CERVICAL SPINE NECK INJURIES

Well this is probably the most discussed topic of the year I would say. It seems like each week we hear of motocross injuries that have happened to our favorite pro rider or maybe someone you know at your local track. I’ve put off discussing this topic due to the nature and severity of the injury.  What I would like to take a look at is the type of injuries that we may encounter in motocross. There are certainly a lot of other neck injuries that can occur in our daily lives but none more prevalent than the ones we see in our sport.

ANATOMY

Your neck is part of a long flexible column, known as the spinal column or backbone, which extends through most of your body. The cervical spine (neck region) consists of seven bones (C1-C7 vertebrae), which are separated from one another by intervertebral discs. These discs allow the spine to move freely and act as shock absorbers during activity.

Attached to the back of each vertebral body is an arch of bone that forms a continuous hollow longitudinal space, which runs the whole length of your back. This space, called the spinal canal, is the area through which the spinal cord and nerve bundles pass. The spinal cord is bathed in cerebrospinal fluid (CSF) and surrounded by three protective layers called the meninges (dura, arachnoid, and pia mater).

At each vertebral level, a pair of spinal nerves exit through small openings called foramina (one to the left and one to the right). These nerves serve the muscles, skin and tissues of the body and thus provide sensation and movement to all parts of the body. The delicate spinal cord and nerves are further supported by strong muscles and ligaments that are attached to the vertebrae.

SPECIFIC CONDITIONS

CERVICAL SPINE FRACTURES

Most injuries that involve the neck or cervical spine are the result of a violent collision that compresses the cervical spine against the shoulders. This force can be so great that a vertebra fractures or even bursts into small fragments. For example, striking your head against the bottom of a pool in shallow water or “spear”" tackling using the crown of your helmet to stop an opposing football player, or landing head first during a motocross event can fracture the cervical spine. Cervical spine injuries may also occur during motor vehicle accidents when the head is violently jerked either backwards or forwards. This type of accident may not cause a fracture but instead injure the muscles and ligaments of the neck. The resulting injury is a neck sprain, which is commonly called whiplash.

Regardless of the cause, cervical spine fractures are serious injuries; they may involve spinal cord damage that can result in partial or complete paralysis or even death.

If you suspect that someone has a neck injury, immediately contact emergency medical services. Do not move the person yourself - no matter how uncomfortable they look. If you move a person who has a cervical spine fracture, you risk further injuring that person.

The surgeon will x-ray the injured person's spine to find out if the cervical spine is fractured. To treat the fractured spine, the surgeon first reduces it through traction. This process involves inserting tongs into the skull, attaching a pulley to the tongs, and attaching small weights to the other end of the pulley. The weights pull the head away from the shoulders just enough to enable the soft tissues around the spine to push the fractured bone back into place. After the fracture is reduced, the surgeon examines the spinal cord for damage. Because the spinal cord is soft tissue, it cannot be seen on an x-ray. Therefore, the surgeon injects a dye into the damaged area that coats the spinal cord and other soft tissues so they can be seen on an x-ray.

Most cervical spine fractures must be treated surgically. The surgeon chooses the treatment method based on the severity of the fracture. For example, the fractured vertebra may be fused to the healthy vertebra next to it, or it may be removed and replaced with a bone graft that is fused to the vertebrae on either side.

BURNERS

A "burner," also called a "stinger," is an injury to 1 or more nerves between your neck and shoulder. It's not a serious neck injury. Burners are not uncommon among people who play contact sports such as football. What causes this is one of 3 things:

• Your shoulder is pushed down at the same time that your head is forced to the opposite side. This stretches nerves between your neck and shoulder.

• Your head is quickly moved to one side, pinching nerves on that side.

• The area above your collarbone is hit directly, bruising nerves.

How do I know if I have a burner?

You'll have a burning or stinging feeling between your neck and shoulder, and probably in your arm. Your shoulder and arm may feel numb, tingly or weak.

Your doctor will ask questions and examine you. Burners happen in only one arm at a time. If both of your arms or one arm and a leg are hurt, you may have a serious neck injury, not a burner. If your doctor thinks you have a serious neck injury, he or she may take x-rays of your neck. Your doctor will also tell you how to protect your neck from further injury.

How are burners treated?

Burners usually get better on their own. You may need physical therapy to stretch and strengthen your muscles.

