Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
MOB TCD

Clinical Anatomy of the Back
Professor Emeritus Moira O’Brien
FRCPI, FFSEM, FFSEM (UK), FTCD
Trinity College
Dubl...
MOB TCD

Progress

Time
Goh et al. Clin Biomech 1999;14:439
MOB TCD

Spine
Consists of
• Cervical Vertebrae
• Thoracic Vertebrae
• Lumbar Vertebrae
• Sacrum
MOB TCD

Spine
• The strength of the skeletal
column is due to the size and
shape of the vertebrae
• Its flexibility is du...
MOB TCD

Vertebral Column
• Lot of stress in variety of sports
• Cervical pathology
• Pain may be referred to upper
limb
•...
MOB TCD

Young Spine

Normal curvature of
infant’s spine

Normal lumbar curve
of toddler’s spine
MOB TCD

Low Back Pain in Sports
• 70% of population will suffer
from back pain at some time
• 10% - 15% of sports injurie...
MOB TCD

Low Back Pain in Sports
• Majority of sports injuries
to lumbar spine
• Soft tissue and many are
not reported
• F...
MOB TCD

Low Back Pain in Sports
• Must know the sport
• Must understand the
biomechanics and stresses
involved in the spo...
MOB TCD

Typical Vertebrae
• Basic parts
• Body and neural arch
• Which consists of
pedicles, lamina and spine
• The trans...
MOB TCD

Lumbar Vertebrae
MOB TCD

Lumbar Vertebrae
•
•
•
•
•

Body kidney shaped
No articular facets for ribs
Inferior facets face anterolateral
Su...
MOB TCD

Lumbar Vertebrae
• Body is convex anteriorly
• Foramina on the posterior
aspect are for the basic
vertebral veins...
MOB TCD

Lumbar Vertebrae
• The superior and inferior
surfaces of the body are flat
and covered by a thin layer
of hyaline...
MOB TCD

Typical Lumbar Vertebrae
• Superior and inferior
articular processes
• Arise from the junction of
the pedicles an...
MOB TCD

The Lumbar Facets
• Vary from the sagittal
disposition at the first and
second, to almost coronal in
the lower
• ...
MOB TCD

Pars Interarticularis
• Pars interarticularis
• Portion of lamina between
superior and inferior
articular process...
MOB TCD

Lumbar Spine
• Cancellous bone
• 50% compressive
strength
• Facet joints 20% in
standing upright position
MOB TCD

Lumbar Vertebrae
MOB TCD

Lumbar Vertebrae
MOB TCD

Lumbar Spine
• Cancellous bone
• 50% of the compressive
strength
• Facet joints, 20% of the
strength in the stand...
MOB TCD

Anterior Longitudinal Ligament
• Attached mainly to the bodies
• This ligament helps to prevent us from
leaning t...
MOB TCD

Posterior Longitudinal Ligament
• Attached mainly to the
inter vertebral discs
• This ligament helps to
restrict ...
MOB TCD

Ligamentum Flava
• Runs between the laminae
of the neural arches
• Helps to restrict hyperflexion
• It extends to...
MOB TCD

Ligamentum Flava
• Gives elasticity to the posterior
aspect of the facet joints
• Helps form the posterior
bounda...
MOB TCD

Spinal Ligaments
• Interspinous ligaments
• Strong supraspinous ligaments
• The inter-transverse ligaments
join t...
MOB TCD

Fifth Lumbar Vertebrae
• Larger, superior and inferior
articular facets in the same
plane
• Fifth lumbar vertebra...
MOB TCD

Arthritis of Spine
•
•
•
•

Painful
Limitation of movement
Extra projections
Narrowing of disc spaces
MOB TCD

Vertebral Joints
• Secondary cartilaginous joints
between the bodies
• Hyaline cartilage covering
bodies
• Disc o...
MOB TCD

Intervertebral Discs
• Annulus fibrosis
• Concentric lamina run
obliquely
• Type I collagen at periphery,
type II...
MOB TCD

Nucleus Pulposus
• Gelatinous, hydrophilic, proteoglycan gel in
collagen matrix
• Lies posterior in the disc
• Th...
MOB TCD

Nucleus Pulposus
• Hydration of the annulus and nucleus is
proportional to the applied compressional
stress
• In ...
MOB TCD

Nucleus Pulposus
• The position of the spine determines
where the compressional forces are
greatest
• The posteri...
MOB TCD

