Chapter 20 The Spine

CHAPTER 20
The Spine
OVERVIEW

Because of its mobility the spine is vulnerable to a wide range of sports injuries.
Since the catastrophic neck injury is one that produces varying degrees of
quadriplegia, the unconscious athlete should always be treated as if he or she has a
cervical spine injury. An important way to prevent neck injuries is to maximize its
muscular strength and flexibility.
The neck and upper back are subject to a number of acute injuries, the most
common of which are wryneck, muscle strains, sprains, and contusions.
The low back can sustain a number of different injuries from sports activities.
Prevention of low back injuries includes correcting or compensating for postural
deviations, maintaining or increasing trunk and general body flexibility, and
increasing trunk stabilization and strength. Spondylolysis, spondylolisthesis, and
herniated disks can cause pain, and as with any musculoskeletal region, the low
back can sustain traumatic sports injuries such as contusions, strains, and sprains.

LEARNING OBJECTIVES
After studying Chapter 20, the student will be able to:
Identify the bony anatomy of the cervical, thoracic, and lumbar spine.
Identify the muscles involved with movements at each spinal level.
Describe the SLR test and Compression/Distraction test.
Describe measures to prevent injury to the cervical spine.
Describe measures to prevent injury to the lumbar spine.
Describe the difference between spondylolysis and spondylolisthesis.
Describe the signs, symptoms, and causes of injuries to the sacroiliac joint.
Identify specific injuries to the lumbar spine including fractures, dislocations,
strains, sprains, contusions, sciatica, and disc herniations.
Identify specific injuries for the cervical spine including fractures, dislocations,
strains, sprains, torticollis, and those involving the brachial plexus.

KEY TERMINOLOGY
Axial loading - A force that acts on the top of the head combined with flexion of
the neck
Acute torticollis - Usually associated with complaints of pain on one side of the
neck when awakening. Head movement is restricted to the side opposite the
irritation
Brachial plexus injury - Commonly known as a stinger or burner. Results from a
stretching or compression of the brachial plexus
Kyphosis Increased convexity in the curvature of the thoracic spine
Lordosis Forward curvature of the lumbar spine
Sciatica - Inflammation of the sciatic nerve that may accompany recurrent or
chronic low back pain
IM-20 | 1
2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

Chapter 20 The Spine

Scoliosis Lateral curvature of vertebral column

Spondylolisthesis - Forward subluxation of the body of a vertebra onto the
vertebra below, usually occurring in the fifth lumbar vertebra. A complication of
spondylolysis
Spondylolysis Degeneration of a vertebra defect in the articular process

DISCUSSION QUESTIONS
1. Discuss the prevention, care, and management of the major soft tissue injuries
to the neck.
2. Describe a "burner".
3. How can low back strains or sprains be prevented?
4. How does a lumbar disk become ruptured?
5. Why does spondylolysis lead to spondylolisthesis?
6. Why does the position of axial loading put the cervical spine at risk for
dislocation and fracture?

CLASS ACTIVITIES

1. As class time permits, have each student perform a static postural examination
on a partner.
2. Ask a chiropractor to speak to the class on spinal manipulation.
3. Have students in small groups prepare a presentation on a single congenital
anomaly of the low back, its symptoms and signs, and the implications for an
athlete with this condition who wishes to participate in a contact sport.
4. Have groups create a list of common activities that can be demonstrated to an
athlete experiencing low back pain. Choose movements that prevent the pain
from getting worse, such as proper lifting techniques, getting in and out of a car,
and sitting in a chair correctly.
5. Have students demonstrate how axial loading can occur in sports and how it can
produce injury.