Some burners only last a few minutes. Others take several days or weeks to heal. If your burner lasts more than a few weeks, see your doctor. You may have a test called an electromyogram (EMG). This test can show that you have a burner and give an idea about how long it will last.

When can I return to my sport?

No matter what sport it is you shouldn't go back to playing if you have pain, numbness or tingling. Also refrain from playing if you aren't able to move your neck in all directions or if your strength is not back to normal. You must be able to return without problems from the injury.

HERNIATED DISC

What is a herniated cervical disc?

A herniated disc occurs when the gel-like center of your disc ruptures out through a tear in the tough disc wall (annulus) (Fig. 1). The gel material is irritating to your spinal nerves, causing something like a chemical irritation. The pain is a result of spinal nerve inflammation and swelling caused by the pressure of the herniated disc. Over time, the herniation tends to shrink and you may experience partial or complete pain relief. In most cases, if neck and/or arm pain is going to resolve it will do so in about 6 weeks.

Different terms may be used to describe a herniated disc. A bulging disc (protrusion) occurs when the disc annulus remains intact, but forms an outpouching that can press against the nerves. A true herniated disc (also called a ruptured or slipped disc) occurs when the disc annulus cracks or ruptures, allowing the gel-filled center to squeeze out. Sometimes the herniation is so severe that a free fragment occurs, meaning a piece has broken completely free from the disc and is in the spinal canal.

What are the symptoms?

Symptoms of a herniated disc vary greatly depending on the location of the herniation and your own response to pain. If you have a herniated cervical disc, you may feel pain that radiates down your arm and possibly into your hand. You may also feel pain on or near your shoulder blade, and neck pain when turning your head or bending your neck. Sometimes you may have muscle spasms (meaning the muscles tighten uncontrollably). Sometimes the pain is accompanied by numbness and tingling in your arm. You may also have muscle weakness in your biceps, triceps, and handgrip.

You may have first noticed pain when you woke up, without any traumatic event that might have caused injury. Some patients find relief by holding their arm in an elevated position behind their head because this position relieves pressure on the nerve.

What are the causes?

Discs can bulge or herniate because of injury and improper lifting or can occur spontaneously. Aging plays an important role. As you get older, your discs dry out and become harder. The tough fibrous outer wall of the disc may weaken, and it may no longer be able to contain the gel-like nucleus in the center. This material may bulge or rupture through a tear in the disc wall, causing pain when it touches a nerve. Genetics, smoking, and a number of occupational and recreational activities lead to early disc degeneration.

What treatments are available?

Conservative nonsurgical treatment is the first step to recovery and may include medication, rest, massage, physical therapy, home exercises, hydrotherapy, chiropractic care, and pain management. Over 95% of people with arm pain due to a herniated disc improve in about six weeks and return to normal activity. If you don't respond to conservative treatment or your symptoms get worse, your doctor may recommend surgery.

NECK SPRAIN

The seven bones of the spinal column in your neck (cervical vertebrae) are connected to each other by ligaments--strong bands of tissue that act like thick rubber bands. A sprain (stretch) or tear can occur in one or more of these ligaments when a sudden movement, such as a motor vehicle accident or a hard fall, causes the neck to extend to an extreme position.

Symptoms

• Pain, especially in the back of the neck, that worsens with movement

• Pain that peaks a day or so after the injury, instead of immediately

• Muscle spasms and pain in the upper shoulder

• Headache in the back of the head

• Sore throat

• Increased irritability, fatigue, difficulty sleeping, and difficulty concentrating

• Numbness in the arm or hand

• Neck stiffness or decreased range of motion (side to side, up and down, circular)

• Tingling or weakness in the arms

Diagnosis and Treatment

To diagnosis a neck sprain, your doctor will perform a comprehensive physical examination. During the physical examination, the doctor will ask you how the injury occurred, measure the range of motion of your neck, and check for any point tenderness.

Radiographs (X-rays) may be requested so the doctor can look closely at the bones in your neck. This evaluation will help the doctor rule out or identify other sources of neck pain, such as spinal fractures, dislocations, arthritis, and other serious conditions.

All sprains or strains, no matter where they are located in the body, are treated in a similar manner. Neck sprains, like other sprains, will usually heal gradually, given time and appropriate treatment. You may have to wear a soft collar around your neck to help support the head and relieve pressure on the ligaments so they have time to heal.

