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 FracturesCause = 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 can 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