Chapter 25: The Spine

William E. Prentice

OBJECTIVES

When you finish this chapter you should be able to

• Describe the anatomy of the cervical, thoracic, and lumbar spine.

• Understand how the nerve roots from the spinal cord combine to form specific peripheral nerves.

• Organize a process to assess injuries of the cervical, thoracic, and lumbar spine.

• Explain how to evaluate and identify various postural deformities.

• Point out measures to prevent injury to the spine.

• Categorize specific injuries that can occur to the various regions of the spine in terms of their etiology, symptoms and signs, and management.

• Plan rehabilitation techniques for the injured neck.

• Create the rehabilitation goals for managing low back injuries.

INTRODUCTION

The spine is one of the most complex regions of the body.⁵⁰ It contains a multitude of bones, joints, ligaments, and muscles, all of which are collectively involved in spinal movement. The proximity and relationship of the spinal cord, the nerve roots, and the peripheral nerves to the vertebral column add to the complexity of this region. Low back pain is one of the most common ailments known to humans. Injury to the cervical spine has potentially life-threatening implications (see Chapter 12 for emergency management). Thus, the athletic trainer requires an in-depth understanding of the anatomy of the spine, the techniques to assess the spine, the various injuries that can occur to different regions of the spine, and rehabilitative techniques.

ANATOMY OF THE SPINE

Bones of the Vertebral Column

The spine, or vertebral column, is composed of 33 individual bones called vertebrae. Twenty-four are classified as movable, or true, and nine are classified as immovable, or false. The false vertebrae, which are fixed by fusion, form the sacrum and the coccyx. The design of the spine allows a high degree of forward and lateral flexibility and limited backward mobility. Rotation around a central axis in the areas of the neck and the low back is also permitted.

The movable vertebrae are separated into three divisions, according to location and function. The first division comprises the 7 cervical vertebrae; the second, the 12 thoracic vertebrae; and the third, the 5 lumbar vertebrae. As the spinal segments progress downward from the cervical region, they grow increasingly larger to accommodate the upright posture of the body and to contribute in weight bearing. The shape of the vertebrae is irregular, but the vertebrae possess certain characteristics that are common to all. Each vertebra consists of a neural arch, through which the spinal cord passes, and several projecting processes that serve as attachments for muscles and ligaments. Each neural arch has two laminae and two pedicles. The latter are bony processes that project backward from the body of the ...