Pain relievers such as aspirin or ibuprofen can help reduce the pain and any swelling. Muscle relaxants can help ease spasms. You can apply an ice pack for 15 to 30 minutes at a time, several times a day for the first 2 or 3 days after the injury. This will help reduce inflammation and discomfort. Although heat, particularly moist heat, can help loosen cramped muscles, it should not be applied too quickly.

Other treatment options include:

• Massaging the tender area

• Ultrasound

• Cervical (neck) traction

• Aerobic and isometric exercise

Most symptoms of neck sprain will go away in 4 to 6 weeks. However, severe injuries, may take longer to heal completely.

PREVENTION AND PROTECTION

The million dollar question!!!!! While we only have minimal information available to us from the Leatt Brace Company, there are still some questions a lot of people are still asking about neck protection. Which one is better? Which one will fit my chest protector? Am I really protected from a serious neck injury?

While I am not a payed sponsor of Leatt, I do use there product with the utmost confidence. They have performed numerous tests on the neck brace and continue to help those who have questions about their product. Dr. Leatt and his staff even go so far as to document every incident and do their best to help solve any issues that may arise involving the neck brace.

I cannot comment on the new EVS and Alpinestar neck braces available without further evaluation of their product. But the bottom line comes done to you and your decision alone as to which brace to buy or even to wear a neck protection system. I feel better about wearing one when I ride. How about you?

LOW BACK INJURIES

(September 2008)

Well now it’s the off season!!!  For some riders at least and with that comes the opportunity to take sometime off to relax or have that nagging injury fixed you’ve been putting off till now. We’ve covered a few of the major injuries that have plagued the pro riders this year. So what about those injuries that affect the ‘regular’ folks out there? I’ve talked with quite a few people who have dealt with back problems over the past few months. But wait, where do we start??? Let’s see if we can cover a few things that we need to know about the back. The low back injuries are the most common, so let’s start there!!!!

What structures make up the back?
The back is an intricate structure of bones, muscles, and other tissues that form the posterior part of the body’s trunk, from the neck to the pelvis. The centerpiece is the spinal column, which not only supports the upper body’s weight but houses and protects the spinal cord — the delicate nervous system structure that carries signals that control the body’s movements and convey its sensations. Stacked on top of one another are more than 30 bones — the vertebrae — that form the spinal column, also known as the spine. Each of these bones contains a round hole that, when stacked in register with all the others, creates a channel that surrounds the spinal cord. The spinal cord descends from the base of the brain and extends in the adult to just below the rib cage. Small nerves (“roots”) enter and emerge from the spinal cord through spaces between the vertebrae. Because the bones of the spinal column continue growing long after the spinal cord reaches its full length in early childhood, the nerve roots to the lower back and legs extend many inches down the spinal column before exiting. This large bundle of nerve roots was dubbed by early anatomists as the cauda equina, or horse’s tail. The spaces between the vertebrae are maintained by round, spongy pads of cartilage called intervertebral discs that allow for flexibility in the lower back and act much like shock absorbers throughout the spinal column to cushion the bones as the body moves. Bands of tissue known as ligaments and tendons hold the vertebrae in place and attach the muscles to the spinal column.

Starting at the top, the spine has four regions:

§      the seven cervical or neck vertebrae (labeled C1–C7),

§      the 12 thoracic or upper back vertebrae (labeled T1–T12),

§      the five lumbar vertebrae (labeled L1–L5), which we know as the lower back, and

§      the sacrum and coccyx, a group of bones fused together at the base of the spine.

The lumbar region of the back, where most back pain is felt, supports the weight of the upper body.

What causes lower back pain?
As people age, bone strength and muscle elasticity and tone tend to decrease. The discs begin to lose fluid and flexibility, which decreases their ability to cushion the vertebrae. Pain can occur when, for example, someone lifts something too heavy or overstretches, causing a sprain, strain, or spasm in one of the muscles or ligaments in the back. If the spine becomes overly strained or compressed, a disc may rupture or bulge outward. This rupture may put pressure on one of the more than 50 nerves rooted to the spinal cord that control body movements and transmit signals from the body to the brain. When these nerve roots become compressed or irritated, back pain results.

Low back pain may reflect nerve or muscle irritation or bone lesions. Most low back pain follows injury or trauma to the back, but pain may also be caused by degenerative conditions such as arthritis or disc disease, osteoporosis or other bone diseases, viral infections, irritation to joints and discs, or congenital abnormalities in the spine. Obesity, smoking, stress, poor physical condition, posture inappropriate for the activity being performed, and poor sleeping position also may contribute to low back pain. Additionally, scar tissue created when the injured back heals itself does not have the strength or flexibility of normal tissue. Buildup of scar tissue from repeated injuries eventually weakens the back and can lead to more serious injury.

