Chapter 20 - The Spine

_________ is an inflammatory condition of the sciatic nerve and is commonly associated with peripheral nerve root compression.

Sciatica

The _____ is formed by the fusion of five vertebrae, and with the two hip bones, constitutes the pelvis.

sacrum

What are the signs of a back contusion? (Check all that apply.)

- A swollen, discolored area may be visible. - The bruise causes local pain, muscle spasm, and point tenderness.

What are the signs of an acute muscle strain of the neck and upper back? (Check all that apply.)

- Muscle guarding resulting from pain - Localized pain - Restricted motion - Point tenderness

True or false: The spinal cord extends from the cranium to the fifth lumbar vertebra.

False

Which of the following is true of the sacrum?

It articulates with the ilium to form the sacroiliac joints.

Which of the following is true of spondylolisthesis?

It has the highest incidence with L5 slipping on S1.

Which of the following refers to a degeneration of the vertebrae and, more commonly, a defect in the articular processes of the vertebrae?

Spondylolysis

Which of the following is the most inferior part of the vertebral column?

The coccyx

True or false: Athletes can prevent low back pain by avoiding unnecessary stresses and strains associated with standing, sitting, lying, working, or exercising.

True. Athletes, like everyone else in the population, can prevent low back pain by avoiding unnecessary stresses and strains associated with standing, sitting, lying, working, or exercising. Care should be taken to avoid postures and positions that can cause injuries.

The sacroiliac joint is maintained by the extremely strong _____.

dorsal sacral ligaments

A feature of thoracic spine is that _____.

it has very little movement

The _____ is that portion of the central nervous system that is contained within the vertebral canal of the spinal column.

spinal cord

Identify the true statements about minimizing the chance of injury to the lumbar spine. (Check all that apply.)

- Basic conditioning should include an emphasis on trunk flexibility. - Both strength and flexibility should be developed in the spinal extensors.

What are the signs experienced by an athlete who has a cervical fracture? (Check all that apply.)

- Cervical pain and pain in the chest and extremities - Neck point tenderness and restricted movement - Numbness, weakness, or paralysis in limbs and/or trunk

Which of the following are true of the treatment of spondylolysis and spondylolisthesis? (Check all that apply.)

- Initially, bracing and occasionally bed rest for 1 to 3 days helps to reduce pain. - Braces are most helpful during high-level activities. - Rehabilitation should emphasize exercises that control or stabilize the hypermobile lumbar segment.

What are the symptoms of a herniated lumbar disc? (Check all that apply.)

- It creates centrally located pain that radiates on one side to the buttocks and down the back of the leg or pain that spreads across the back. - Straight leg raising increases pain. - Onset may be sudden or gradual, with pain increasing after the athlete sits and then tries to resume activity.

Which of the following are the signs of coccygeal injuries? (Check all that apply.)

- Pain is often prolonged and at times chronic. - The athlete has difficulty sitting. - There is tenderness over the bone.

Which of the following are true of the treatment of back contusions? (Check all that apply.)

- Recovery usually ranges from 2 days to 2 weeks. - Ice massage combined with gradual stretching benefits soft-tissue contusion in the low back. - Cold and pressure should be applied intermittently for approximately the first 72 hours or longer, with rest.

Identify the true statements about the coccyx. (Check all that apply.)

- The gluteus maximus muscle attaches to the coccyx posteriorly. - It is also known as the tailbone. - It consists of four or more fused vertebrae.

Identify the true statements about a herniated lumbar disc. (Check all that apply.)

- The mechanism of a disc injury is forward bending and twisting that places abnormal strain on the lumbar region. - Initially, rest and ice should be used to help relieve pain. - In many cases, backward bending or extension makes the athlete more comfortable.

Which of the following are true of the muscles of the spine? (Check all that apply.)

- The muscles that flex the spine are the sternocleidomastoid muscle, located in the neck, and the abdominal muscles. - The muscles that extend the spine and rotate the vertebral column can be classified as either superficial or deep.

Which of the following are true of the thoracic spine? (Check all that apply.)

- Thoracic vertebrae 1 through 10 articulate with the ribs. - It consists of twelve vertebrae. - Thoracic vertebrae have long transverse processes and prominent but thin spinous processes.

What should football players do to prevent injuries to the cervical spine? (Check all that apply.)

- Use appropriate tackling techniques. - Avoid spearing with the helmet.

True or false: Spondylolisthesis is an inflammatory condition commonly associated with peripheral nerve root compression.

False. Spondylolisthesis is a complication of spondylolysis, often resulting in hypermobility of a vertebral segment. Sciatica is an inflammatory condition of the sciatic nerve and is commonly associated with peripheral nerve root compression.

In the context of assessing injuries to the spine, identify a true statement about palpation.

It should progress from proximal to distal.

Match the types of bones that comprise the spine (in the left column) with their parts (in the right column).

