INDEPENDENT LEARNING: DISC HERNIATION IN THE NATIONAL FOOTBALL LEAGUE: ANATOMICAL FACTORS TO CONSIDER IN REVIEW
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1 INDEPENDENT LEARNING: DISC HERNIATION IN THE NATIONAL FOOTBALL LEAGUE: ANATOMICAL FACTORS TO CONSIDER IN REVIEW
2 CDC REPORT - CAUSES OF DISABILITY, 2005
3 REVIEW QUESTIONS ABOUT DISC HERNIATION IN THE NATIONAL FOOTBALL LEAGUE QUESTION 1- The most common site of disc herniation was at level L5-S1 which was much greater than the frequency of occurrence at L1-L2, L2-L3 or L3-L4. Based upon your knowledge of vertebral anatomy, what are two factors that could contribute to the high frequency of occurrence at L5-S1?
4 DISC HERNIATIONS IN DIFFERENT REGIONS
5
6 NUMBER OF HERNIATIONS PER YEAR
7 REVIEW ANATOMY: WEIGHT SUPPORTED BY VERTEBRAE Cervical (neck) - support ONLY head Thoracic (chest) - support head, neck + upper extremities Lumbar (lower back) - support head + neck + upper extremities + thorax Sacral (pelvis) - fused vertebrae; transmit forces to pelvis WEIGHT SUPPORTED BY VERTEBRAL COLUMN - increases from cervical to thoracic to lumbar regions
8 2) LOWER SPINE EXTENSION : MOVEMENTS PERMITTED IN LUMBAR REGION OF SPINE spinous process lamina pedicle Bodies - hefty Pedicles - stout Lamina - thick Spinous Processes - broad body posterior view Articular processes in sagittal plane - permit flexionextension movements of spine
9 E. MOVEMENTS OF VERTEBRAL COLUMN a. Extension b. Flexion a. Extension b. Flexion - Bend anterior - Bend posterior Flexion-Extension of back occurs in Lumbar region of spine
10 REVIEW QUESTIONS ABOUT DISC HERNIATION IN THE NATIONAL FOOTBALL LEAGUE QUESTION 1- The most common site of disc herniation was at level L5-S1 which was much greater than the frequency of occurrence at L1-L2, L2-L3 or L3-L4. Based upon your knowledge of vertebral anatomy, what are two factors that could contribute to the high frequency of occurrence at L5-S1? Article page 'In the lumbar spine, high loading from the weight of the linemen, rigorous weight training, and forcible lower spine extension during blocking likely play a role in lumbar herniations'
11 ARTICLE ALSO DISCUSSES INCREASE IN WEIGHT OF FOOTBALL PLAYERS IN NFL F = ma force = mass X acceleration Source of data: Associate press study reported in See also: Weigh in Results for Lineman 2014:
12 FORCIBLE LOWER SPINE EXTENSION DURING BLOCKING: PRACTICE DRILL LUMBAR EXTENSION START POSITION INITIAL CONTACT PUSH PLAYER BACK from: Techniques & Drills for Creating Championship Lineman
13
14 QUESTION 2- The second most common region for disc herniation was in the Cervical spine. What aspect of the anatomy of cervical vertebrae could contribute to the relatively high frequency of occurrence of herniation in this region?
15 B. REGIONS OF VERTEBRAL COLUMN Cervical (neck) - 7 vertebrae (C1-C7) Thoracic (chest) - 12 vertebrae (T1-T12) Lumbar (lower back) - 5 vertebrae (L1-L5) Sacral (pelvis) - 5 fused vertebrae (S1-S5) Coccygeal (tail) vertebrae (Co1-Co3) Note: Bodies increase in size from rostral to caudal = superior to inferior
16 NOSE BODY CERVICAL VERTEBRA ant. - body is small TRANSVERSE PROCESS post. Helmet to Helmet contact in NFL - force transmitted through cervical vertebrae
17 QUESTION 2- The second most common region for disc herniation was in the Cervical spine. What aspect of the anatomy of cervical vertebrae could contribute to the relatively high frequency of occurrence of herniation in this region? Review Anatomy: 1) vertebral bodies increase in size from superior to inferior 2) bodies of cervical vertebrae (and, therefore intervertebral discs) are small
18 QUESTION 3- Disc herniation was rare in the thoracic region. Name one specialization of thoracic vertebrae that could contribute to the infrequency of occurrence of herniations in this region?
