The Spine

1. The Spine Chapter 24

2. The Nervous System • Body’s information gatherer, storage center, control system • Function: • Collect information about external conditions in relation to body’s internal state • Analyze this information • Initiate appropriate responses to satisfy needs • Brain + spinal cord = central nervous system • Peripheral nervous system • Autonomic nervous system

3. Peripheral Nervous System • Includes all the nerves and ganglia of the body outside the brain and spinal cord • Functions of Peripheral Nervous System: • Connect body to central nervous system • Control involuntary activities of the body • Act as reflex center of body • Autonomic Nervous System • Specialized part of peripheral nervous system • Controls the involuntary activities of the vital internal organs

4. Nerves • Bundles of nerve fibers enclosed by connective tissue • Afferent (sensory) nerve: Fibers carry impulses from sense organs to brain or spinal cord • Efferent (motor) nerve: Fibers carry impulses from brain or spinal cored to muscles or glands • Mixed nerve: contains both sensory and motor fibers

5. 12 nerve pairs that begin in areas of the brain • Designated by number & name • Most are mixed nerves • 3 are sensory only

6. Spinal Nerves • Originate at the spinal cord and go through openings in the vertebrae • 31 pairs • All mixed nerves • Named in relation to location on spinal cord • Carry messages to and from spinal cord, brain, and all parts of body • Each divides and branches • Go directly to body segment • Form network with adjacent spinal nerves and veins (plexus)

7. Autonomic Nervous System • Includes nerves, ganglia, and plexuses • Carry impulses to all smooth muscle, secretory glands, and heart muscle • Regulates activities of the visceral organs • Heart, blood vessels, respiratory organs, alimentary canal, kidneys, urinary bladder, reproductive organs • Two divisions • Sympathetic: prepares the body for action • Parasympathetic: inhibits/opposes effects of sympathetic system

8. Sympathetic Nervous System • Consists of two cords, beginning at base of brain and proceeding down both sides of spinal column • Consist of nerve fibers and ganglia of nerve cell bodies • Closely associated with spinal cord • Sympathetic nerves extend to all the vital organs • Liver, pancreas, heart, stomach, intestines, blood vessels, iris of eye, sweat glands, bladder • “Fight or Flight system” • message sent to adrenal medulla • Hormones secreted to prepare body for action

9. Parasympathetic Nervous System • Two important active nerves: • Vagus nerve • Extends from medulla and proceeds down neck • Pelvic nerve • Emerging from spinal cord around hip regions, sends branches to organs in LE

11. Reflex Act • Simplest type of nervous response • Unconscious • Involuntary • Examples: • Blink of eye when particle of dust touches it • Removal of finger from hot object • Secretion of saliva at sight or smell of food • Movements of heart, stomach, and intestines

12. Reflex Act continued • Preceded by change in environment (stimulus) • Sound waves, light waves, heat energy, odors • Receptors pick up these stimuli • Retina in eye receptor for light • Special cells in inner ear receptors for sound waves • Special structures in skin receptors for heat/cold • Reaction to a stimulus is called the response • Effector: organ that responds to a stimulus • Reflex actions involving the skeletal muscles, controlled by spinal cord, called somatic reflexes

14. The Spine

15. The Spine • aka vertebral column • Strong & flexible • Supports head and provides attachment of ribs • Encloses spinal cord • Bones of spine called vertebrae • Separated by pads of cartilage tissue called intervertebral discs

16. The Spine • Cervical (7): located in neck area • Atlas: first cervical vertebra; articulates with occipital bone in skull • Axis: second cervical vertebra; the odontoid process forms a pivot on which the atlas rotates • Thoracic (12): located in chest area • Articulate with ribs • Lumbar (5): associated with lower back • Bear most of body’s weight • Sacrum: wedge-shaped unit formed by 5 fused bones • Coccyx : formed by 4 fused bones • Tailbone

17. Vertebrae • Body—large solid part • Foramen—central opening for spinal cord • Processes • Transverse process • Spinous process

19. Spinal Cord • Base of skull to second lumbar vertebra • White & soft • Lies within vertebrae of spinal column • Submerged in cerebrospinal fluid • Surrounded by three meninges (any of three linings that enclose the brain and spinal cord) • Gray matter: inner part of spinal cord • White matter: outer part of spinal cord

20. Injuries to the Spine

21. Spinal Curvature • Scoliosis • Spine curved from side to side • Kyphosis • Over-curvature for thoracic spine • Roundback or hunchback • Lordosis • Inward curvature of a portion of the lumbar and cervical vertebrae

22. Scoliosis Lordosis Kyphosis

23. Cervical Spine Injuries • Minor neck pain  complete paralysis  death • C-Spine suspected? • Stabilize to protect athlete for further injury • Improper handling and transportation may cause irreparable spinal-cord damage • MOI: forced movement of hear on cervical spine or excessive motion of neck • Blow that forces head beyond normal limits of motion • Can involve vertebrae, facet joints, intervertebral disc, ligaments, muscles, nerve roots, or spinal cord