Moveable or true vertebrae matches Choice, The cervical vertebrae, thoracic vertebrae, and lumbar vertebrae Immovable or false vertebrae matches Choice, The sacrum and the coccyx

Which of the following is a characteristic of the lumbar spine?

Rotation is important in this region.

Match the types of the muscles of the spine (in the left column) with their descriptions (in the right column).

The deep muscles matches Choice, They extend from one vertebra to another. The superficial muscles matches Choice, They extend from the vertebrae to ribs.

The _____ consists of seven vertebrae, with the first two differing from the other true vertebrae.

cervical spine

Which of the following is true of the cause of a cervical dislocation?

It usually results from violent flexion and rotation of the head.

Identify the true statements about a cervical dislocation. (Check all that apply.)

- A unilateral dislocation leads to extreme muscle tightness on the elongated side of the neck and a relaxed muscle state on the tilted side. - It can result in considerable pain, numbness, and muscle weakness or paralysis. - It occurs much more frequently in sports than does a cervical fracture. - A unilateral dislocation causes the neck to be tilted toward the dislocated side.

Which of the following are true of a cervical fracture? (Check all that apply.)

- Axial loading of the cervical vertebrae from a force to the top of the head combined with flexion of the neck can result in an anterior compression. - In cases of suspected cervical fracture, the athlete should not be moved except by individuals specifically trained to do so.

What are the typical causes of a low back strain in sports activities? (Check all that apply.)

- Chronic strain commonly associated with faulty posture - A sudden extension, usually in combination with trunk rotation

Which of the following are true of a low back muscle strain? (Check all that apply.)

- Discomfort in the low back may be diffused or localized in one area. - Initially, cold packs and/or ice massage should be used to decrease muscle guarding. - Injuries of moderate to severe intensity may require complete bed rest to help break the pain-muscle guarding cycle. - Pain is present on active extension and with passive flexion.

Which of the following are true of the symptoms of lumbar sprains? (Check all that apply.)

- Flexion, extension, and rotational movements of the vertebrae can increase pain. - Pain becomes sharper with certain movements or postures, and the athlete limits movement in painful ranges. - The pain is localized and located just lateral to the spinous process.

Which of the following are true of a sacroiliac sprain? (Check all that apply.)

- Hip levels may appear to be asymmetrical. - It may result in palpable pain and tenderness directly over the joint, with some associated muscle guarding. - Core strengthening exercises for the lumbopelvic-hip complex should be incorporated to improve stability to a hypermobile joint. - Ice can be used to reduce pain.

Identify the true statements about the treatment of a cervical sprain. (Check all that apply.)

- Ice is used for 48 to 72 hours while the injury is in the acute stage of healing. - A soft cervical collar may be applied to reduce muscle spasm. - In an athlete with a severe injury, the physician may prescribe 2 to 3 days of bed rest along with analgesics and anti-inflammation agents.

Identify the true statements about lumbar sprain. (Check all that apply.)

- Initial treatment should include ice to reduce pain. - It occurs with a single episode or with chronic repetitive stress that becomes progressively worse with activity. - An abdominal brace or support should be worn to limit movement during early return to activity. - The most common type of lumbar sprain occurs when the athlete is bending forward and twisting while lifting or moving some object.

Which of the following are true of the signs of a cervical sprain? (Check all that apply.)

- It displays all the signs of the strained neck, but the symptoms persist longer. - There may be tenderness over the transverse and spinous processes that serve as sites of attachment for the ligaments.

Which of the following are true of acute torticollis? (Check all that apply.)

- It happens when a small piece of synovial membrane lining the joint capsule is impinged or trapped between the cervical vertebrae. - Head movement is restricted to the side opposite the irritation, with marked muscle guarding. - It occasionally follows exposure to a cold draft of air or holding the head in an unusual position over time.

Which of the following are true of sciatica? (Check all that apply.)

- It is likely to produce some tingling and numbness along the nerve pathway. - In the acute stage, rest is essential. - It produces a sharp shooting pain that follows the nerve pathway along the posterior and medial thigh.

Which of the following are true of a pinched nerve? (Check all that apply.)

- It is the most common cervical neurological injury in athletes. - It results from the stretching of the brachial plexus of nerves when the neck is forced laterally to the opposite side while the shoulder is depressed.

Which of the following are true of an acute muscle strain of the neck and upper back? (Check all that apply.)

- It usually occurs when the athlete turns the head suddenly or has forced flexion, extension, or rotation. - Care usually includes use of ice immediately after the strain occurs and use of a soft cervical collar for protection.

Which of the following are true of a cervical sprain? (Check all that apply.)

- It usually results from a more violent motion than a strain does. - It produces tears in the supporting tissue of the anterior or posterior longitudinal ligaments, the interspinous ligament, or the supraspinous ligament. - It occurs when the head snaps suddenly, such as when the athlete is tackled or blocked while unprepared.

