Dr. Jack Dolbin Session 5 1 Role of the Lumbar Spine: The most important region as it relates to performance, treatment and prevention of soft tissue injuries. The relation of the spine to somatoautonomic and somatosomatic components have recently been “discovered” by the medical profession
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Dr. Jack Dolbin Session 5 1 Role of the Lumbar Spine: The most important region as it relates to performance, treatment and prevention of soft tissue injuries.
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Dr. Jack Dolbin Session 5 1
Role of the Lumbar Spine: The most important region as it relates
to performance, treatment and prevention of soft tissue injuries.
The relation of the spine to somatoautonomic and
somatosomatic components have recently been “discovered” by the
medical profession
Dr. Jack Dolbin Session 5 2
Key to performance:
As it relates to the shoulderVillanova swimmers 75%As it relates to Lower Extremity injuriesAs it relates to injuries of the upper
extremityAs it relates to performance2nd most common injury in sports
Inspection: Look for Atrophy/AsymetryARTDTRManual Muscle TestingAdsons, Allens , Wrights
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Treatment
Imflammation/PainRestore normal ROM: Adjustment,
Impulse, ME,Strengthen/Stabilize
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Dr. Jack Dolbin Session 5 68
Concussions:Evaluation Impact StudyReturn to participationRepeat Concussions
Concussions
Def: A complex pathophysiological complex involving the brain induced by traumatic biomechanical forces
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Concussions and Depression
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Common features include
1.Maybe caused by a direct blow to the head, neck or elsewhere in the body which transmits impulsive forces to the head.
2.Typically results in in a rapid onset of short lived impairment of of neurological impairment that resolves spontaneously
3.May result in neuropathological changes but largely functional disturbance rather than structural
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Common features ( cont.)
Result in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution of clinical and cognitive typically follow a sequential course. In a small percentage post concussive symptoms may be prolonged
No abnormality on standard structural neuroimaging studies is seen in concussions
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Dr. Jack Dolbin Session 5 73
Symptoms
Somatic( headache) cognitive( feeling in a fog, emotional( lability)
Second Impact SyndromeHyperemiaSecond acceleration head injuryRapid progression to coma.
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Concussion Eval
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Concussion Eval
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Return to Play Protocols
1. No Activity: Complete physical and cognitive rest. Until abate of symptoms
2. Light aerobic exercise: Increase HR3. Sport Specific Exer: add movement4. Non contact drills: exercise,
coordination, cognitive load5. Full contact: restore confidience,
assessment of functional skills5. RTP Dr. Jack Dolbin Session 5 86
Dr. Jack Dolbin Session 5 87
Neck and Spinal Cord Injuries
Cervical SprainDamage to musculo/tendinous/
ligamentous unitRemove from competition
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Neck and Spinal Cord Injuries
Spinal Cord ConcussionViolent impact to the vertebral columnTransient loss of motor or sensory
functionSymptoms last less than 24 hoursIf greater than 24 hours may produce
permanent injury
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Neck and Spinal Cord Injuries
Central Cord Syndrome Greater loss in upper extremity Hyperextension Cervical
Sprain Can an adjustment cause a
disc to herniate?
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Neck and Spinal Cord Injuries
Burning Hand Syndrome:
Lateral Pinch( Stinger) Radiate down arm to thumb Several minutes duration Generally if radial in distribution it is the
neck. If ulnar distribution it is the thoracic outlet.
Direct Trauma
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Thoracic Outlet
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Traction
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Compression
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Evaluation
Range of motion cervical spineRange of motion shoulder, elbow, handDeep Tendon ReflexesMuscle testingPathological reflexesMake transport decision
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Evaluation
Adsons
Allens
Wrights
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Treatment
Ice to effected areaLaser Impulse Adjustments to Scalene Muscles Impulse Adjustments to TOSExercises to retract scapulaReturn to competition as symptoms allow.
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Return to competition decision-making
Concussions:Grade 1: 1st concussion: May return if
symptoms clear rapidly at rest and with exertion.
Grade 1: 2nd occurrence: Remove from competition for two weeks. Must then be asymptomatic for 7 days before return.
Grade 1: 3rd occurrence: Season over. No contact for three months.
Return to competition decision-making
MRI or EEG Neuro Psychiatric exam Grade 2: 1st occurrence: Stabilize the neck.
Asymptomatic for 7 days. Grade 2: 2nd occurrence: Asymptomatic for 1
month before return Grade 2: 3rd occurrence: Terminate season Grade 3: Transport, Remove from competition
for 1 month, asymptomatic for 1 week.
Return to competition decision-making
Factors to look at to prevent head and neck injuries
Head gearTechniqueNeck muscle conditioning
Return to competition after a neck injury:
Neurological Exam: Reflexes Hoffman’s sign Motor strength Sensory exam
Return to competition after a neck injury:
Orthopedic Exam: Full ROM in Cervical Spine Negative Spurlings Maneuver. Strength in all planes of motion in