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Chapter 20: The Spine

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©William E. Prentice

OBJECTIVES

When you finish this chapter you will be able to:

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

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

  • Formulate measures to prevent injury to the spine.

  • Describe a process to assess injuries of the cervical and lumbar spine.

  • Recognize specific injuries that can occur to the various regions of the spine.

INTRODUCTION

The spine is one of the most complex regions of the body. It contains a multitude of bones, joints, ligaments, and muscles, all of which are collectively involved in spinal movement. The relationship of the spinal cord and the peripheral nerves and their proximity to the vertebral column adds to the complexity of this region. Injury to the cervical spine has potentially life-threatening implications. Low back pain is one of the most common ailments known to humans. Thus, some understanding of the anatomy, assessment techniques, and specific injuries of the spine is essential. Coaches and fitness professionals should routinely refer athletes complaining of back pain to trained health care professionals for treatment.

Regions of the spinal column:

  • Cervical

  • Thoracic

  • Lumbar

  • Sacrum

  • Coccyx

ANATOMY OF THE SPINE

Bones

The spine, or vertebral column, is composed of 33 individual bones called vertebrae (Figure 20–1). Twenty-four are classified as movable, or true, and nine are classified as immovable, or false. The movable vertebrae are the cervical vertebrae, thoracic vertebrae, and lumbar vertebrae. The false vertebrae, which are fixed by fusion, form the sacrum and the coccyx. The design of the spine allows a high degree of flexibility forward and laterally and limited mobility backward. Rotation around a central axis in the areas of the neck and the lower back is also permitted.

Movements of the vertebral column:

  • Flexion

  • Extension

  • Lateral flexion

  • Rotation

FIGURE 20–1

Vertebrae and curves of the different regions of the spinal column.

An illustration shows the right lateral view of the spinal column. The right side of the spinal column is anterior and the opposite side is inferior. The superior and inferior sides are located. The cervical curve extends between the atlas (C1) followed by the axis (C2) and C7 vertebra where the spine is convex anteriorly. The thoracic curve extends between the T1 vertebra and T12 vertebra where the curve is concave anteriorly. The vertebras and intervertebral discs are labeled. The lumbar curve extends between the L1 vertebra and L5 vertebra where the curve is convex anteriorly. The intervertebral foramina are located. The pelvic curve extends between the fused sacrum and fused coccyx where the curve is concave anteriorly.
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The Cervical Spine

Because of the vulnerability of the cervical spine to sports injuries, coaches and fitness professionals should have a general knowledge of the cervical spine anatomy and its susceptibility to sports injuries. The cervical spine consists of seven vertebrae, with the first two differing from the other true vertebrae (Figure 20–2). These first two are called the atlas and the axis, respectively, and they function together to support the head on the spinal column and to permit cervical rotation.

FIGURE 20–2

Anatomy of (A) the atlas, axis, and (B) cervical vertebrae.

An illustration shows the posterior view of the atlas and axis, along with the movement of the axis. The atlas is comprised of two bony arches with two bony masses laterally without a body or spinous process. The dens or odontoid process of the axis is held to the atlas by the transverse ligament. The axis below that is composed of a vertebral body, heavy pedicles, laminae, and transverse processes. A vertical line passes through the dens and the clockwise arrow represents the movement. Two arrows in the lateral bony masses point to the movement in a clockwise direction. An illustration shows the superior view of the cervical vertebra. Posteriorly the spinous process is short and bifid. Following the spinous process anteriorly the laminae are long, narrow, thinner, and curve posteromedial. The superior articular facet the superior facet is backward, upward, and slightly medially and is seen at the end of the lamina anteriorly. The transverse foramen is the opening on either side of the body. The transverse process that hosts the transverse foramen project out laterally on either side. The body of the vertebra between the two transverse processes is the single block of an almost circular structure.
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The Thoracic Spine

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