Which of the following are true of the considerations related to preventing injuries to the spine? (Check all that apply.)

- Protective cervical collars can help limit movement of the cervical spine. - When making contact with an opponent, the athlete should elevate both shoulders and isometrically contract the muscles surrounding the neck. - The athlete's neck should have a full range of motion.

Identify the causes of a sacroiliac sprain. (Check all that apply.)

- Stepping too far down - Stumbling forward or falling backward - Twisting with both feet on the ground - Landing heavily on one leg

What are the signs of spondylolysis and spondylolisthesis? (Check all that apply.)

- The athlete complains of persistent aching pain or stiffness across the low back, with increased pain after physical activity. - The athlete feels the need to change positions frequently or pop the low back to reduce the pain.

How should acute torticollis be treated? (Check all that apply.)

- The athlete should not return to activity until full range of motion has been regained. - The athlete should gradually engage in strengthening and stretching exercises for the neck and the shoulder complex to help prevent recurrence. - Cold or heat and massage may be used to modulate pain in an attempt to break a pain-guarding-pain cycle. - Gentle traction, rotation, and lateral bending, first in the pain-free direction, then in the direction of pain, can help reduce muscle guarding.

In the context of assessing injuries to the spine, which of the following are true of palpation? (Check all that apply.)

- The musculature on each side of the spine should be palpated for tenderness or guarding. - It should be performed with the athlete lying prone and the spine as straight as possible.

Which of the following are true of low back pain? (Check all that apply.)

- The older the athlete, the more prone he or she is to develop chronic low back pain. - Gradually, this problem can lead to muscular weakness and impairment of sensation and reflex responses. - It is often the result of congenital anomalies, mechanical back defects caused mainly by faulty posture, or trauma to the back.

Which of the following tests help determine whether there is a problem in the sacroiliac joint? (Check all that apply.)

- The straight leg raising test - Compression and distraction tests

Which of the following are true of the lumbar vertebrae? (Check all that apply.)

- They are the major support of the low back. - They are the largest and thickest of the vertebrae, with large spinous and transverse processes.

Identify the true statements about coccygeal injuries in sports. (Check all that apply.)

- They occur primarily from direct impact, which may result from falling on the butt or being kicked by an opponent. - Once the injury is healed, the athlete should be protected against reinjury by appropriately applied padding. - Treatment consists of analgesics and a ring seat pillow to relieve the pressure on the coccyx while sitting.

Identify the true statements about lumbar vertebral fractures. (Check all that apply.)

- Transporting and moving the athlete should be done on a spine board to minimize movement of the fractured segment. - Lumbar vertebral fractures of the greatest concern in sports are compression fractures and fractures of the transverse and spinous processes.

Which of the following should weight lifters do to minimize the chance of injury to the lumbar spine? (Check all that apply.)

- Use weight belts to help stabilize the lumbar spine. - Incorporate appropriate breathing techniques that involve inhaling and exhaling deeply during lifting.

Match the types of lumbar vertebral fractures (in the left column) with their descriptions (in the right column).

Compression fractures matches Choice, They occur as a result of hyperflexion of the trunk or by falling from a height and landing on the feet or buttocks. Fractures of the transverse and spinous processes matches Choice, They result most often from a kick or other direct impact to the back.

Match the ligaments of the spine (in the left column) with their functions (in the right column).

The interspinous and supraspinous ligaments matches Choice, Stabilizing the transverse and spinous processes, extending between adjacent vertebrae The sacrotuberous and sacrospinous ligaments matches Choice, Maintaining the position of the sacrum relative to the ischium The ligamentum flavum matches Choice, Connecting the laminae of adjacent vertebrae from the axis to the sacrum

Which of the following are true of spondylolysis? (Check all that apply.)

- It is often attributed to a congenital weakness, with the defect occurring as a stress fracture. - It is more common among boys than among girls.

What are the signs of a pinched nerve or a brachial plexus injury? (Check all that apply.)

- There is pain extending from the shoulder down to the hand, with some loss of function of the arm and hand that lasts for several minutes. - The athlete complains of a burning sensation and numbness and tingling.

Identify the true statements about intervertebral discs. (Check all that apply.)

- They act as important shock absorbers for the spine. - They are composed of the annulus fibrosus and the nucleus pulposus.

Which of the following are true of the first two vertebrae of the cervical spine? (Check all that apply.)

- They are called the atlas and the axis, respectively. - They function together to support the head on the spinal column and to permit cervical rotation.

Refer to the given image and match the letters of the alphabet (in the left column) with the parts of the intervertebral disc they represent (in the right column).

A matches Choice, The nucleus pulposus B matches Choice, The annulus fibrosus

Which of the following special tests is most likely to indicate a problem in the sciatic nerve or the lumbar spine?

The straight leg raising test