Lavc Health 12 First Aid Muscles Bones Joints Injuries Spring 2007
Muscles, Bones and
Los Angeles Valley College
Physical Education and Health Department
Patty Melody, M.A.
Health 12 First Aid and Safety Education
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.
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,
Types of Injuries – fractures, dislocations, sprains, strains
Care of injuries – RICE, splinting (anatomic splints, soft
splints, rigid splints, the ground)
Annual Deaths Due to Selected
Accidental Injuries 2005
Motor vehicle crashes 45,549
Poisoning (including drug
Assault by firearm 11,829
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
Other breathing threats 583
Heat exposure 350
Venomous animals and plants 76
Introduction to Back Injuries in the
4 out of 5 adults in America (80%)
Leading result of accidents (<45 years old)
Workplace injuries and illnesses 20% due to
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
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.
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)
Your Back Anatomy is
responsible for various
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
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
The vertebral body
provides the surface
against which the
The spinal canal
provides the foramen
(hole) where the
spinal cord is housed
Each Vertebral Disc
The vertebral bones are separated
from one another by intervertebral
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
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
Every two vertebral bones are
separated from one another by
The two vertebral bones and
the disc together make one
The strong fibers of the
annulus and the posterior facet
joints prevent excessive
The spine can bend and
extend because there are
many motion segments which
Spinal Cord and
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
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
Fusion surgeries are sometimes
recommended for excessive
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
Do you cradle the phone between your ear and
Do you sleep on a mattress that is too hard or too
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?
Hippocratic treatment of spinal injuries –
“the rack” or using gravity to straighten the
Types of Muscle, Bone and Joint
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
Sprain – tear or stretch of ligaments – ligaments hold
bone to bone – joints most affected ankle, knee, wrist,
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,
Signals of Muscle, Bone and Joint
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
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
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
Methods of Splinting
Anatomic splints – the person’s body is the splint
Soft splints – blankets, towels, pillows, triangular
Rigid splints – boards, magazines, newspapers,
metal strips with no sharp edges
The ground – the ground is the splint
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
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.
Neurological Assessment Would
Include the Following:
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)
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
C7 – The middle finger.
C8 – The smallest fingers and part of
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.
Myotomes are muscles that are innervated by a
List of Myotomes of Commonly Injured Nerve
C5 – The deltoid muscle (abduction of the
arm at the shoulder).
C6 – The biceps (flexion of the arm at the
C7 – The triceps (extension of the arm at
C8 – The small muscles of the hand.
L4 – The quadriceps (extension of the leg at
L5 – The tibialis anterior (upward flexion of
the foot at the ankle).
S1 – The gastrocnemius muscle (downward
flexion of the foot at the ankle).
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
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.
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
The American Red Cross. Workplace Training
Module, Back Injury Prevention. Staywell, 2000.