Axial Load and End-plates
MOB TCD

End-plate Mechanics
• Functionally, the vertebral end-plate
displays characteristics of a trampoline
• With the s...
MOB TCD

End-plate Mechanics
• End-plate lesions can be induced
experimentally before a disc will
prolapse through the anu...
MOB TCD

End-plate Susceptibility

Notochord
Schmorl & Junghanns. The human spine in health and disease.
New York: Grune &...
MOB TCD

Facet Joints
• L1,L2 Facets sagittal
plane
• Lower joints in coronal
plane
• Synovial plane joints
• Meniscoid st...
MOB TCD

Facet Joints
• Narrowing of disc space,
results in stress on
facet joint
• Highest pressure during
• Combined
• E...
MOB TCD

Facet Joint Syndrome
•
•
•
•
•

Extension and rotation
Pain rising from flexion
Pain worse standing
Lateral shift...
MOB TCD

Segmental Rotation

Singer et al. J Musculoskel Res 2001;5: 45-55
MOB TCD

Movements of Lumbar Spine
• Flexion limited by
disc problems
• Lateral flexion
• Extension limited by
facet joint...
MOB TCD

Nerve Supply
•
•
•
•

Nerve supply
Peripheral annulus
Facet joint
Nerve is medial branch
dorsal ramus
MOB TCD

Blood Supply
•
•
•
•
•

Lumbar arteries
Internal venous plexuses
External venous plexuses
Basivertebral veins
Val...
MOB TCD

Lumbar Vertebrae
MOB TCD

Cancellous Bone
• Cancellous bone
• 50% compressive
strength
• Facet joints 20% in
standing upright position

Nor...
MOB TCD

Anatomical Abnormalities
•
•
•
•

Spina Bifida Occulta
Facet Tropism
Kyphosis
Scoliosis
MOB TCD

Anatomical Abnormalities

Kyphosis

Scoliosis
MOB TCD

Anatomical Abnormalities
• Hemi-vertebra
• Spina Bifida
Occulta
• Facet Tropism
• Scoliosis
• Kyphosis
MOB TCD

Anatomical Abnormalities
• Unilateral lumbarisation
• Unilateral sacralisation
MOB TCD

The Spine in Sports
•
•
•
•
•
•
•

Spine injury epidemiology
Contact vs. non-contact sports
Spine injury mechanis...
MOB TCD

Epidemiology

Cooke & Lutz. Phys Med Rehab Clinics N Am 2000;11:837
MOB TCD

Epidemiology
• Back pain in the community
is 60% - 80%
• Recurrence of back pain is
70% - 90%
• Progression to ch...
MOB TCD

Low Back Pain in Sports
• Majority of sports injuries
are to the lumbar spine
• Many soft tissue injuries
are not...
MOB TCD

Chronic Low Back Pain
•
•
•
•
•
•

Local structures
Muscles
Ligaments
Poor lifting techniques
Joints
Bones
MOB TCD

Back Pain
Local structures
• Muscles, ligaments
• Joints
Referred pain
• Abdominal organs
• Pelvic organs
Must ou...
MOB TCD

Acute Low Back Pain
•
•
•
•
•
•

Non-specific low back pain
Usually settles quickly
History
Examination
Pain reli...
MOB TCD

Acute Low Back Pain
• Nerve root pain
• Leg pain worse than back
pain
• Numbness and pins and
needles
• Neurologi...
MOB TCD

Investigate Low Back Pain
•
•
•
•
•
•
•
•
•

Under 20 or over 55 years
Non-mechanical pain
Past history cancer
Th...
MOB TCD

Chronic Low Back Pain
Pain referred
• Abdominal organs
• Pelvic organs
Must out rule
• Infection
• Tumours
MOB TCD

Pain Referred
MOB TCD

Young Athlete
• Junior rugby team 15
years of age
• M. Scheuermann
• 5 Spina bifida occulta
• The scrum half had
...
MOB TCD

Sacroiliac Joint – Sciatic Nerve
MOB TCD

Spinal Stenosis
• Congenital or acquired
• Abnormally short pedicles or
lamina
• Formation of osteophytes
• Osteo...
MOB TCD

Spinal Stenosis
MOB TCD

Predisposing Factors
•
•
•
•
•
•
•
•

Intrinsic factors
Anatomical abnormalities
Biomechanical
Extrinsic factors
...
MOB TCD

