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Lavc Health 12 First Aid Muscles Bones Joints Injuries Spring 2007

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  • 1. Muscles, Bones and Joints Injuries Los Angeles Valley College Physical Education and Health Department Patty Melody, M.A. Health 12 First Aid and Safety Education Spring 2007
  • 2. Disclaimer This wellness seminar is not intended to substitute a consultation by your doctor. If you have been experiencing any neck or back problems you should seek advice from a physician immediately. Also, if you are starting an exercise program consult with a health care provider before beginning your program.
  • 3. Agenda
    • Introduction to Back Injuries in the U.S.
    • What is a Back Injury?
    • Back Anatomy and Physiology
    • Are you at risk?
    • Risk Factors for Back Pain
    • Prevention – Good Posture, Exercise, Eat Healthy, Ergonomics
    • Types of Injuries – fractures, dislocations, sprains, strains
    • Care of injuries – RICE, splinting (anatomic splints, soft splints, rigid splints, the ground)
  • 4. Annual Deaths Due to Selected Accidental Injuries 2005
    • Motor vehicle crashes 45,549
    • Suicide 31,655
    • Poisoning (including drug overdose) 17,550
    • Falls 16,257
    • Assault by firearm 11,829
    • Choking 4,934
    • Drowning 3,447
    • Smoke, fire, flames 3,159
    • Mechanical forces 2,871
    • Source: National Safety Council, Injury Facts 2005.
    • Assault by sharp objects 2,074
    • Bicycle crashes 767
    • Cold exposure 646
    • Water transport/boating accidents 617
    • Other breathing threats 583
    • Electrocution 454
    • Heat exposure 350
    • Burns 102
    • Venomous animals and plants 76
  • 5. Introduction to Back Injuries in the United States
    • 4 out of 5 adults in America (80%)
    • Leading result of accidents (<45 years old)
    • Workplace injuries and illnesses 20% due to back injuries
    • Annual costs $20-$50 billion dollars in workers compensation, lost days of work, reduction in worker productivity, higher insurance rates, and long-term disability claims
  • 6. What is a Back Injury?
    • Defined as damage to the spine or to its supporting structures that house and protect the spinal cord. This can result in mild fatigue or a dull ache or could be more serious. A physician should always be consulted for a diagnosis or referral.
  • 7. Back Anatomy and Physiology
    • The Spine : 33 oddly shaped bones called vertebrae (divided into 4 naturally curved sections)
    • 1) Cervical (7)
    • 2) Thoracic (12)
    • 3) Lumbar (5)
    • 4) Sacrum and Coccyx (9)
  • 8. Your Back Anatomy is responsible for various functions :
    • Cervical (7) – supports the neck, tilts, bends and turns the head
    • Thoracic (12) – supports the mid-back, ribs and is limited in flexibility
    • Lumbar (5) – supports the lower back and carries most of the body weight. Under constant stress when you sit, stand and to some extent when you lay down on your back.
    • Sacrum and Coccyx (9) – 5 fused vertebrae in the sacral region and 4 fused vertebrae in the coccyx region. Responsible for positioning of pelvis and therefore the rest of the spine. Can be altered by excess weight, pregnancy, lordosis or poor body mechanics.
  • 9. The Bones and Discs of the Spine
    • The vertebrae are the bones of the spine that collectively support the entire body’s framework.
    • Each vertebral bone is separated from its neighbor by a disc. The discs are in the anterior (front part) of the spine.
    • The discs allow movement and cushion shocks.
  • 10. Each Vertebral Bone
    • The vertebral body provides the surface against which the discs rest.
    • The spinal canal provides the foramen (hole) where the spinal cord is housed and protected.
  • 11. Each Vertebral Disc
    • The vertebral bones are separated from one another by intervertebral discs.
    • The discs provide flexibility and absorb impacts and shock.
    • The discs consist of two parts. The inner area is the nucleus and the outer area is called the annulus. It is described like a jelly donut.
    • The nucleus, or inner core of the disc, consists of a gelatinous material. The outer ring, or annulus, is the strongest portion, like a tire. When there is a rupture or herniated disc the annulus may be torn.