24. Axial loading or cervical compression are most serious • Occurs when athlete receives blow straight to crown of head, with neck slightly flexed • Cause fracture of vertebra or force articular facets to slide away from each other

25. Cervical Spine Injuries • DO NOT MOVE ATHLETE! (except from immediate danger) • Assume neck injury if athlete is/has • Unconscious • Numbness and paralysis • Neck pain or pain with neck movement • Severe neck injuries usually accompanied by pain and/or neurologic symptoms

27. Cervical Sprains/Strains • Mild • No feelings of weakness or instability • May be tenderness and pain at site of injury • Athlete can demonstrate normal ROM • Moderate • Limited motion of C-spine • No radiation of pain or paresthesia • Severe • Athlete will resist moving neck through FROM • Localized pain and muscle spasm • c/o insecure feeling about neck

28. Cervical Nerve Syndrome • Result of forced lateral flexion, causing the nerve roots to be stretched or impinged • Sharp, burning, radiating pain • aka: pinched nerve, burner, stinger • c/o pain shooting into posterior scalp, behind ear, around neck, or down top of shoulder • May return to activity when paresthesia has subsided and full strength

29. Cervical Fracture & Subluxation • Not common in athletics • Football, diving, gymnastics • Most fatal or paralyzing injuries occur when neck in flexion and blow to crown of head • Spinal cord may be completely or partially • Transected • Contused—cause swelling within cord, results in various degrees of temporary/permanent damage • Concussed—may cause transitory paralysis and symptoms, but usually complete recovery

30. Cervical Injuries—Signs/Symptoms • Athletes may experience: • Quadriparesis • Quadriplegia • Neuropraxia • Symptoms may include: • Burning pain • Numbness • Tingling • Loss of sensation • weakness • Complete paralysis • Recovery of complete motor/sensory function usually occurs within a few minutes to 36-48 hours • Additional cervical injuries: • Stenosis • Congential abnormality • Cervical instability • Intervertebral disk herniation

31. Stenosis

32. Thoracic Spine Injuries • Common are contusions, strains, and sprains • MOI: • Direct blow • Overstretching soft tissue surrounding thoracic vertebrae (paraspinal muscles) • Violent muscular contraction against resistance • Serious injuries rare in athletics—compression fracture to body of vertebrae • MOI: forced forward flexion (jackknifing effect) • Compresses anterior portion of adjacent vertebral bodies

33. Thoracic Spine Injuries—Signs/Symptoms • Difficult to distinguish between sprain and strain • Tenderness • Spasms • Increase pain with active contraction or stretching • Moderate/severe—exhibit stiff back and may resist motion/movement of thoracic spine • Compression fx • Usually no neurological complaints • Move and walk normal • c/o constant localized pain, increase with movement of the area

34. Lumbar Spine Injuries • Lumbar spine very susceptible to injury • Structural defect in vertebrae or intervertebral discs • Aggravated by contributing factors: • Inadequate or inappropriate conditioning • Inflexibility • Congenital anomalies • Poor postural habits • Common athletic injuries include: contusions, sprains, strains • Directed blow to lumbar area • Violent muscle ctx against resistance, overuse, overstretching

35. Spondylolysis • Most common structural defect of lumbar spine • Breakdown of structure of vertebrae • Defect in pars interarticularis of vertebrae

36. Spondylolisthesis • Slippage of one vertebra on the vertebra directly below it • Considered to be stress fracture • Result of repeated trauma and stress • Can be congenital

37. Signs/Symptoms • LBP with increased activity • Pain diminishes with rest • Pain radiating into buttocks and upper thigh

38. Intervertebral Disc Herniation • Nucleus pulposus herniates through the annulus fibrosus and presses against the spinal cord or spinal nerve roots • Signs & Symptoms: • Extreme pain • LB stiffness • Pain in buttocks • Unique type of radiating leg pain if compression severe • Leg pain unilateral • Follows route of sciatic nerve

41. Disc Herniation Continued • Signs & Symptoms: • Unilateral muscle weakness • Sensory loss • Reflex loss in leg • Sitting for prolonged periods of time uncomfortable • Uncomfortable standing with both legs straight • Pain with forward trunk flexion • Treatment: • Refer to physician

42. Sacroiliac Injuries • Signs & Symptoms • Stiffness • Consistent soreness of SI joint • Better in am; worsens as day progresses • No neurologic signs • Referred pain in back of thigh, groin, or hamstrings • Activity may diminish discomfort, but pain return as athlete cools down • Sprains that occur as result of acute or chronic trauma • MOI: • Single maneuver • Twist • Awkward movement • Overuse • Poor posture • Bad lifting techniques • Strenuous maneuvers repeated