Occasionally, low back pain may indicate a more serious medical problem. Pain accompanied by fever or loss of bowel or bladder control, pain when coughing, and progressive weakness in the legs may indicate a pinched nerve or other serious condition. People with diabetes may have severe back pain or pain radiating down the leg related to neuropathy. People with these symptoms should contact a doctor immediately to help prevent permanent damage.

What conditions are associated with low back pain?
Conditions that may cause low back pain and require treatment by a physician or other health specialist include:

Bulging disc (also called protruding, herniated, or ruptured disc). The intervertebral discs are under constant pressure. As discs degenerate and weaken, cartilage can bulge or be pushed into the space containing the spinal cord or a nerve root, causing pain. Studies have shown that most herniated discs occur in the lower, lumbar portion of the spinal column.

A much more serious complication of a ruptured disc is cauda equina syndrome, which occurs when disc material is pushed into the spinal canal and compresses the bundle of lumbar and sacral nerve roots. Permanent neurological damage may result if this syndrome is left untreated.

Sciatica is a condition in which a herniated or ruptured disc presses on the sciatic nerve, the large nerve that extends down the spinal column to its exit point in the pelvis and carries nerve fibers to the leg. This compression causes shock-like or burning low back pain combined with pain through the buttocks and down one leg to below the knee, occasionally reaching the foot. In the most extreme cases, when the nerve is pinched between the disc and an adjacent bone, the symptoms involve not pain but numbness and some loss of motor control over the leg due to interruption of nerve signaling. The condition may also be caused by a tumor, cyst, or degeneration of the sciatic nerve root.

Spinal degeneration from disc wear and tear can lead to a narrowing of the spinal canal. A person with spinal degeneration may experience stiffness in the back upon awakening or may feel pain after walking or standing for a long time.

Spinal stenosis related to congenital narrowing of the bony canal predisposes some people to pain related to disc disease.

Osteoporosis is a metabolic bone disease marked by progressive decrease in bone density and strength. Fracture of brittle, porous bones in the spine and hips results when the body fails to produce new bone or

absorbs too much existing bone. Women are four times more likely than men to develop osteoporosis.

Skeletal irregularities produce strain on the vertebrae and supporting muscles, tendons, ligaments, and tissues supported by spinal column. These irregularities include scoliosis, a curving of the spine to the side; kyphosis, in which the normal curve of the upper back is severely rounded; lordosis, an abnormally accentuated arch in the lower back; back extension, a bending backward of the spine; and back flexion, in which the spine bends forward.

Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and multiple “tender points,” particularly in the neck, spine, shoulders, and hips. Additional symptoms may include sleep disturbances, morning stiffness, and anxiety.

Spondylitis refers to chronic back pain and stiffness caused by a severe infection to or inflammation of the spinal joints. Other painful inflammations in the lower back include osteomyelitis (infection in the bones of the spine) and sacroiliitis (inflammation in the sacroiliac joints).

How is low back pain diagnosed?
A thorough medical history and physical exam can usually identify any dangerous conditions or family history that may be associated with the pain. The patient describes the onset, site, and severity of the pain; duration of symptoms and any limitations in movement; and history of previous episodes or any health conditions that might be related to the pain. The physician will examine the back and conduct neurologic tests to determine the cause of pain and appropriate treatment. Blood tests may also be ordered. Imaging tests may be necessary to diagnose tumors or other possible sources of the pain.

A variety of diagnostic methods are available to confirm the cause of low back pain:

X-ray imaging includes conventional and enhanced methods that can help diagnose the cause and site of back pain. A conventional x-ray, often the first imaging technique used, looks for broken bones or an injured vertebra. A technician passes a concentrated beam of low-dose ionized radiation through the back and takes pictures that, within minutes, clearly show the bony structure and any vertebral misalignment or fractures. Tissue masses such as injured muscles and ligaments or painful conditions such as a bulging disc are not visible on conventional x-rays. This fast and painless procedure is usually performed in a doctor’s office or at a clinic.