Predisposing Factors Back Pain
• Poor posture
• Overweight
• Unfit
MOB TCD

Predisposing Factors
• Poor core stability
• Weak abdominal
muscles
• Weak gluteal muscles
• Muscle imbalance
MOB TCD

Predisposing Factors
• Poor core stability
• Weak abdominal
muscles
• Weak gluteal muscles
• Muscle imbalance
• P...
MOB TCD

Predisposing Factors
• Badly designed furniture
• No back support
• Poor posture at work
MOB TCD

Acute Low Back Pain
MOB TCD

Annular tears
• Loaded compression with
rotatory component
• As little as 3 degrees of
high torque rotation
• Fac...
MOB TCD

Annular Bulge
MOB TCD

Disc Lesion
MOB TCD

Young Athlete
• Junior rugby team 15
years of age
• M. Scheuermann
• 5 Spina bifida occulta
• The scrum half had
...
MOB TCD

Scheuermann’s Disease

Greene et al. J Pediatr Orthop 1985;5:1
MOB TCD

Spondylolisthesis
MOB TCD

Pars Interarticularis
• Pars interarticularis, portion
of lamina between superior
and inferior articular
processe...
MOB TCD

Spondylolisthesis
MOB TCD

Spondylolysis and Spondylolisthesis
MOB TCD

Pars Interarticularis; Facet Joint
MOB TCD

Spondylolisthesis
Rapid Flexion and Extension
•
•
•
•
•
•
•
•

Gymnastics, flips
Vaulting
Ballet, arabesque
Lifti...
MOB TCD

Ankylosing Spondylitis, Infection
465 Athletes Low Back Pain
(M318;F147)
male (39)
female(14)
Spina Bifida Occulta (SBO)
6.6%(21)
4.1%(6)
Lumbarisation
3.5%...
MOB TCD

Mechanism of Injuries
• Compression or weight
loading
• Torque or rotation
• Tensile stresses produced
by excessi...
MOB TCD

Compression or Weight Loading
•
•
•
•
•
•
•

Sports requiring
Massive strength
High body weight
Weight lifter
Hoo...
MOB TCD

Weight Lifting
• 40 % weight lifters have
low back pain
• Greatest stress is when weight
is lifted above the head...
MOB TCD

Axial Compressive Loading
•
•
•
•
•
•
•

Head on collisions
Motor sports
Boating accidents
Wrestling
Horseback ri...
MOB TCD

Axial Compressive Loading
MOB TCD

Axial Compressive Loading
MOB TCD

Axial Compressive Loading
MOB TCD

Compression Stress
MOB TCD

Rotational Stress
MOB TCD

Rotational Stress
MOB TCD

Spondylolisthesis
Rapid Flexion and Extension
•
•
•
•
•
•
•
•

Gymnastics, flips
Vaulting
Ballet, arabesque
Lifti...
MOB TCD

Australian Football League

Seward & Orchard. 2000 AFL Injury Report, Australian Sports Commission
MOB TCD

Golf
• Highest incidence of back
injuries in professional sports
• Torsional stress is lessened by
spreading the ...
MOB TCD

Sustained Postures - Hyperextension
MOB TCD

Sustained Postures - Hyperextension
MOB TCD

Sustained Postures - Hyperextension
MOB TCD

Sustained Postures - Flexion
MOB TCD

Scoliosis due to Unilateral Sports
•
•
•
•
•

Racquet sports
Fencing
Sweep rowing
Javelin
Freestyle unilateral
br...
MOB TCD

Scoliosis due to Unilateral Sports
MOB TCD

Running
•
•
•
•
•
•

Poor posture
Poor abdominal
Pronated feet
Muscle imbalance
Leg length discrepancy
Osteoporos...
MOB TCD

Cricket
• Bowlers
• Rotational forces
• Extension followed by
rotation and flexion
MOB TCD

Thank You
“BMJ Publishing Group Limited (“BMJ Group”) 2012. All rights reserved.”
Clinical anatomy of the back
Upcoming SlideShare
Loading in …5
×

