Cervical Spine Movements of the vertebral column Flexion

Cervical Spine

• Movements of the vertebral column – Flexion – Extension – Rotation – Lateral flexion

Prevention of Injuries to the Spine • Cervical spine – Neck strengthening – Range of Motion (ROM) – Correct techniques

Assessment of the Spine • History – – – RULE OUT SPINAL CORD INJURY! What happened? Did you hit someone or land directly on the top of your head? Were you knocked out or unconscious? Do you have any pain in your neck? Do you have tingling, numbness, or burning in your shoulders, arms or hands?

– Are you able to move your ankles and toes? – Where is the pain located? – Were you standing, sitting, bending or twisting? – Did the pain begin immediately? – Do certain movements or positions cause or get rid of the pain? – Is there any pain in the buttocks or the back of the legs? – What position do you sleep in? How do you prefer to sit? – Have you ever had any previous back pain?

Recognition and Management of Cervical Spine Injuries • Cervical Fractures Cause = axial loading of cervical vertebrae from top of head combined with flexion of the neck S&S = neck point tenderness and restricted movement, muscle spasm, cervical pain and pain in chest and extremities, numbness and weakness in trunk and/or limbs, loss of bladder/bowel control Care = EXTREME caution in moving athlete - a catastrophic spinal injury can occur with improper handling and transportation

• Cervical dislocations – Cause = more frequent than a fracture, violent flexion and rotation to head – S&S = pain, numbness, muscle weakness or paralysis, discernable difference is position of neck - unilateral dislocation cause neck to tilt toward dislocated side, with tight muscles on the elongated side and relaxed muscles on the tilted side – Care = same as with fracture, but even greater care because a dislocation has a greater likelihood of causing injury to the spinal cord

• Acute muscle strains of the neck and upper back – Cause = turning head suddenly, or forced flexion, extension, or rotation – S&S = localized pain, point tenderness and restricted movement, muscle guarding from pain – Care = RICE, cervical collar, ROM exercises, followed by isometric exercises, progressing to full range isotonic strengthening, heat

• Cervical sprain (whiplash) – Cause = same mechanism of strains, but more violent, frequently muscle strains occur with ligament sprains producing tears of the supporting ligamentous tissue – S&S = same as strains but persist longer, may have tenderness over transverse and spinous processes; may not have pain until 24 hrs after injury – Care = rule out fracture, dislocations, or disk injury. RICE for first 72 hrs, cervical collar, NSAID’s, heat, massage

• Acute torticollis (wryneck/stiffneck) – Cause = most common, acute cervical joint lock, a small piece of synovial membrane lining the joint capsule is impinged or trapped between the cervical vertebrae. May be caused by cold draft or holding head in unusual position – S&S = point tenderness, muscle spasm, head movement restricted to opposite side of irritation with marked muscle guarding – Care = heat, massage, joint mobilization that involves gentle traction, rotation, and lateral side bending

• Brachial Plexus Injury (pinched nerve) – Cause = stinger/burner, stretching of the nerves when the neck is forced laterally to opposite side when the shoulders depressed – S&S = burning sensation, numbness and tingling pain down shoulder to hand, loss of function of arm and hand that lasts several minutes – Care = return to activity once symptoms resolve; strengthening and stretching of neck musculature