CERVICAL SPINE INJURIES Care and Prevention of Athletic

CERVICAL SPINE INJURIES Care and Prevention of Athletic Injuries Ms. Herrera MS, ATC/L

Bony Anatomy

Bony Anatomy Cont’d

Vertebrae Anatomy Demonstrate importance of atlas and axis

Soft Tissue Anatomy Importance of ligaments

Cervical Spine FACTS l Made of 7 vertebrae l 8 cervical nerves ¡Sensory vs motor ¡dermatome vs myotomes l Atlas supports base of skull on spine l Atlas-Axis relationship

Cervical Spine FACTS cont’d l Transverse foramen ¡Opening allows the nerves to go through l Capable ROM: ¡Flexion ¡Extension ¡Lateral Flexion ¡Lateral Rotation

Intervertebral Disk made of fibrocartilage l Function: ¡ Shock absorber l Nucleus Pulposus: ¡ Think of “jelly doughnut”

History & Observation l HX Essentials: ¡ MOI ¡ Parathesia in extremities ¡ Hit someone with the top of your head? ¡ Loss of strength? ¡ LOC? l Observation Essentials: ¡ Head tilted to one side ¡ Shoulder higher than other side ¡ Scapula protruding/atrophied ¡ Forward posture

POSTURAL CONSIDERATIONS l Study using “plumb line” and chart l Abnormal postures: ¡Forward head posture l. Every inch head is forward, adds 10 lbs more of resistance to posterior neck muscles ¡Kyphosis l. Hunchback appearance caused by excessive flexion of thoracic spine ¡Lordosis l. Excessive lumbar curve

Cervical Fracture & Dislocation l Cervical Fx l MOI: ¡ Axial load ¡ Flexion ¡ Hyperextension l S&S: ¡ Parathesia ¡ TTP over C-Spine ¡ Loss of movement ¡ Loss of bladder control l Management: ¡ EMS ¡ In-line stabilization l Cervical Dislocation l MOI: ¡ Flexion ¡ I. e. diving, football tackles l S&S: ¡ Head tilted to dislocated side ¡ Pain ¡ Numbness/loss of function l Management: ¡ Same as C-spine fx

Sponylolysis Vs. Spondylolisthesis Sponylolysis Spondylolisthesis l A. k. a. stress fx or degeneration of pars interaricularis l Due to fx, vertebrae seperates and becomes displaced making the spine unstable l Dangers? ¡ Can sever spinal cord Management: -See physician ASAP -Place in lumbar brace to add stability to spine -Complete rehabiltation exercises that focus on strengthening the core muscles

Cervical Sprain (Whiplash) l MOI: sudden snap of the neck ¡ Examples? l Can cause… ¡ Sprain of ligaments ¡ Strain of neck muscles l Isolated incident l S&S ¡ Pain on transverse and spinous processes ¡ Inflammation ¡ Muscle spasms l Why? l Management: ¡ ¡ ER to r/o serious injury NSAIDS Rest for 48 -72 hours Ice, heat, massage

Acute Torticollis (Wryneck, stiff neck) l MOI: small piece of synovium trapped within facet joint ¡ Demonstrate on anatomy ¡ Holding head to 1 side for extended time l S&S ¡ TTP ¡ Muscle Spasm ¡ Restricted movement l Which side? l Management: ¡ Modalities to break painspasm cycle

Brachial Plexus Neurapraxia l A. k. a “burners” or “stingers” l MOI: Compression or distraction of brachial plexus. ¡ Examples of MOI’s? l S&S ¡ “elephant trunk” ¡ Burning/numbness/ tingling down arm to hand ¡ Weakness (temporary)

Burners Management l Assess myotomes/dermatomes ¡Determine location of weakness l Ice over brachial plexus for 10 -15 minutes l Re-assess l Recurrent? ¡Neck collar/roller for fb players ¡Strengthening program of neck and shoulder muscles ¡Stretching

Neck Collars

Herniated Disks l MOI: ¡ Repetitive loading on CSpine l Common in sports l Disk commonly herniated posteriorly. l S&S ¡ Pain ¡ Limited ROM ¡ Motor weakness ¡ Parathesia down arms l Management: ¡ Conservative tx l Examples? ¡ If fails, then SX.

Types of Herniated Disks

Prevention of Spine Injuries l Maintain optimal flexibility ¡ How? Stretching hamstrings, hip flexors, gluts, and paraspinal muscles l Exercise ¡ Strengthen core muscles, specifically: l Abdominals, erector spinae, quadratus lumborum l Gluteus maximus, why? l Wear back supports when lifting heavy weight l Pick up boxes/heavy items using your legs NOT bending forward and reaching for it l Use correct technique during sports activities ¡ i. e. in football ‘NEVER HIT WITH YOUR HEAD DOWN (AXIAL LOAD)