BPK 241 Week 5

Vertebrae

33 Types - 24 true, 9 false

Kyphodic curve

Distributes forces on spine

Vertebrae types

• 7 Cervical

• 12 Thoracic

• 5 Lumbar

• 5 Sacral (fused)

• Coccyx

Spine Features

• Body (or anterior mass)

• Spinous process

• Lateral (transverse) process

  • Articulations with ribs (thoracic spine)

  • Facet joints (superior & inferior)

Atlas (C1) & Axis (C2)

• Holds your skull

• Allows flexion + extension

• C1 rotates on C2 - pivot joint

• Bone gets bigger downwards as we bear more weight

Cervical

High back

Thoracic

Middle back

Lumbar

Lower back

Spine ROM

• Occipital joint: 50º Flexion-extension, 4º Rotation, 8º Lateral Bend

• Atlanto-axial joint: 10º Flexion-extension, 50º Rotation, 0º Lateral Bend

• Subaxial Cervical Spine: 50º Flexion-Extension, 50º Rotation, 60º Lateral Bend

• Thoracic spine: 75º Flexion-Extension, 70º Rotation, 75º Lateral Bend

• Lumbar Spine: 85º Flexion-Extension, 10º Rotation, 30º Lateral Bend

Intervertebral discs

• Lie between vertebral bodies

• Annulus fibrosus (fibrocartilage)

• Nucleus pulposus (gel)

• Functions: Stability and Cushioning

Spine Joints

• Fibrocartilaginous

  • Between discs & vertebral bodies

• Synovial

  • Facets joints (4 per vertebrae)

Annulus Fibrosis

• Disc Annulus fibres arranged in 15-25 concentric layers

  • Fibres are angles

  • Angle changes with alternate layers (a strong configuration)

Innervation of Disc

Layers of the annulus fibrosis is thicker at front and thinner at back and collagen is a bit stronger at front and weaker at back. Outer third of disc is innervated

Blood Supply to Disc

Outer third of annulus of annulus fibrosis is the only good area of blood supply

Disc Annulus fibres on bending

Stretch out and compress in on the other side

Disc Annulus fibres on rotation

Certain layers are taught and others are squished in

Disc Nucleus Pulposus behaves hydrostatically

• Centre of disc (nucleus pulposus) is like a liquid

• Liquids are incompressible, so applied load creates outward (radial) pressure in all directions inside the disc

Compressive & Radial Forces

• Striped bars show vertical load

• White bars show tensile stress in annulus fibrosis

• For every posture, compression is << tension

Spine Ligaments

• Anterior & posterior longitudinal ligaments

• Ligamenta flava

• Intertransverse ligaments

• Interspinous & supraspinous ligaments

Anterior and Posterior longitudinal ligaments

Connect vertebral bodies

Ligamenta flava

Connect Laminae

Intertransverse ligaments

Connect transverse process

Interspinous & Supraspinous ligaments

Connect spinous processes

Spine Muscles

• Erector spinae - superficial

• Transversospinalis - deep

• Many others

Spine Movements

• Flexion & extension

  • Cervical, thoracic, lumbar

• Lateral flexion (moderate)

  • Cervical, thoracic (minimal), lumbar

• Rotation

  • Cervical and thoracic only

Transversospinalis Muscle Group

• Smaller stabilizer muscles

• Actions

  • Uilateral: one side

    • lateral flexion

    • turning H & N to the opposite side

    • Contralaterally - if contract on right, will turn to left

  • Bilateral: extension of spine

    • Muscle fibers run superiorly and medially

Spinal Nerves

• Cervical nerves

• Thoracic nerves

• Lumbar nerves

• Sacral nerves

• Coccygeal nerve

Sciatic Nerve

Arises from the spinal nerves of L4 through S3

Dermatomes

Sensations + compression areas

Spine Injuries

• Cause:

  • Congenital predispositions

  • Previous trauma

  • Mechanical factors

    • Poor Posture (lifting, bending)

    • Obesity

  • Acute or repetitive trauma

• Effects:

  • Pain, tenderness, spasm, restricted ROM

  • Neurological SSx?