  • 12. The Motion Segment
    • Every two vertebral bones are separated from one another by a disc.
    • The two vertebral bones and the disc together make one motion segment.
    • The strong fibers of the annulus and the posterior facet joints prevent excessive movement.
    • The spine can bend and extend because there are many motion segments which act together.
  • 13. Spinal Cord and Nerves
    • The spinal cord begins at the base of the brain and runs down the spine to the low back.
    • Between every two vertebral bones, two nerves exit the spinal canal (one on the left and one on the right).
    • When there is damage to a disc, or the facet joint or the vertebral bone there can be too much movement resulting in pain, inflammation and possibly more damage.
    • Fusion surgeries are sometimes recommended for excessive movement.
  • 14. Are you at risk? Pg.6
    • Do you carry heavy items?
    • Are you more than 20% overweight?
    • Do you stand or sit in one position for 30 minutes or more?
    • Do you cradle the phone between your ear and shoulder?
    • Do you sleep on a mattress that is too hard or too soft?
    • Do you wear improper footwear?
    • Do you perform tasks requiring frequent bending?
    • Do you reach for items above your shoulders?
    • Do you carry children?
    • Do you lift heavy objects off the floor?
  • 15. Causes of Back Pain
    • Poor Body Mechanics
  • 16. Causes of Back Pain
    • Weak and Fatigued Muscles
  • 17. Causes of Back Pain
    • Overweight and Obesity
  • 18. Causes of Back Pain
    • Improper Footwear
    • Lack of Exercise
  • 19. Causes of Back Pain
  • 20. Causes of Back Pain
    • Trauma
  • 21. Clinical Causes of Back Pain
    • Osteoporosis
    • Cervical stenosis
    • Cervical disc herniation
    • Cervical spondylosis
    • Rheumatoid arthritis
    • Meningitis
    • Spinal cord tumors and abnormal growths
    • Facet joint syndrome
    • Pregnancy
    • Chiari malformation
  • 22. Treatment Options
    • Hippocratic treatment of spinal injuries – “the rack” or using gravity to straighten the spine
    Maybe not…
  • 23. Types of Muscle, Bone and Joint Injuries
    • Fracture – complete, chip or crack – open or closed – acute or chronic – can be life threatening
    • Dislocation/Subluxation – movement of bone or joint away from normal position –obvious w/ a bump, ridge or hollow
    • Sprain – tear or stretch of ligaments – ligaments hold bone to bone – joints most affected ankle, knee, wrist, finger
    • Strain – stretch or tear of muscles or tendons – usually caused by lifting or overworking – neck, back, thigh, shoulder, lower leg, feet
    • To care for any of the above: R.I.C.E. (Rest, Ice, Compression, Elevation)
  • 24. Signals of Muscle, Bone and Joint Injuries
    • Significant deformity
    • Bruising and Swelling
    • Inability to move affected area
    • Bone fragments open to outside of skin
    • Person heard snap or pop or grinding either during or after injury
    • Injured area is cold or numb
    • Loss of consciousness, signs of shock
  • 25. Splinting
    • Splinting is used to protect and immobilize affected (injured) area and should ONLY be used if you have to move or transport a person AND if splinting does not cause more pain.
  • 26. If you have to splint…
    • Splint the injury as you found it
    • Splint the injured area and the joints above and below the injury site
    • Check for circulation (i.e. feeling, warmth and color) BEFORE and AFTER splinting
    • Do not remove shoes, Do not realign head, neck or spine
  • 27. Methods of Splinting
    • Anatomic splints – the person’s body is the splint
    • Soft splints – blankets, towels, pillows, triangular bandage
    • Rigid splints – boards, magazines, newspapers, metal strips with no sharp edges
    • The ground – the ground is the splint
  • 28. Head, Neck, Back Injuries
    • Signals (consciousness, pain, pressure, confusion, loss of sensation, tingling, partial or complete loss of movement, bumps, depressions on the head, neck or spine, blood or clear fluid from ears or nose, heavy external bleeding, seizures, impaired breathing or vision, nausea or vomiting, persistent headache, loss of balance, bruising of the head, especially around the eyes and behind the ears
    • Signals – motor vehicle crash, fall from height, report of head, neck or back pain or pressure, has tingling or weakness, is not fully alert, appears intoxicated, appears frail or over 65 years of age
    • Care – call 9-1-1, minimize movement of head, neck or spine (back), minimize your (the rescuer) movements of palpating the victim, gently hold the person’s head with the body, Do Not Realign the victim, maintain your ABC’s, control bleeding and keep the victim relaxed with a blanket if needed. Do not remove a bike helmet unless it is in the way of opening the victim’s airway.
