protect head and neck
Maintain in line with long
axis of body
In one move, patient is rotated away from prone position.
Rescuer 1 at head, rescuers 2 and 3 at midthorax and knees
Rescuer 4 manages spine board
Maintain immobilization and roll in one move
In one move, rescuers log-roll and center patient on spine board
Rescuer 1 provides in-line stabilization; prepares for rotation
In one move, rescuers log-roll and center patient on spine board
Protects cervical spine from compression
Reduces movement and some range of motion of
head
Does not provide adequate spinal immobilization
Use
with manual in-line stabilization or
immobilization by a suitable device
Many sizes (or are adjustable)
Appropriate size reduces flexion or

hyperextension
Must not:
Inhibit ability to open mouth or clear airway
Obstruct airway or ventilations
Apply after head is in neutral in-line position
Rescuer 1 maintains
in-line stabilization
Rescuer 2 positions
and secures collar
Rescuer 1 maintains
support until patient
has been secured to
board
Splint cervical and thoracic spine
Vary in design
Spinalimmobilization for patient in a sitting

position or a confined space
After
short spine board has been applied,
patient is transferred to a long spine board
Steps vary depending on:
Size and make of vehicle
Patient’s location inside vehicle
Rescuer 1 maintains
in-line stabilization
Rescuer 2 supports
midthorax as rescuer 3
frees lower extremities
Patient lowered onto
long spine board
Patient centered and
secured on spine
board
Support victim’s
head in the position
found.
Support victim’s head in position found
Do not move victim’s head to move it in line
Supporting victim’s head inline with body is
called inline stabilization
If unresponsive victim must be moved to give
CPR, keep head in line with body
Inline Stabilization
Hold victim’s head with both
hands to prevent
movement of neck or spine.
Monitor victim’s breathing.
If needed, use objects to
maintain head support.
1. Assess a responsive victim.
2. Stabilize victim’s head and neck in position
found.
3. Monitor victim’s breathing.
4. Send someone to call 9-1-1.
5. Prevent victim’s head movement if you
must leave.
Rolling a Victim (Log Roll)
Keep inline stabilization of
head.
First aider at victim’s head
directs others to roll body as
unit.
Some may not damage spinal cord or be
serious
Usually results from stressful activity (not
traumatic injury)
Muscle or ligament may be strained, or disk may
be damaged
Usually not an emergency
But still require medical attention
Signs and symptoms include:
Pain in lower back
Stiffness
Reduced movement in back
Possible sharp pain in one leg
Head and Spinal Injury
Assessment
Check the victim’s
head.
Check neck for
deformity, swelling,
and pain.
Check sensation in
feet.
Ask victim to point
toes.
Ask victim to push against
your hands with feet.
Check sensation in hands.
Ask victim to make a fist
and curl it in.
Ask victim to squeeze
your hands.

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SPORTS REHABILITATION

Annually15,000 permanent spinal injuries

Wedge-shaped compression fractures and

Motor vehicle crashes

Patient may say, “I broke my tailbone”

Sacrococcygeal joint may be injured from

Severity of injuries depends on:

Absence of pain, pressure, and joint sensation

Complete motor paralysis below injury

Manifestations of autonomic dysfunction

Signs and symptoms

Signs and symptoms

Treat spine as a long bone with a joint at either

Use complete spinal immobilization

Begins at initial assessment

Maintain until spine is immobilized on a long

Appropriate size reduces flexion or

Apply after head is in neutral in-line position

Spinalimmobilization for patient in a sitting

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