WORKSHEET ANSWERS
Matching
1.
2.
3.
4.

a
h
g
f

5.
6.
7.
8.

e
b
d
c

9. b
10. c
11. e
12. d

13.
14.
15.
16.

f
a
h
j

17. g
18. i

Short Answer
19.They act as important shock absorbers for the spine.
20.As a result of hyperflexion of the trunk, or falling from a height and landing on
the feet or buttocks
21.There are 7 cervical, 12 thoracic, and 5 lumbar
22.Axial load to the top of the head combined with flexion of the neck
23.Forced lateral side bending of the neck with depression of the opposite shoulder
24.The difference is the position of the neck in a dislocation. A unilateral dislocation
causes the neck to be tilted towards the dislocated side with extreme muscle
tightness on the elongated side and relaxed muscles on the tilted side.
25.Occurs when the head snaps suddenly
26.Once the symptoms have completely resolved and there are no associated
IM-20 | 2
2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

Chapter 20 The Spine

neurological problems
27.Upper trapezius, sternocleidomastoid, the scalenes on the front of the neck, and
the splenius capitis and cervicis
Listing
28.Congenital anomalies
29.Faulty posture
30.Trauma
31.Centrally located pain that radiates on one side to the buttocks and down back
of leg or pain that spreads across the back
32.Symptoms worse on rising in the morning
33.Onset may be sudden or gradual
34.Pain increases with activity after sitting
35.Slight forward bend with side bending away from the side of pain
36.Straight leg raising increases pain
Essay
37-41.Cervical pain and pain in the chest and extremities; numbness in the trunk
and/or limbs; weakness or paralysis in limbs and/or trunk; loss of bladder or
bowel control; neck point tenderness and restricted movement; and cervical
muscle spasm.
42-47.Refer to focus box 20-1, Page 322.

IM-20 | 3
2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

Chapter 20 The Spine

NAME ______________________________
SECTION__________

CHAPTER 20 WORKSHEET
The Spine
MATCHING: Match each structure with the appropriate name.
_____
_____
_____
_____
_____
_____
_____
_____

1.
2.
3.
4.
5.
6.
7.
8.

Vertebral body
Lamina
Spinous process
Superior articular process
Transverse process
Vertebral foramen
Pedicle
Facet for first rib

MATCHING: Match each disorder with the appropriate definition.

________9. Herniated disk
_______10. Spondylolisthesis
_______11. Spondylolysis
_______12. Acute torticollis
_______13. Cervical dislocation
_______14. Sciatica
_______15. Straight leg raise
_______16. Compression/distraction test
_______17. Whiplash
_______18. Burner or stinger

a. Inflammatory condition of a nerve

that can accompany low back pain
b. Most often occurs between the L4L5 vertebrae
c. Forward slippage of lumbar
vertebrae
d. Stiffness in the neck due to pinching
of synovial membrane
e. Defect in the articular process
f. Occurs from violent flexion and
rotation of the head
g. Another name for a cervical sprain
h. Indicates a sciatic nerve, SI joint or
lumbar spine problem
i. Pinched nerve from stretch or
compression to brachial plexus
j. Indicates a sacroiliac joint problem

IM-20 | 4
2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

Chapter 20 The Spine

SHORT ANSWER: Answer the following questions with a brief response.

19.What is the main function of the intervertebral disk?
20.How can a compression fracture of a lumbar vertebra occur?
21.How many vertebrae are present in the cervical, thoracic, and lumbar spine?
22.What is the mechanism of injury for a cervical fracture?
23.What is the mechanism of injury for a brachial plexus injury?
24.What is the differentiation between a cervical fracture and a cervical dislocation?
25.What is the mechanism of injury for a cervical sprain (whiplash)?
26.When can an athlete return to participation following a brachial plexus injury?
27.What muscles are often involved in a neck or upper back strain?
LISTING: List the common causes of low back pain.
28.
29.
30.
List the signs of a herniated lumbar disk.
31.
32.
33.
34.
35.
36.
ESSAY
37-41.What are the signs and symptoms in a cervical fracture?

IM-20 | 5
2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.

Chapter 20 The Spine

42-47.Describe two postural suggestions that can be made for the following
activities:
Sitting:
a.

Lifting:
a.

b.

b.

Standing:
a.

Sleeping:
a.

b.

b.

IM-20 | 6
2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any
manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.