Clinical anatomy of the back

2,619 views

Published on

website: http://www.am-medicine.com

Facebook page : https://www.facebook.com/pages/Am-medicine/207726329406832

Facebook group: https://www.facebook.com/groups/1409138472653811/

Published in: Health & Medicine, Technology
  • Be the first to comment

Clinical anatomy of the back

  1. 1. MOB TCD Clinical Anatomy of the Back Professor Emeritus Moira O’Brien FRCPI, FFSEM, FFSEM (UK), FTCD Trinity College Dublin
  2. 2. MOB TCD Progress Time Goh et al. Clin Biomech 1999;14:439
  3. 3. MOB TCD Spine Consists of • Cervical Vertebrae • Thoracic Vertebrae • Lumbar Vertebrae • Sacrum
  4. 4. MOB TCD Spine • The strength of the skeletal column is due to the size and shape of the vertebrae • Its flexibility is due to the many joints that are close together
  5. 5. MOB TCD Vertebral Column • Lot of stress in variety of sports • Cervical pathology • Pain may be referred to upper limb • Lumber pathology • Lower limb
  6. 6. MOB TCD Young Spine Normal curvature of infant’s spine Normal lumbar curve of toddler’s spine
  7. 7. MOB TCD Low Back Pain in Sports • 70% of population will suffer from back pain at some time • 10% - 15% of sports injuries are spinal injuries • 0.6% - 1% have neurological complications Deyo & Tsui-Wu. Spine 1987;12:264-8
  8. 8. MOB TCD Low Back Pain in Sports • Majority of sports injuries to lumbar spine • Soft tissue and many are not reported • Fractures • Fracture dislocation • Abrasions, bruising • Contusions Tall & De Vault. Clin Sports Med 1993;12:441-8
  9. 9. MOB TCD Low Back Pain in Sports • Must know the sport • Must understand the biomechanics and stresses involved in the sport • Must examine the spine in the appropriate position
  10. 10. MOB TCD Typical Vertebrae • Basic parts • Body and neural arch • Which consists of pedicles, lamina and spine • The transverse processes arise from the pedicles • Superior and inferior articular processes
  11. 11. MOB TCD Lumbar Vertebrae
  12. 12. MOB TCD Lumbar Vertebrae • • • • • Body kidney shaped No articular facets for ribs Inferior facets face anterolateral Superior facets face posteromedial Intervertebral notch increase in size • Accessory processes base of transverse process • Mammillary process on posterior aspect of superior articular process
  13. 13. MOB TCD Lumbar Vertebrae • Body is convex anteriorly • Foramina on the posterior aspect are for the basic vertebral veins, which drain into the internal vertebral plexus • The walls of the veins, which are valve less, have afferent nerve fibers • Secondaries can spread from pelvis, prostate, adrenal glands lungs and breast
  14. 14. MOB TCD Lumbar Vertebrae • The superior and inferior surfaces of the body are flat and covered by a thin layer of hyaline cartilage • The body of the vertebra consists of trabecular or cancellous bone
  15. 15. MOB TCD Typical Lumbar Vertebrae • Superior and inferior articular processes • Arise from the junction of the pedicles and lamina • Superior face posteromedially • With rough mammillary processes on the posterior border • Inferior face anterolaterally • Accessory processes at the base of transverse process • Prevents rotation
  16. 16. MOB TCD The Lumbar Facets • Vary from the sagittal disposition at the first and second, to almost coronal in the lower • Facet tropism is when the facet on one side is in the sagittal plane and the other is in the coronal plane, which adds to rotational stress • This change may occur in the lower thoracic vertebrae
  17. 17. MOB TCD Pars Interarticularis • Pars interarticularis • Portion of lamina between superior and inferior articular processes • Site of spondylolysis or spondylolisthesis
  18. 18. MOB TCD Lumbar Spine • Cancellous bone • 50% compressive strength • Facet joints 20% in standing upright position
  19. 19. MOB TCD Lumbar Vertebrae
  20. 20. MOB TCD Lumbar Vertebrae
  21. 21. MOB TCD Lumbar Spine • Cancellous bone • 50% of the compressive strength • Facet joints, 20% of the strength in the standing upright position