    • Radiating pain (scaltia)

    • Weakness, numbness, absent DTR(deep tendon reflexes)

Spine Sprain and Strains

• Common (twisting, lifting)

• Recurrence is common (lower back pain)

• SSx:

  • Pain & Tenderness

  • Muscle spasm (delayed onset)

  • Restricted ROM (early or delayed onset)

  • Increased warmth towards area

  • If any neurologic SSx are present, assume fracture (#), dislocation or disc injury - stabilize and transport to hospital

Spine Sprain and Strains Treatment

• Rest - supine - no more than 2 days

• NSAID/pain medication

• Cold therapy at first

• Heat therapy later

• Physiotherapy or massage Tx

• Comprehensive, supervised rehabilitation program

  • Flexibility (ROM)

  • Strengthening (the back)

  • Task specific

• Correct predisposing factors

• Gradual return to activity

Lumbar DISC Herniation

• Nucleus pulposus breaks through annulus fibrosis

• Most often occurs at the L4L5 and L5S1 levels

• Vulnerable between ages 30 to 50 as elasticity and water content of the nucleus pulposus decreases with age

• 4 stages

  • Protusion

  • Prolasped

  • Extrusion

  • Sequestered

Disc Protrusion

(disc bulge) cracks in annulus fibrosis begin to appear

Prolasped Disc

Nucleus pulposus moves completely through annulus fibrosis

Extruded Disc

Nucleus pulposus moves into spinal canal, comes in contact with a nerve root

Sequestered Disc

Portion of nucleus pulposus separates from disc and begins to migrate in spinal canal

Intervertebral disc disease

• As in sprains and strains

• Herniation of nucleus pulposus

• Compression of nerve root(s) or spinal cord

• Effects:

  • SSx as for sprains & strains plus neurologic (e.g. sciatica)

  • Instability - muscles need to work harder & bone laying down more calcium

  • Osteoarthritis (Osteophytes, sterosis)

• Tx:

  • Conservative if possible

  • Surgical (discectomy, laminectomy, fusion)

  • Strengthening, ROM

Stinger or Burner

• Brachial Plexus Neuropraxia

  • Hx:

    • Stretching or compression of brachial plexus

    • Neck forced laterally

  • SSx:

    • Pain/ numbness into fingers, burning, numbness, tingling from shoulder to hand

    • Athlete may return only symptoms resolve

  • Tx:

    • Rest

    • If symptoms not diminishing or resolving within a few minutes (or worsening) send to hospital

Spine Fracture (Axial Load)

• Cervical spine (head into boards at hockey, helmet to helmet in football)

• 4th, 5th, 6th cervical vert most common

• Hyperextension

• SSx:

  • Point tenderness, decreased ROM

  • Pain in neck, chest, extremities

  • Numbness/weakness in trunk/limbs

  • Sore spinal process, sharp pain and very painful at specific spot

• Tx:

  • Stabilize, c-spine collar, spine board

  • If unconscious, assume c-spine injury

Management of back injuries

• Key is balance

  • Demands with functional capacity(younger players can return)

  • Expectations with realistic goals

• Mainstays

  • Time! (rest, healing)

  • Cold, heat, NSAIDs, braces

  • Physiotherapy, massage therapy, chiropractic

  • Rehabilitation (indefinite)

  • Correct predisposing factors

  • May need to change job or sport

McGill Big 3

• Goal is to build endurance in spinal stabilizers

• Bird Dog

• Trunk Raise

• Side Plank

  • 10 seconds of activity

  • 2 seconds rest

  • Descending pyramid of repetitions (i.e. 8-6-4)

  • No sit ups

Why don’t we recommend back braces for everyday use or extended periods of time? When might use of back braces be warranted?

• Muscles are working harder to resist back brace

• Falsehood of belief of good use

• No protective benefit → increase of injury