Spine Injuries-AC-Spine Injuries PowerPoint.pptx

The Spine Advanced Anatomy and Injuries.

Dr. Spine, Stuart McGill.

Objectives 1. To identify key structures of the spine 2. To identify the symptoms of a given spinal condition 3. To identify the injury mechanism of a given spinal condition 4. To identify the exercise indications and contraindications for a given spinal condition 5. To coach and progress exercises for spinal stability 6. To develop effective exercise programs that are safe for the spine.

Spinal Anatomy.

Spinal Column What is the ROLE of the spinal column? • Structure • Protection of Spinal Cord • C – Stability • T – Mobility • L – Stability.

Lumbar Vertebral Body.

Lumbar Vertebral Body Vertebral Body • 5 blocky lumbar vertebrae which bear the weight of the body • Posterior structures • spinous processes form the “spine” • transverse processes are site of muscle and ligament attachments Lamina ⚫ protects and acts as an exit for spinal nerves Superior and inferior articular processes (from 2 vertebra) articulate to form the facet joints. These facets are covered with cartilage..

Vertebral vs. Intervertebral Foramen.

Vertebral vs. Intervertebral Foramen •Vertebral canal/spinal canal/central foramen (vertical) contains spinal cord •Intervertebral/lateral canal/lateral foramen (horizontal) contains spinal nerves •The spinal canal is like an elevator shaft, and intervertebral canals occur at regular intervals like each floor in the building. The lamina is like the doors that open and allow you to exit the elevator on each floor..

Intervertebral Disc.

Intervertebral Disc The intervertebral disc located between vertebrae acts as shock absorber and facilitates movement in the spine 1) Outer annulus is made of ~13 rings of tough, fibrous connective tissue. Fibers alternate direction to provide strength and resiliency. 2) Inner nucleus is made of a jelly-like fluid with high affinity for water. H20 content decreases after age 50 and with smoking. The end plate is a piece of cartilage that lies between the vertebral body and disc, and acts as an interface to nourish the disc. The disc lacks its own blood supply so it derives nutrients from the vertebral body via the end plate..

Spinal Ligaments.

Biomechanics of the Motion Segment The “motion segment” includes: • Vertebral body and lamina • Posterior structures and facet joint • Disc and end plate • Ligaments (that lie anterior and posterior).

Biomechanics of the Spine Picture 1: Spinal Extension • Anterior ligaments stretched • Disc compressed posteriorly and nucleus moves anteriorly • Facet joint closed Picture 2: Spinal Flexion • Posterior ligaments stretched • Disc compressed anteriorly and nucleus moves posteriorly • Facet joint open 1 2.

Spinal Anatomy (Musculature).

Spinal Musculature ⚫ Movement vs. stability ⚫ Core muscles contract together to protect the spine ⚫ Act as a brace to support and stabilize the spine against outside forces ⚫ QL ⚫ “Workhorse” ⚫ Often strained ⚫ Multifidi ⚫ 2 branches ⚫ INTERSEGMENTAL stability ⚫ 3 changes associated w/ LBP ⚫ Atrophy ⚫ Decreased contraction speed ⚫ Decreased # and size of mitochondria.

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Spine Anatomy Review:.

Principles of Spinal Stabilization ⚫ Find and maintain neutral spine ⚫ Emphasize neuromuscular reeducation ⚫ retraining the body to move properly – recruiting the correct muscles in the correct order to create stability ⚫ Teach musculature to stabilize the spine ⚫ Proximal stability for distal mobility.

Principles of Spinal Stabilization ⚫ Progress from static to dynamic stabilization ⚫ Static stability = NO movement (e.g., plank). Dynamic stability is resisting movement in one place (e.g., the spine) through movement elsewhere (e.g., the limbs, as with a plank with shoulder taps.) ⚫ Determine functional ranges and pain-free positions ⚫ Progress from fully supported to unsupported.

ACTIVITY 1.

Spinal Pathologies.

Biomechanics of the Motion Segment What happens to facets and discs with each position/movement of the spine?.

Low Back (Lumbar)/Cervical Pain.