  22. 22. MOB TCD Anterior Longitudinal Ligament • Attached mainly to the bodies • This ligament helps to prevent us from leaning too far back (hyperextension)
  23. 23. MOB TCD Posterior Longitudinal Ligament • Attached mainly to the inter vertebral discs • This ligament helps to restrict forward bending (hyperflexion)
  24. 24. MOB TCD Ligamentum Flava • Runs between the laminae of the neural arches • Helps to restrict hyperflexion • It extends to the capsule of the facet joint • It is highly elastic and ensures that the ligament does not buckle in extension
  25. 25. MOB TCD Ligamentum Flava • Gives elasticity to the posterior aspect of the facet joints • Helps form the posterior boundary of the intervertebral foramen • The ligamentum flava is thicker in the lumbar region
  26. 26. MOB TCD Spinal Ligaments • Interspinous ligaments • Strong supraspinous ligaments • The inter-transverse ligaments join the transverse processes and are thin and membranous in the lumbar region
  27. 27. MOB TCD Fifth Lumbar Vertebrae • Larger, superior and inferior articular facets in the same plane • Fifth lumbar vertebrae has large transverse processes • Arise from the body as well as the pedicles
  28. 28. MOB TCD Arthritis of Spine • • • • Painful Limitation of movement Extra projections Narrowing of disc spaces
  29. 29. MOB TCD Vertebral Joints • Secondary cartilaginous joints between the bodies • Hyaline cartilage covering bodies • Disc of fibrocartilage in between • Synovial plane joints between the facets
  30. 30. MOB TCD Intervertebral Discs • Annulus fibrosis • Concentric lamina run obliquely • Type I collagen at periphery, type II near nucleus • Weakest portion is the postero-lateral and posterior • Periphery has a nerve supply
  31. 31. MOB TCD Nucleus Pulposus • Gelatinous, hydrophilic, proteoglycan gel in collagen matrix • Lies posterior in the disc • There are no nerve endings in a mature disc • Nerve endings are found in the posterior longitudinal ligament and the dura • Nutrition of the disc is by diffusion via the central 40% of the cartilaginous end plate • The discs are thicker in the cervical and lumbar sections of the vertebral column • Where there is more movement. The largest disc is between L5 S1
  32. 32. MOB TCD Nucleus Pulposus • Hydration of the annulus and nucleus is proportional to the applied compressional stress • In vivo, there is a loss of 1 cm standing height over the course of the day • A disc loaded in vitro for four hours by 100% body weight will lose 6% of the fluid from the nucleus and 13% from the annulus • May be due to end plate fracture • There is more rotational stress in the posterior part of the disc
  33. 33. MOB TCD Nucleus Pulposus • The position of the spine determines where the compressional forces are greatest • The posterior longitudinal ligament is thin and expanded at the level of the disc • High compressional loading at L4,L5,S1 may be due to end plate fracture and not to rupture of the annulus • End plate failure is a possible precursor of disc degeneration
  34. 34. MOB TCD Axial Load and End-plates
  35. 35. MOB TCD End-plate Mechanics • Functionally, the vertebral end-plate displays characteristics of a trampoline • With the sub-end-plate trabecular bone acting as springs to sustain and dissipate axial load • Despite the thinness of the vertebral end-plate • The hydraulic nature of marrow and blood vessels within the vertebral body, act to dampen axial loads, unless the local point pressure is too high
  36. 36. MOB TCD End-plate Mechanics • End-plate lesions can be induced experimentally before a disc will prolapse through the anulus, suggesting a protective mechanism over annular injury and potentially cord or root compression • Excessive loads may result in perforation of the end-plate, usually in the region of the nucleus and often in the path of the developmental notchord
  37. 37. MOB TCD End-plate Susceptibility Notochord Schmorl & Junghanns. The human spine in health and disease. New York: Grune & Stratton, 1965
  38. 38. MOB TCD Facet Joints • L1,L2 Facets sagittal plane • Lower joints in coronal plane • Synovial plane joints • Meniscoid structures • Synovial membrane some contain fat • Supplied by medial branch of dorsal ramus