Discography involves the injection of a special contrast dye into a spinal disc thought to be causing low back pain. The dye outlines the damaged areas on x-rays taken following the injection. This procedure is often suggested for patients who are considering lumbar surgery or whose pain has not responded to conventional treatments. Myelograms also enhance the diagnostic imaging of an x-ray. In this procedure, the dye is injected into the spinal canal, allowing spinal cord and nerve compression caused by herniated discs or fractures to be seen on an x-ray.

Computerized tomography (CT) is a quick and painless process used when disc rupture, spinal stenosis, or damage to vertebrae is suspected as a cause of low back pain. X-rays are passed through the body at various angles and are detected by a computerized scanner to produce two-dimensional slices of internal structures of the back. This diagnostic exam is generally conducted at an imaging center or hospital.

Magnetic resonance imaging (MRI) is used to evaluate the lumbar region for bone degeneration or injury or disease in tissues and nerves, muscles, ligaments, and blood vessels. MRI scanning equipment creates a magnetic field around the body strong enough to temporarily realign water molecules in the tissues. This noninvasive procedure is often used to identify a condition requiring prompt surgical treatment.

Electrodiagnostic procedures include electromyography (EMG), nerve conduction studies. EMG assesses the electrical activity in a nerve and can detect if muscle weakness results from injury or a problem with the nerves that control the muscles. Very fine needles are inserted in muscles to measure electrical activity transmitted from the brain or spinal cord to a particular area of the body. With nerve conduction studies the doctor uses two sets of electrodes (similar to those used during an electrocardiogram) that are placed on the skin over the muscles. The first set gives the patient a mild shock to stimulate the nerve that runs to a particular muscle. The second set of electrodes is used to make a recording of the nerve’s electrical signals, and from this information the doctor can determine if there is nerve damage.

Bone scans are used to diagnose and monitor infection, fracture, or disorders in the bone. A small amount of radioactive material is injected into the bloodstream and will collect in the bones, particularly in areas with some abnormality. Scanner-generated images are sent to a computer to identify specific areas of irregular bone metabolism or abnormal blood flow, as well as to measure levels of joint disease.

Ultrasound imaging, also called ultrasound scanning or sonography, uses high-frequency sound waves to obtain images inside the body. The sound wave echoes are recorded and displayed as a real-time visual image. Ultrasound imaging can show tears in ligaments, muscles, tendons, and other soft tissue masses in the back.

How is back pain treated?
Most low back pain can be treated without surgery. Treatment involves using analgesics, reducing inflammation, restoring proper function and strength to the back, and preventing recurrence of the injury. Most patients with back pain recover without residual functional loss. Patients should contact a doctor if there is not a noticeable reduction in pain and inflammation after 72 hours of self-care.

Although ice and heat (the use of cold and hot compresses) have never been scientifically proven to quickly resolve low back injury, compresses may help reduce pain and inflammation and allow greater mobility for some individuals. As soon as possible following trauma to the back, patients should apply a cold pack or a cold compress (such as a bag of ice or bag of frozen vegetables wrapped in a towel) to the tender spot several times a day for up to 20 minutes. After 2 to 3 days of cold treatment, they should then apply heat (such as a electric heating pad or hot pack) for brief periods to relax muscles and increase blood flow. Warm baths may also help relax muscles. Patients should avoid sleeping on a heating pad, which can cause burns and lead to additional tissue damage.

Exercise is the most effective way to speed recovery from low back pain and help strengthen back and abdominal muscles. Maintaining and building muscle strength is particularly important for persons with skeletal irregularities. Doctors and physical therapists can provide a list of gentle exercises that help keep muscles moving and speed the recovery process. A routine of back-healthy activities may include stretching exercises, swimming, walking, and movement therapy to improve coordination and develop proper posture and muscle balance. Yoga is another way to gently stretch muscles and ease pain. Any mild discomfort felt at the start of these exercises should disappear as muscles become stronger. But if pain is more than mild and lasts more than 15 minutes during exercise, patients should stop exercising and contact a doctor.

Medications are often used to treat acute and chronic low back pain. Effective pain relief may involve a combination of prescription drugs and over-the-counter remedies. Patients should always check with a doctor before taking drugs for pain relief. Certain medicines, even those sold over the countermay conflict with other medications, may cause side effects including drowsiness, or may lead to liver damage.