Lower Cross Syndrome (Anterior Pelvic Tilt) ⚫ Which muscles are tight / weak? ⚫ Hip flexors and spinal erectors tight, glutes and abs weak ⚫ At the spine, an anterior pelvic tilt will pull the lumbar spine into extension ⚫ What happens to spinal discs when the spine is in extension? ⚫ Posterior disc compression and tension ⚫ Which trunk joint action should we avoid? ⚫ Extension.

Upper Cross Syndrome (Cervical Spine) ⚫ Forward head posture causes cervical extension in order to keep the gaze forward, and we see compression on the discs of the cervical spine and facets. ⚫ To alleviate cervical pain and more serious cervical conditions, we need to address upper body posture as well..

Stenosis/Arthritis and Degenerative Disc Disease The wearing away of articular cartilage is arthritis and causes associated pain as we get bone-on-bone contact. The way the body responds to this pain is to attempt to heal itself by laying down more bone in the form of bone spurs..

Stenosis/Arthritis and Degenerative Disc Disease • Changes in posture or spinal biomechanics (e.g., repetitive movements) causes damage to cartilage • Bone spurs develop (arthritis) • Canal narrows = Stenosis • Central Stenosis • Pain down BOTH legs.

Stenosis/Arthritis and Degenerative Disc Disease • Changes in posture or spinal biomechanics (e.g., repetitive movements) causes damage to cartilage • Bone spurs develop (arthritis) • Degenerative Disc • End Plate will start to wear away with spinal movement.

Stenosis/Arthritis and Degenerative Disc Disease: Exercise Rx • Clients with stenosis, arthritis and degenerative disc disease should avoid: • Movement of the lumbar spine, especially extension. • Program should focus on: • Spinal stability and strength • Hip and T-spine mobility • lower body strength to spare the spine during ADLs (e.g getting up from a chair) • Proper lifting technique.

Disc Herniation ⚫ Repetitive trauma disorder where the disc continues to degenerate ⚫ A tear in the annulus allows the nucleus to bulge and aggravate/press against the sciatic nerve ⚫ Pain down one leg: “Sciatica” ⚫ Numbness/tingling Most common disc herniation is L4-L5 posteriorly laterally.

Disc Herniation: Exercise Rx ⚫ Injury Mechanism ⚫ Flexion & Rotation ⚫ CONTRAINDICATIONS ⚫ Exercises that are contraindicated: ⚫ Crunches, Sit-ups, Russian Twists ⚫ Program Management: ⚫ Core stability/strength ⚫ Emphasize neutral spine ⚫ Overall Lower Body Strength ⚫ Glute Max, Glute Med*.

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Disc Herniation: Video.

Compressive Loads on Discs.

Compressive Loads on Discs • Seated positions offer more support to the spine itself BUT have more > compression on discs • Standing exercises are probably better for the client with the herniation. • Stability Balls work well for sitting to decompress spine.

Compressive Loads on Discs • Supine and Side Lying positions provide LEAST compression: • Hip bridges, clam shells, hip abduction & adduction • Think arthritis too.

Spondylolisthesis/Fractures ⚫ Acute trauma causes fracture to vertebra ⚫ Occurs at facet joint (posterior) ⚫ Vertebra moves anteriorly over another ⚫ Pain with extension.

Spondylolisthesis/Fractures: Exercise Rx ⚫ Contraindication: ⚫ Extension ⚫ Spinal stability = MOST important to train, but a little bit of flexion in the program may actually help the client with spondylolisthesis. ⚫ Anti-Movement Core Exercises: Resist Ext.

Spinal Surgeries ⚫ Laminectomy •Occurs first •Lamina removed from vertebral arch to decompress nerve root/take pressure off the nerve via more space ⚫ Discectomy •Part or all of disc removed and implant inserted •Also done prior to spinal fusion.

Spinal Surgeries ⚫ Spinal fusion •Done to limit movement at a segment •Bone taken from iliac crest to fuse segments together •May create movement compensations at segments above and below (joint by Joint) •Surgery should be LAST resort!.

ACTIVITY 2.

⚫ The ability to keep post-rehab clients with spinal injuries safely training while still addressing their goals in the larger context of fitness is a learned but essential skill for personal trainers. 80% of the population has low back pain, but NOT ALL LOW BACK PAIN IS CREATED EQUAL! What helps one condition may harm another, so assessments, referrals and a solid understanding of the injury is essential..