  39. 39. MOB TCD Facet Joints • Narrowing of disc space, results in stress on facet joint • Highest pressure during • Combined • Extension • Rotation • Compression
  40. 40. MOB TCD Facet Joint Syndrome • • • • • Extension and rotation Pain rising from flexion Pain worse standing Lateral shift in extension Point tenderness over facet • Referred leg pain
  41. 41. MOB TCD Segmental Rotation Singer et al. J Musculoskel Res 2001;5: 45-55
  42. 42. MOB TCD Movements of Lumbar Spine • Flexion limited by disc problems • Lateral flexion • Extension limited by facet joint problems • Very little rotation • Extension and rotation affect facet joints
  43. 43. MOB TCD Nerve Supply • • • • Nerve supply Peripheral annulus Facet joint Nerve is medial branch dorsal ramus
  44. 44. MOB TCD Blood Supply • • • • • Lumbar arteries Internal venous plexuses External venous plexuses Basivertebral veins Valveless
  45. 45. MOB TCD Lumbar Vertebrae
  46. 46. MOB TCD Cancellous Bone • Cancellous bone • 50% compressive strength • Facet joints 20% in standing upright position Normal bone Osteoporotic bone
  47. 47. MOB TCD Anatomical Abnormalities • • • • Spina Bifida Occulta Facet Tropism Kyphosis Scoliosis
  48. 48. MOB TCD Anatomical Abnormalities Kyphosis Scoliosis
  49. 49. MOB TCD Anatomical Abnormalities • Hemi-vertebra • Spina Bifida Occulta • Facet Tropism • Scoliosis • Kyphosis
  50. 50. MOB TCD Anatomical Abnormalities • Unilateral lumbarisation • Unilateral sacralisation
  51. 51. MOB TCD The Spine in Sports • • • • • • • Spine injury epidemiology Contact vs. non-contact sports Spine injury mechanisms Overuse – overload – overlooked Vertebral end-plate injury Disc injury Future issues
  52. 52. MOB TCD Epidemiology Cooke & Lutz. Phys Med Rehab Clinics N Am 2000;11:837
  53. 53. MOB TCD Epidemiology • Back pain in the community is 60% - 80% • Recurrence of back pain is 70% - 90% • Progression to chronic back pain is 5% - 10% Cooke & Lutz. Phys Med Rehab Clinics N Am 2000;11:837-65
  54. 54. MOB TCD Low Back Pain in Sports • Majority of sports injuries are to the lumbar spine • Many soft tissue injuries are not reported • Fractures • Fracture dislocation • Abrasions, bruising • Contusions Tall & De Vault. Clin Sports Med 1993;12:441-8
  55. 55. MOB TCD Chronic Low Back Pain • • • • • • Local structures Muscles Ligaments Poor lifting techniques Joints Bones
  56. 56. MOB TCD Back Pain Local structures • Muscles, ligaments • Joints Referred pain • Abdominal organs • Pelvic organs Must out rule • Infection • Tumours
  57. 57. MOB TCD Acute Low Back Pain • • • • • • Non-specific low back pain Usually settles quickly History Examination Pain relief Stay as active as possible within limit of pain
  58. 58. MOB TCD Acute Low Back Pain • Nerve root pain • Leg pain worse than back pain • Numbness and pins and needles • Neurological signs • Refer to specialist • If it does not resolve in first 4 weeks
  59. 59. MOB TCD Investigate Low Back Pain • • • • • • • • • Under 20 or over 55 years Non-mechanical pain Past history cancer Thoracic pain Steroids or HIV Unwell, weight loss Widespread neurology Structural deformity Gait disturbance or sphincter disturbance
  60. 60. MOB TCD Chronic Low Back Pain Pain referred • Abdominal organs • Pelvic organs Must out rule • Infection • Tumours
  61. 61. MOB TCD Pain Referred
  62. 62. MOB TCD Young Athlete • Junior rugby team 15 years of age • M. Scheuermann • 5 Spina bifida occulta • The scrum half had degenerative facet joint changes
  63. 63. MOB TCD Sacroiliac Joint – Sciatic Nerve
  64. 64. MOB TCD Spinal Stenosis • Congenital or acquired • Abnormally short pedicles or lamina • Formation of osteophytes • Osteo-arthritis of facet joints • Pain aggravated by walking • Relieved by rest
  65. 65. MOB TCD Spinal Stenosis
  66. 66. MOB TCD Predisposing Factors • • • • • • • • Intrinsic factors Anatomical abnormalities Biomechanical Extrinsic factors Sport Surfaces Equipment Training
  67. 67. MOB TCD Predisposing Factors Back Pain • Poor posture • Overweight • Unfit
