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Chapter 24. The Spine. Consists of the brain and spinal cord Collects information about external and internal conditions Analyzes the information Initiates appropriate responses aimed primarily toward survival needs 2 parts of the CNS Peripheral Autonomic . The nervous system.

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the nervous system

Consists of the brain and spinal cord

    • Collects information about external and internal conditions
    • Analyzes the information
    • Initiates appropriate responses aimed primarily toward survival needs
  • 2 parts of the CNS
    • Peripheral
    • Autonomic
The nervous system
the peripheral nervous system

Consists of all the nerves and ganglia located outside the brain and spinal cord (CNS)

  • Nerves carry impulses to the brain
    • Sensory (afferent) nerves
    • Motor (efferent) nerves
  • Cranial/Spinal nerves make up the entire peripheral nervous system
    • Cranial nerves provide communication pathways between the head and neck and the brain
    • The spinal nerves provide communication pathways between the rest of the body and spinal cord, which also provides links to the brain
    • The spinal nerves form a network, called a plexus
The peripheral nervous system
the autonomic nervous system

Divided into 2 systems

    • Sympathetic
      • Prepares the body for action
        • “fight or flight”
    • Parasympathetic
      • Counteracts the sympathetic system to prepare the body for more restful activities
    • The 2 systems operate as a pair
The autonomic nervous system
reflexes

The simplest type of nervous response

    • They are unconscious and involuntary
    • As few as 2 neurons are necessary for a reflex, though many involve 3 neurons
    • Every reflex act is preceded by a change in the environment, called a stimulus
    • Special structures called receptors pick up the stimuli
reflexes
reflexes cont d

If two nerves are involved, all that is necessary is a sensory receptor, which is the distal end of the sensory neuron that carries the sensation to the CNS

The sensory neuron communicates to a motor neuron through a neurotransmitting chemical diffusing across a synapse

The motor neuron then sends a signal to an effector, which provides the response (usually a muscle contraction or glandular secretion)

Reflexes (cont’d)
the vertebral column

Vertebral column is divided into 5 sections

    • Cervical
      • 7 vertebrae including the atlas and axis
    • Thoracic
      • 12 vertebrae that articulate with ribs
    • Lumbar
      • 5 vertebrae that bears most of the body’s weight
    • Sacrum
      • 5 fused vertebrae that serve as an articulation point for the hips
    • Coccyx
      • 4 fused vertebrae that form the tailbone
The Vertebral Column
spinal cord

Begins at the base of the skull and continues to the second lumbar vertebrae

    • It is surrounded by the 3 meninges and cerebrospinal fluid for protection
    • The spinal cord consists of gray matter internally, which is surrounded by white matter
    • For reflex action and communication with the brain, neuron connections are made within the gray matter, while the white matter consists of neuron fibers.
Spinal cord
injuries to the spine

Cervical Spine Injuries

    • Can lead to serious problems or death
    • Most serious injuries are the result of axial loading or cervical compression,
      • may cause vertebral fracture or the articular facets to slide away from each other
    • Symptoms
      • Unconsciousness, numbness, paralysis and neck pain with movement
Injuries to the spine
treatment of cervical spine injury

Manage airway using jaw-thrust technique

  • If helmet is work, do no remove
    • Head movements may increase the severity of the injury
  • Check for carotid pulse
  • If absent, begin chest compressions
  • Immobilize until EMS arrives
Treatment of cervical spine injury
cervical sprains strains

Symptoms

    • Tenderness and pain at the injury site
    • Neck motion not affected
    • Moderate strains/sprains will present with limited motion
      • But without radiation of pain/parathesia
    • Severe injuries will have localized pain and muscle spasm
      • Athlete may complain of an insecure feeling about the neck
  • Treatment
    • Protect the area, exclude from further activity, refer to a physician
Cervical sprains & strains
cervical neck syndrome

Caused by forced lateral flexion

  • Causes nerve roots to be stretched or impinged
    • Commonly called a pinched nerve, burner or stinger
  • Symptoms
    • Sharp, burning, radiating pain
    • If brachial plexus is involved, there may be radiating pain, numbness and loss of function of the arm and possible hand
    • Symptoms usually subside in minutes, though it may leave residual soreness and paresthetic (numbness, tingling) areas
Cervical neck syndrome
cervical fractures and subluxations

Not common athletic injuries

Can occur in football, diving, and gymnastics

Most fatal or paralyzing injuries occur when an athlete’s neck is in flexion and the athlete receives a blow to the head

Cervical fractures and subluxations
cervical fx subluxation symptoms

Swelling within the spinal cord

  • Transitory paralysis
  • Neck pain
  • Muscle spasms
  • Numbness
  • Loss of sensation
  • Weakness
  • Paresthesia
  • Partial or complete limb paralysis
  • Athletes may experience transient quadriparesis or quadriplegia, also called neuropraxia
    • Recovery can occur within a few minutes, but can last 1-2 days.
  • Referral to a physician for further medical attention is necessary
Cervical Fx/Subluxation Symptoms
causes of neuropraxia and transient quadriparesis

Spinal stenosis

Congenital abnormality

Cervical instability

Interverterbal disk herniation

Because most mechanisms causing cervical spine injury involve forces to the head, injuries to the head and neck must be considered together

Causes of neuropraxia and transient quadriparesis
thoracic spine injuries

Include the following

    • Contusions
    • Sprains
    • Strains
  • Symptoms include
    • Tenderness
    • Spasms
    • Increased pain with active contraction or stretching
    • Stiff back
  • Athlete should be referred to a physician for further evaluation
Thoracic spine injuries
lumbar spine injuries

Can be aggravated by inadequate or inappropriate conditioning, inflexibility, congenital anomalies, and poor postural habits

Contusions are more common in the paraspinal muscles, but may also occur over the subcutaneous spinous process

Severe injuries are extremely rare in athletics.

Lumbar Spine INjuries
spondylolysis

A defect in the pars interarticularis of the vertebrae; if bilateral

  • It can allow the vertebrae to slip forward on the vertebrae of the sacrum
  • Known as spondylolisthesis
  • Symptoms
    • Complaint of low back pain associated with increased activity
    • Pain radiating into the buttocks and upper thighs
  • Refer athletes to a physician for diagnosis
Spondylolysis
intervertebral disc herniation

Occurs when the nucleus pulposusherniates, or protudes, through the annulus fibrosus and presses against the spinal cord or spinal nerve

Symptoms

Extreme pain and stiffness in the lower back

Pain in the buttocks

Radiating leg pain

Pain is usually unilateral and follows the route of the sciatic nerve

Possible unilateral weakness, sensory loss, or reflex loss in the affected leg

Refer to a physician for further evaluation

Intervertebral disc herniation
sacroiliac injuries

Usually sprains to the SI joint

    • Occurs as a result of acute or chronic trauma
  • Symptoms
    • Sacroiliac pain
    • Stiffness
    • Soreness of the SI joint that diminishes during activity
      • Returns as the athlete cools down
Sacroiliac injuries