19 CT OF THORACIC VERTEBRA body of Vertebra T10 rib rib transverse process spine Note: In radiographic images (CT= Computed Tomography and X rays) bone and metal appear white, air is black; soft tissues appear grey
20 THORACIC VERTEBRAE ARE STABILIZE BY RIBS WHICH ATTACH ANTERIORLY TO STERNUM Dorsal view of skeleton Ventral view of thorax Vertebrae Sternum Ribs Ribs Vertebrae
21 LATERAL VIEW OF THORACIC VERTEBRA Superior Articular process Inferior Articular process post ant 3. Costal Facets for Ribs - Body - Facets for Heads of rib; Transverse Process - Facets for Tubercle 5. Articular Processes in coronal plane THORAX IS NOT BENT WHEN SPINE IS FLEXED permit some rotation - little or no flex-extend (also limited by ribs); useful - no flex down on heart, lungs
22 QUESTION 3- Disc herniation was rare in the thoracic region. Name one specialization of thoracic vertebrae that could contribute to the infrequency of occurrence of herniations in this region? REVIEW ANATOMY - 1) Thoracic vertebrae are stable due to posterior attachment of ribs. Anteriorly ribs are attached anteriorly to form thoracic cage. 2) Articular process - In thorax, articular processes are in coronal plane, preventing flexion-extension movements.
23 QUESTION 4- The highest number of injuries to spinal nerves occurred in the Cervical region. Based upon your knowledge of vertebral anatomy, what could contribute to the high rate of occurrence of nerve injuries in this region?
24 TYPE OF INJURIES: NERVE INJURIES IN CERVICAL REGION
25 NOSE BODY TRANSVERSE PROCESS CERVICAL VERTEBRA ant. - body is small ARTICULAR FACETS - angled superiorly & medially - considerable freedom of movement permit considerable flexion-extension, lateral flexion, rotation - useful - move head
26 MOVEMENTS OF HEAD AND NECK: body language YES FLEXION - anterior MAYBE EXTENSION - posterior NO LATERAL FLEXION - head on shoulder, face forward ROTATION - face turned, look over shoulder
27 FIRST CERVICAL VERTEBRA = C1 (ATLAS) LATERAL MASS ANTERIOR ARCH POSTERIOR ARCH Ant. tubercle Post. tubercle 1) has no body only ring of bone 2) Anterior and Posterior Arches and Lateral mass 3) bumps on arches - Ant. and Post. Tubercles 4) has Foramina Transversaria 5) superior articular facets to occipital bone of skull; permits Flex-Ext yes movement of head SECOND CERVICAL VERTEBRA = C2 (AXIS) DENS 1) has peg-like Odontoid process = Dens (may be fused body of C1) 2) joint between C1-C2 is pivot joint allowing rotation; Rotation = no movement of head; joint is important in hanging
28 NOSE BODY TRANSVERSE PROCESS CERVICAL VERTEBRA ant. - body is small ARTICULAR FACETS - angled superiorly & medially - considerable freedom of movement permit considerable flexion-extension, lateral flexion, rotation - useful - move head
29 SPINAL CORD GENERAL TERMINOLOGY: ORGANIZATION OF SPINAL CORD WHITE MATTER Grey and white matter - some nervous tissue appears white because of myelin. Lateral Spinothalamic tract section of cord removed GREY MATTER Dorsal Columns Lat. Corticospinal - descending 1. 'White matter' of nervous system is composed of myelinated axons. Ascending and descending tracts (axons from and to other places). ex. Ascending - Dorsal Columns Spinothalamic tract ex. Descending - Corticospinal tract 2. 'Grey matter' is composed of everything else in nervous system (mainly cell bodies, unmyelinated axons, etc.). Neurons form synapses mostly in Grey matter. histological section (thin section) of spinal cord
30 NERVE DAMAGE SPINAL CORD SPINAL NERVE DORSAL PRIMARY RAMUS INTER- VERTEBRAL DISC SYMPATHETIC CHAIN VENTRAL PRIMARY RAMUS SPINAL NERVE Excessive bending of neck can damage Spinal Nerves
31 EXCESSIVE BENDING OF NECK CAN INJURE SPINAL NERVES Excessive bending of neck can damage Spinal Nerves Tackling in NFL - photo of Ahmed Brooks tackling Drew Brees (quarterback of New Orleans Saints) Brachial Plexus innervates upper extremity - most ventral primary rami from Cervical spinal nerves (C5-T1)
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