The Spine PE 236 Juan Cuevas, ATC

1. The SpinePE 236Juan Cuevas, ATC

7. Assessment of the Spine • History • _____________ (rule out spinal cord injury) • _________, tingling, burning? • Can you move your ankles and toes? • Do you have equal strength in both __________?

8. Other general questions • Where and ________ of pain are you experiencing? • What were you doing when the pain started? • Did the pain begin immediately and how long have you had it? • _______ or movements that increase/decrease pain? • Past history of back pain • Sleep position and patterns, seated positions and postures

9. ______________ • Body type • Postural alignments and asymmetries should be observed from all views • Assess height differences between anatomical landmarks

10. Postural Malalignments

11. Palpation • Should be performed with athlete __________ • Head and neck should be slightly flexed, pillow under hips if suffering from low back pain • _________ and transverse processes of each vertebrae should be palpated along with sacrum and coccyx • __________ should also be palpated bilaterally

12. Special Tests • Test for lumbar spine should be performed standing, sitting, supine, _________ and prone • Assess levels of pain and ________________ during the following tests • Forward and backward bending • Side-bending and rotation

13. Straight Leg Raises • Applies pressure to SI joint and may indicate problems with __________, SI joint or lumbar spine

14. Low Back Pain • Cause of Injury • ___________ anomalies • Mechanical defects of the spine (posture, obesity and body mechanics) • Back trauma -Signs of Injury • Pain, possible weakness, __________ gait, muscle strains and bony defects • Neurological signs and symptoms if it becomes disk related • Care • Correct alignments and body mechanics • Strengthening and stretching – avoid unnecessary stresses and strains associated with daily living

15. Lumbar Vertebrae Fracture and Dislocation • Cause • __________ fractures or fracture of the spinous or transverse processes • Compression fractures are usually the result of trunk hyperflexion or falling from a _________ • Fractures of the processes are generally the result of a direct blow • Dislocations tend to be ________ • Signs of Injury • Point tenderness over the affected area • Palpable ___________ over the spinous and transverse processes • Localized swelling and guarding

16. Care • X-ray and physician referral • Transport with extreme caution and care to minimize movement of the segments • Utilize a spine board

17. Low Back Muscle Strain • Cause of Injury • Sudden ______________ overload generally in conjunction w/ some type of rotation • Chronic strain associated with posture and mechanics • Signs of Injury • Pain may be diffuse or localized; pain w/ _________ extension and ____________ flexion • Care • RICE to ________ spasm; followed by a graduated stretching and strengthening program • Elastic wrap/back brace may be useful for support and compression • Complete bed rest may be necessary if it is severe enough • ____________

18. Back Contusions • Cause of Injury • Significant impact or ___________ to the back • Signs of Injury • Pain, swelling, discoloration, muscle spasm and point tenderness • Management • RICE for the first _______ hours • Ice massage combined with gradual stretching • Recovery generally last 2 days to 2 weeks

19. __________ • Cause of Injury • ___________ condition of the sciatic nerve • Nerve is vulnerable to torsion or direct blows that place abnormal amounts of stretching or pressure on nerve • Signs of Injury • Arises abruptly or gradually; produces _______ shooting pain, tingling and numbness • Sensitive to palpation with straight leg raises intensifying the pain • Care • Rest is _________; acutely – recovery = 2-3 weeks • Treat the cause of inflammation; traction if disk protrusion is suspected; NSAID’s

20. Herniated Disk • Cause of Injury • Caused by abnormal stresses and degeneration due to use (forward bending and twisting) • ________ Pulposus • Annulus ________

21. Signs of Injury • Centrally located pain that radiate • Symptoms are worse in the __________ • Onset is sudden or gradual, pain may increase after the athlete sits and then tries to resume activity • Forward bending and _______ increase pain, while back extension __________ pain • Straight leg raise to 30 degrees is ___________ • Care • Rest and ice for pain management • Extension exercises may be comfortable • _________ stabilization exercises should be integrated as athlete improves

22. Spondylolysis and Spondylolisthesis • Cause of Injury • Spondylolysis refers to degeneration of the vertebrae due to congenital weakness (____________ results) • ___________ of one vertebrae above or below another is referred to as spondylolisthesis and is often associated with a spondylolysis • Signs of Injury • Pain and persistent _________, low back stiffness with increased pain after activity • Frequent need to change position or “_____” back to reduce pain • Localized tenderness to one segment

25. Care • __________and occasionally bed rest for 1-3 days will help to reduce pain • Major focus should be on exercises directed as controlling or stabilizing hypermobile segments • Progressive trunk strengthening, dynamic core strengthening, concentration on abdominal work • Braces can also be helpful during high level activities • Surgery in extreme cases

26. Sacroiliac Joint Dysfunction • Sacroiliac Sprain • Cause of Injury • Result of twisting with both feet on the ground, stumbles forward, falls backward, steps too far down, heavy landings on ______, bends forward with knees locked during lifting • Signs of Injury • Palpable pain and tenderness over the joint, medial to the ________ w/ some muscle guarding • Pelvic ____________ are possible

27. Care • Ice can be used to reduce pain • Bracing can be helpful in acute sprains • Strengthening exercises should be used to stabilize the joints