Spine and Thorax

• -C1-C7
• -C1 and C2 support skull and allow left and right motion

•Twelve vertebrae (T1 to T12).

•Protect the spinal cord (with the ribs) and protect the organs in the chest.

• •The lumbar spine is the lowest of the spinal regions and connects the spine to the
• pelvis.

•Five vertebrae articulate to form the lumbar spine (L1 to L5).

•The spine also includes facets and intervertebral discs.

•Provide shock absorption and increases the range of motion of the spine

•Sensory (dermatomes) and Motor (myotomes) nerves

•The rib cage (12 sets of ribs)

•The inferior two sets of ribs (#11 and #12) are floating ribs.

• •The sternum provides added protection to the heart and allows the ribs to move
• properly.

•Include muscles that flex and extend the spine and upper body

•Includes:

• –The trapezius and latissimus dorsi-posterior
• muscles

–The pectoralis muscles and the abdominal muscles-anterior muscles

•Intercostals muscles within the rib cage assist in respiration

•History

–Mechanism of injury (rule out spinal cord injury)

•What happened? Did you hit someone or did someone hit you?  Did you lose consciousness

•Pain in your neck? Numbness, tingling, burning?

•Can you move your ankles and toes?

•Do you have equal strength in both hands

• –Positive responses to any of these questions will necessitate extreme caution when the
• athlete is moved

–Other general questions

•Where is the pain and what kind 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?

•Positions or movements that increase/decrease pain?

•Past history of back pain

•Sleep position and patterns, seated positions and postures

–Body type

–Postural alignments and asymmetries should be observed from all views

–Assess height differences between anatomical landmarks

Signs & Symptoms:

•Pain and tenderness at affected site

•Restricted ROM

•Numbness and tingling

•Weakness in extremities

•Possible paralysis

Treatment:

•Immediate in-line stabilization and immobilization is mandatory for spinal fractures.

Signs & Symptoms: 

•Pain at injury site

•Possible neural symptoms

•Slight swelling and discoloration

•Muscle spasm


Treatment:

• •If there are acute neurological (radicular) symptoms, athlete should be spine
• boarded

•Refer to a physician for x-rays

•RTP within his/her pain tolerance

•Signs & Symptoms:

•Mild to moderate pain, especially with hyperextension 

•Increased pain with prolonged sitting or standing.

•Weakness or fatigue in lumbar area.

Treatment:

•Follow up with physician for x-rays

•Reduced activity with gradual return as symptoms allow.

•Core stabilization and strengthening

Signs & Symptoms:

•Pain throughout neck

•Significant decrease in ROM 

•Muscle spasm

Treatment:

•Refer to physician to rule out cervical fractures.

•Light stretching and massage

Signs & Symptoms:

•Pain just lateral to the spine

•Pain with back extension and rotation

•Muscle spasm

•Slight swelling

Treatment:

•RICE therapy with electrical stimulation

•Muscle strengthening and core stabilization

Signs & Symptoms:

•Pain localized over injury site

•Muscle spasm

•Increased pain in certain motions or positions

•Decreased ROM

Treatment:

•Stretching and strengthening exercises for strains

•A strengthening program only is suggested for sprains.

Signs & Symptoms:

•Sharp pain over the affected disc (L4-5 or L5-S1)

•Decreased ROM

•Pain increasing with flexion and decreasing with extension 

•Radicular pain

•Muscle weakness

• Special Test:
• Valsalva Maneuver

Treatment:

•Conservative treatment with joint immobilization

•Mackenzie exercises

•If symptoms do not diminish, use steroid injections.

•Early return to activity may make injury worse.

Signs & Symptoms: 

•Severe pain over injured site

•Pain increases with inhalation

•Possible swelling and discoloration

•Crepitus

Bucket Handle Test

Treatment:

•Refer to a physician for x-rays

•Conservative treatment with ice, rest, and a rib brace

Signs & Symptoms: 

•Severe pain over injury site

•Pain increases with inhalation

•Possible swelling and discoloration

•Possible crepitus with breathing

Treatment:

•Same as for rib fractures

Signs & Symptoms:

•Severe pain

•Pain increases with breathing

•Possible swelling and discoloration

•Possible crepitus at fracture site

Treatment:

•Refer to a physician to rule out internal injuries.

Signs & Symptoms:

•Pain at injury site

•Decreased ROM

•Decreased strength

Treatment:

•RICE therapy

•Decrease lifting weight or performing alternate lifts during strength training

Signs & Symptoms:

•Pain at injury site 

•Decreased ROM

•Decreased strength

Treatment:

•Ice and rest

•Progressive rehabilitation involving core stabilization

Signs & Symptoms:

•Pain at injury site in upper back

•Decreased ROM

•Decreased strength in affected movements

Treatment:

• •A stretching and progressive strengthening program should follow RICE and
• conservative therapy.

Signs & Symptoms:

•Pain at injury site in lower back

•Decreased ROM

•Decreased strength

Treatment:

•Conservative therapy followed by stretching and strengthening

Cervical Spine

–Muscle Strengthening

• •Muscles of the neck resist hyperflexion,
• hyperextension and rotational forces

•Prior to impact the athlete should brace by “bulling” the neck (isometric contraction of neck and shoulder muscles)

•Variety of exercises can be used to strengthen the neck

–Range of Motion

•Must have full ROM to prevent injury

•Can be improved through stretching

–Using Correct Technique

• •Athletes should be taught and use correct technique to reduce the likelihood of cervical
• spine injuries

•Avoid using head as a weapon, diving into shallow water

Lumbar Spine

–Avoid Stress

•Avoid unnecessary stresses and strains of daily living

•Avoid postures and positions that can cause injury

–Correction of Biomechanical Abnormalities

• •ATC should establish corrective programs based on athlete’s
• anomalies

•Basic conditioning should emphasize trunk flexibility

• •Spinal extensor and abdominal musculature strength should be stressed in order to
• maintain proper alignment

–Using Correct Lifting Techniques

•Weight lifters can minimize injury of the lumbar spine by using proper technique

•Incorporation of appropriate breathing techniques can also help to stabilize the spine

•Weight belts can also be useful in providing added stabilization

•Use of spotters when lifting

–Core Stabilization

• •Core stabilization, dynamic abdominal bracing and maintaining neutral position can
• be used to increase lumbopelvic-hip
• stability

• •Increased stability helps the athlete maintain the spine and pelvis in a comfortable and
• acceptable mechanical position (prevents microtrauma)