this is a description of spinal injuries in sports players

1. SPINAL INJURIES IN ATHLETES

2. CERVICAL SPINE INJURIES
•

3. •

4. Thoracolumbar injuries

5. •

6. THE BURNER SYNDROME

7. The Burner Syndrome

8. •

9. Mechanism of injury
•

10. •

11. prevention

12. Management

13. return to play
•

14. Serratus Anterior Palsy

15. Causes

16. signs and symptoms

18. special tests

19. Diagnostic tests

20. physiotherapy management
• to avoid:
• GOALS

21. management
•

22. To do

23. Thoracolumbar injuries

24. Quadratus lumborum syndrome
• Quadratus lumborum is one of the common sources of pain
• It is a myofascial pain syndrome
• Pain is due to spasm and stiffness of the muscle
• Weak back muscles are compensated by quadratus lumborum
leading to painful spasm.

25. clinical features
• deep and aching pain
• lancinating pain during movement
• pain in the outer upper aspect of the groin.
• referred pain to greater trochanter and outer
aspect of the upper thigh
• The greater trochanter can be tender to
pressure, patient cannot tolerate lying on that
side
• pain may prevent weight bearing by the lower
limb on the involved side.
pain while
Turning in the bed
getting up from the bed or chair
standing, and walking all are very painful
Palpation of myofascial TrPs will produce or
increase a referred, radiating pain pattern
• More commonly, a patient will flinch away from the
palpation in a reaction known as the “jump sign.”
• local twitch response.
• The resistance to stretching leads to apparent
shortening of the affected muscle with limitation of
motion and weakness.
• Abnormal gait
• stiff back
• paraspinal muscle spasm
• The pelvis is tilted downward on the side opposite
to the affected muscle
• lumbar scoliosis .
• normal lumbar lordosis gets flattened

26. special tests
• Quadratus lumborum test 1:
 The patient is side-lying and asked to take
the upper arm over the head to grasp the
top edge of the table, for opening out the
lumbar area.
 The practitioner faces back of patient, and
has easy access for palpation of quadratus
lumborum lateral border with the cephalad
hand.
• Activity of quadratus is tested (palpated for)
with the cephalad hand as the leg is
abducted, while also palpating gluteus
medius with the caudad hand
• if quadratus fires first, then it is stressed,
probably short, and will benefit from
stretching.

27. SPECIAL TESTS
• Quadratus lumborum test 2:
• The patient stands, back towards crouching practitioner.
• Any leg length disparity (based on pelvic crest height) is equalised by using a book or pad
under the short leg side heel.
• With the patient’s feet shoulder-width apart, a pure sidebending is requested, so that the
patient runs a hand down the lateral thigh/calf. (Normal level of sidebending excursion
allows the fingertips to reach to just below the knee.)
• The side to which the fingertips travel furthest is assessed. If sidebending to one side is
limited then quadratus on the opposite side is probably short.
• Combined evidence from palpation (test a) and this sidebending test indicate whether or
not it is necessary to treat quadratus.

28. Management
• MET for Shortness in Quadratus
Lumborum
• The patient lies supine with the feet crossed (the
side to be treated crossed under the non-treated
side leg) at the ankle
• The patient is arranged in a light sidebend, away
from the side to be treated, so that the pelvis is
towards that side, and the feet and head away
from that side (banana shaped).
• As this sidebend is being achieved the affected
quadratus can be palpated for bind so that the
barrier is correctly identified.
• The patient is instructed to very lightly sidebend
towards the treated side.
• This should produce an isometric contraction in
quadratus lumborum on the side to be treated.

29. Management
• After 7 seconds the patient is asked to relax completely, and then to
sidebend towards the nontreated side
• practitioner simultaneously transfers his bodyweight from the
cephalad leg to the caudad leg and leans backwards slightly, in order
to sidebend the patient. This effectively stretches quadratus
lumborum.
• The stretch is held for 15-20 seconds, allowing a lengthening of
shortened musculature in the region.

30. Quadratus lumborum MET method (b)
• The practitioner stands behind the side-lying
patient, at waist level.
• The patient has the uppermost arm extended
over the head to firmly grasp the top end of the
table and, on an inhalation, abducts the
uppermost leg until the practitioner palpates
strong quadratus activity (elevation of around
30 degree usually).
• The patient holds the leg (and, if appropriate,
the breath) isometrically in this manner,
allowing gravity to provide resistance.
• After the 10-second contraction, the patient
allows the leg to hang slightly behind him over
the back of the table.
• The practitioner straddles this and, cradling the
pelvis with both hands (fingers interlocked over
crest of pelvis), leans back to take out all slack
and to ease the pelvis away from the lower ribs
during exhalation.

31. • stretch for 10 - 30 seconds. ( method will be successful if the patient is grasping the top edge of
the table, to provide a fixed point )
• Contraction followed by stretch is repeated once or twice more with raised leg in front of, and
once or twice with raised leg behind the trunk in order to activate different fibres.
• The direction of stretch should be varied so that it is always in the same direction as the long axis
of the abducted leg.
• This calls for the practitioner changing from the back to the front of the table for the best results
• . When the leg hangs to the back of the trunk the long fibres of the muscle are mainly affected
• when the leg hangs forward of the body the diagonal fibres are mainly involved.

32. REFERENCES
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684151/
• https://journals.lww.com/ijpn/fulltext/2018/32030/quadratus_lu
mborum__one_of_the_many_significant.11.aspx
• Indian Journal of Pain 32(3):p 184-186, Sep–Dec 2018.