  68. 68. MOB TCD Predisposing Factors • Poor core stability • Weak abdominal muscles • Weak gluteal muscles • Muscle imbalance
  69. 69. MOB TCD Predisposing Factors • Poor core stability • Weak abdominal muscles • Weak gluteal muscles • Muscle imbalance • Pronated or cavus feet
  70. 70. MOB TCD Predisposing Factors • Badly designed furniture • No back support • Poor posture at work
  71. 71. MOB TCD Acute Low Back Pain
  72. 72. MOB TCD Annular tears • Loaded compression with rotatory component • As little as 3 degrees of high torque rotation • Facets protect disc • As annulus fails, facets joints may be injured
  73. 73. MOB TCD Annular Bulge
  74. 74. MOB TCD Disc Lesion
  75. 75. MOB TCD Young Athlete • Junior rugby team 15 years of age • M. Scheuermann • 5 Spina bifida occulta • The scrum half had degenerative facet joint changes
  76. 76. MOB TCD Scheuermann’s Disease Greene et al. J Pediatr Orthop 1985;5:1
  77. 77. MOB TCD Spondylolisthesis
  78. 78. MOB TCD Pars Interarticularis • Pars interarticularis, portion of lamina between superior and inferior articular processes • Site of spondylolysis or spondylolisthesis
  79. 79. MOB TCD Spondylolisthesis
  80. 80. MOB TCD Spondylolysis and Spondylolisthesis
  81. 81. MOB TCD Pars Interarticularis; Facet Joint
  82. 82. MOB TCD Spondylolisthesis Rapid Flexion and Extension • • • • • • • • Gymnastics, flips Vaulting Ballet, arabesque Lifting during dance Diving Butterfly swimming Decathlon Pole vaulting
  83. 83. MOB TCD Ankylosing Spondylitis, Infection
  84. 84. 465 Athletes Low Back Pain (M318;F147) male (39) female(14) Spina Bifida Occulta (SBO) 6.6%(21) 4.1%(6) Lumbarisation 3.5%(11) 1.4%(2) Sacralisation 2.2% (7) 6.1% (9) Spondylolisthesis (13) 30% had SBO; 21 of 56 had other pathology MOB TCD
  85. 85. MOB TCD Mechanism of Injuries • Compression or weight loading • Torque or rotation • Tensile stresses produced by excessive motion of spine • Hyperextension and flexion Watkins & Dillin, 1985
  86. 86. MOB TCD Compression or Weight Loading • • • • • • • Sports requiring Massive strength High body weight Weight lifter Hooker and No 8 Wrestling Line back American football Watkins & Dillin, 1985
  87. 87. MOB TCD Weight Lifting • 40 % weight lifters have low back pain • Greatest stress is when weight is lifted above the head • Dangerous time is shift from spinal flexion to extension Aggrawal et al. Br J Sports Med 1979;13:58-61
  88. 88. MOB TCD Axial Compressive Loading • • • • • • • Head on collisions Motor sports Boating accidents Wrestling Horseback riding Bicycling Bobsleigh
  89. 89. MOB TCD Axial Compressive Loading
  90. 90. MOB TCD Axial Compressive Loading
  91. 91. MOB TCD Axial Compressive Loading
  92. 92. MOB TCD Compression Stress
  93. 93. MOB TCD Rotational Stress
  94. 94. MOB TCD Rotational Stress
  95. 95. MOB TCD Spondylolisthesis Rapid Flexion and Extension • • • • • • • • Gymnastics, flips Vaulting Ballet, arabesque Lifting during dance Diving Butterfly swimming Decathlon Pole vaulting
  96. 96. MOB TCD Australian Football League Seward & Orchard. 2000 AFL Injury Report, Australian Sports Commission
  97. 97. MOB TCD Golf • Highest incidence of back injuries in professional sports • Torsional stress is lessened by spreading the stress over the entire spine • Rigid abdominal control • Parallel shoulders and pelvis Watkins and Dillin, 1985
  98. 98. MOB TCD Sustained Postures - Hyperextension
  99. 99. MOB TCD Sustained Postures - Hyperextension
  100. 100. MOB TCD Sustained Postures - Hyperextension
  101. 101. MOB TCD Sustained Postures - Flexion
  102. 102. MOB TCD Scoliosis due to Unilateral Sports • • • • • Racquet sports Fencing Sweep rowing Javelin Freestyle unilateral breathing
  103. 103. MOB TCD Scoliosis due to Unilateral Sports
  104. 104. MOB TCD Running • • • • • • Poor posture Poor abdominal Pronated feet Muscle imbalance Leg length discrepancy Osteoporosis
  105. 105. MOB TCD Cricket • Bowlers • Rotational forces • Extension followed by rotation and flexion
  106. 106. MOB TCD Thank You
  107. 107. “BMJ Publishing Group Limited (“BMJ Group”) 2012. All rights reserved.”

×