  • 29. Neurological Assessment Would Include the Following:
    • Medical History
    • Dermatomes, Myotomes and Reflexes (sensation, strength and reactions)
    • Decide on further testing and outcome
    • Possibly prescribe physical therapy or other modalities (heat, ice, anti-inflammatories or pain-killers, RICE)
  • 30. Dermatomes
    • Dermatomes is the area of skin served by a particular nerve
    • List of Dermatomes of Commonly Injured Nerve Roots
    • C5 – The area over the shoulder.
    • C6 – The thumb and part of the forearm.
    • C7 – The middle finger.
    • C8 – The smallest fingers and part of the forearm.
    • L4 – The thigh.
    • L5 – The medial part of the calf and foot, the big toe.
    • S1 – The lateral part of the calf and foot, the smaller toes.
  • 31. Myotomes
    • Myotomes are muscles that are innervated by a particular nerve.
    • List of Myotomes of Commonly Injured Nerve Roots
    • C5 – The deltoid muscle (abduction of the arm at the shoulder).
    • C6 – The biceps (flexion of the arm at the elbow).
    • C7 – The triceps (extension of the arm at the elbow).
    • C8 – The small muscles of the hand.
    •  
    • L4 – The quadriceps (extension of the leg at the knee).
    • L5 – The tibialis anterior (upward flexion of the foot at the ankle).
    • S1 – The gastrocnemius muscle (downward flexion of the foot at the ankle).
  • 32. Reflexes
    • Some, but not all, of the nerve roots have a reflex.  C5, C6 and C7 have reflexes.  L4 and S1 have reflexes.
    • For example, when the C6 nerve is pinched, there is loss of the pronator reflex in the forearm.  When the L5 nerve is pinched, there is no reflex loss.  Not all nerves have a reflex which can be tested.
    • List of Reflexes of Commonly Injured Nerve Roots
    • C5 – Flexion at the elbow, biceps.
    • C6 – Flexion at the elbow, brachioradialis.
    • C7 – Extension at the elbow, triceps.
    • C8 – Finger flexion.
    •  
    • L4 – The knee reflex, quadriceps.
    • L5 – No reflex.
    • S1 – The ankle reflex, gastrocnemius.
  • 33. Holistic Modalities
  • 34. Prevention Primary prevention – Prehabilitation, Exercise, eat healthy, don’t smoke, get plenty of rest, maintain proper posture and mechanics at work or play, see your doctor for regular check ups, wear flat shoes, maintain healthy body weight, don’t lift more than you can handle, don’t reach overhead Secondary prevention – Consists of primary prevention guidelines plus the following: Consult a physician immediately, Begin early rehabilitation, take pain medications if needed and prescribed by your doctor, modify movements that are painful Tertiary prevention – Consists of primary and secondary guidelines plus the following: Continue consulting with your physician, continue with physical or occupational therapy, surgery may be given as an option
  • 35. Resources
    • The American Red Cross. Workplace Training Module, Back Injury Prevention. Staywell, 2000.
    • www.lieberson.com/en/neuro_medical_info/spinal_anatomy.htm
    • www.sorm.state.tx.us/training2/backsafety/backsafety.htm
    • http://en.wikipedia.org/wiki/vertebrae
    • http://www.gpc.edu/~jaliff/axskel.htm
    • http://siri.uvm.edu/ppt/yourbacklifting/sld002.htm