COMMON INJURIES OF

THE BACK AND NECK

 LOW BACK PAIN

• Extremely prevalent problem, with up to 85% of people experiencing low back pain at some
time during their lives
• Low back pain is second only to the common cold in causing absences from the workplace
• Psychological and social components and mechanical stress contribute to low back pain
• Increasing incidence of overweight and obesity is significantly associated with low back pain
 • Back pain and occupation:
• The incidence of low back pain in children is nearly 30% and is associated with increased
physical activity and weak back extensor and strong flexor muscles
• It is usually associated with musculotendinous strains and ligamentous sprains
• 9% of college athletes and 85% of the participants in gymnastics experience low back pain
• Workers who sit for prolonged periods and those unable to sit at all during the work day have
High incidences of low back pain
• High-risk occupations for the development of low back pain include laborers, truck drivers,
garbage collectors, warehouse workers, mechanics, nursing aides, materials handlers, lumber
workers, practical nurses, and construction laborers
• Cigarette smokers have an increased incidence of low back pain compared to nonsmokers,
possibly due to the contributions of habitual smoking to disc degeneration
• Work involving dynamic motion in multiple planes is also associated with significantly
increased risk for developing low back pain
 MECHANISM OF LOW BACK PAIN:

• One or a few repetitions of a large load or numerous repetitions of a small load injure
biological tissues
• Bone structure, intervertebral discs, and ligaments provide stability to spine
• Muscles surrounding the spine are primary active contributors to spinal stability as they
serves to increase the stiffness of the motion segments and enhance spinal stability
• In the absence of contraction of the surrounding musculature, buckling of the lumbar spine
occurs under compressive loads
• Fatigue of the spinal extensor muscles also reduce the spine stability
• This reduced activity of muscles put stress directly on the ligaments and other surrounding
tissues, producing back pain
 HOW BACK PAIN IS TREATED

• Strengthening of abdominal muscles as they contribute to spinal stability

• Partial curl-up exercises have been advocated as providing strong abdominal muscle
challenge, with minimal spinal compression
• The use of sit-up exercises for abdominal strengthening should be avoided as they cause
spinal compression and contribute to low back pain
• Endurance training for back extensor muscles to resist fatigue
Partial curl-up exercises sit-up exercises
 SOFT-TISSUE INJURIES

• Any external blow or overloading the spinal muscles, particularly those of the lumbar region
lead to Contusions, muscle strains, and ligament sprains
• As a result of these injuries, Painful spasms and knot like contractions of the back muscles
occur that immobilize the area and prevent further injury
 ACUTE FRACTURES
• Transverse or spinous process fractures:
• Result from extremely forceful contraction of the muscles attached to spinous process or
from the hard blow to the back of the spine in many sports
• Cervical fractures:
• Result from force applied to the head or trunk rather than to the cervical region itself
• most common mechanism is an axial force to the top of the head with the neck in slight
flexion like result from impacts to the head when people dive into shallow water
• Wrestling involves several scenerios with cervical injury
• Lumber spine:
• Large compressive loads during weight lifting or in the handling of heavy materials can cause
fractures of the vertebral end plates
• High levels of impact force like road traffic accident may result in anterior compression
fractures of the vertebral bodies
• Rib fracture:
• Caused by blows received during accidents or participation in contact sports
• Extremely painful because pressure is exerted on the ribs with each inhalation
• Ribs fracture may damaged underlying soft tissue and lungs leading to serious complication
• Acute spinal fractures:
• Acute spinal fractures are extremely serious as the fractured spine may compress against
spinal cord.
• This cord compression may result in paralysis of body below the level of injury and
sometimes death depending upon injury level
• Whenever a spinal fracture is a possibility, only trained personnel should move the victim
 STRESS FRACTURES

• Spinal stress injuries can also result from repeated episode of moderate stress
• Most common type of vertebral stress fracture is that of pars interarticularis, the region
between the superior and inferior articular facets, which is the weakest portion of the neural
arch termed spondylolysis
• it result from repeated axial loading of lumber spine when spine is hyperextended
• A bilateral separation in the pars interarticularis results in the anterior displacement of a
vertebra with respect to the vertebra below it. This vertebral displacement is termed as
spondylolisthesis
• Common among participants in sports involving repeated hyperextension of the lumbar spine
• Risk factors for spondylolysis and spondylolisthesis include genetics, repetitive stresses, and
participation in sports for more than 15 hours per week
• Fracture of pars interarticularis tend to persist if there is no interruption in sport participation
 DISC HERNIATIONS

• 1–5% of back pain is a because of herniated disc

• Disc herniation consists of the protrusion of part of the nucleus pulposus from the annulus
fibroses of the disc that is undergoing degenerative changes either traumatic or stress related
• Most common sites of disc protrusion are C5-C6, C6-C7 and in lumber spine L4-L5 and L5-S1
• Posterior or posterior-lateral aspect of the disc is involved
• Disc itself is incapable of generating any sensation of pain as disc does not its nerve supply
• Pain result when herniated disc compresses spinal nerve root or surrounding ligaments and
other soft tissue that have extensive nerve supply
• Disc herniation is not visible on x-ray as there is no remarkable reduction in disc height is
noted
• Treatment:
• Most lumbar disc herniations are treated conservatively, meaning without surgery.
• Treatment for pain and symptoms of neural deficit includes medications, physical
therapy, and sometimes lumbar injection
• More serious cases that fail to respond to conservative treatment options are treated
with surgical interventions, often lumbar discectomy.
 WHIPLASH INJURIES:
• Whiplash injury is the injury to cervical region, occur during automobile collisions
• Whiplash typically occurs when head is forcefully and quickly moved backward and then
forward.
• This motion can injure bones in the spine, disks between the bones, ligaments, muscles,
nerves and other tissues of the neck.
• Rear-end collisions are a major cause of whiplash.
• Symptoms of whiplash injury include neck pain; muscle pain; pain or numbness radiating
from the neck to the shoulders, arms, or hands; and, in 50–60% of cases, accompanying
headache
• Women appear to be at greater risk for whiplash injury than men due to less stiffness of the
cervical structures