§  Over-the-counter analgesics, including nonsteroidal anti-inflammatory drugs (aspirin, naproxen, and ibuprofen), are taken orally to reduce stiffness, swelling, and inflammation and to ease mild to moderate low back pain. Counter-irritants applied topically to the skin as a cream or spray stimulate the nerve endings in the skin to provide feelings of warmth or cold and dull the sense of pain. Topical analgesics can also reduce inflammation and stimulate blood flow. Many of these compounds contain salicylates, the same ingredient found in oral pain medications containing aspirin.

§  Opioids such as codeine, oxycodone, hydrocodone, and morphine are often prescribed to manage severe acute and chronic back pain but should be used only for a short period of time and under a physician’s supervision. Side effects can include drowsiness, decreased reaction time, impaired judgment, and potential for addiction. Many specialists are convinced that chronic use of these drugs is detrimental to the back pain patient, adding to depression and even increasing pain.

Spinal manipulation is literally a "hands-on" approach in which professionally licensed specialists (doctors of chiropractic care) use leverage and a series of exercises to adjust spinal structures and restore back mobility.

When back pain does not respond to more conventional approaches, patients may consider the following options:

Interventional therapy can ease chronic pain by blocking nerve conduction between specific areas of the body and the brain. Approaches range from injections of local anesthetics, steroids, or narcotics into affected soft tissues, joints, or nerve roots to more complex nerve blocks and spinal cord stimulation. When extreme pain is involved, low doses of drugs may be administered by catheter directly into the spinal cord. Chronic use of steroid injections may lead to increased functional impairment.

Traction involves the use of weights to apply constant or intermittent force to gradually “pull” the skeletal structure into better alignment. Traction is not recommended for treating acute low back symptoms.

Transcutaneous electrical nerve stimulation (TENS) is administered by a battery-powered device that sends mild electric pulses along nerve fibers to block pain signals to the brain. Small electrodes placed on the skin at or near the site of pain generate nerve impulses that block incoming pain signals from the peripheral nerves. TENS may also help stimulate the brain’s production of endorphins (chemicals that have pain-relieving properties).

Ultrasound is a noninvasive therapy used to warm the body’s internal tissues, which causes muscles to relax. Sound waves pass through the skin and into the injured muscles and other soft tissues.

Minimally invasive outpatient treatments to seal fractures of the vertebrae caused by osteoporosis include

vertebroplasty and kyphoplasty. Vertebroplasty uses three-dimensional imaging to help a doctor guide a fine needle into the vertebral body. A glue-like epoxy is injected, which quickly hardens to stabilize and strengthen the bone and provide immediate pain relief. In kyphoplasty, prior to injecting the epoxy, a special balloon is inserted and gently inflated to restore height to the bone and reduce spinal deformity.

In the most serious cases, when the condition does not respond to other therapies, surgery may relieve pain caused by back problems or serious musculoskeletal injuries. Some surgical procedures may be performed in a doctor’s office under local anesthesia, while others require hospitalization. It may be months following surgery before the patient is fully healed, and he or she may suffer permanent loss of flexibility. Since invasive back surgery is not always successful, it should be performed only in patients with progressive neurologic disease or damage to the peripheral nerves.

§  Discectomy is one of the more common ways to remove pressure on a nerve root from a bulging disc or bone spur. During the procedure the surgeon takes out a small piece of the lamina (the arched bony roof of the spinal canal) to remove the obstruction below.

§  Foraminotomy is an operation that “cleans out” or enlarges the bony hole (foramen) where a nerve root exits the spinal canal. Bulging discs or joints thickened with age can cause narrowing of the space through which the spinal nerve exits and can press on the nerve, resulting in pain, numbness, and weakness in an arm or leg. Small pieces of bone over the nerve are removed through a small slit, allowing the surgeon to cut away the blockage and relieve the pressure on the nerve.

§  Spinal fusion is used to strengthen the spine and prevent painful movements. The spinal disc(s) between two or more vertebrae is removed and the adjacent vertebrae are “fused” by bone grafts and/or metal devices secured by screws. Spinal fusion may result in some loss of flexibility in the spine and requires a long recovery period to allow the bone grafts to grow and fuse the vertebrae together.

§  Spinal laminectomy (also known as spinal decompression) involves the removal of the lamina (usually both sides) to increase the size of the spinal canal and relieve pressure on the spinal cord and nerve roots.

Quick tips to a healthier back
Following any period of prolonged inactivity, begin a program of regular low-impact exercises. Speed walking, swimming, or stationary bike riding 30 minutes a day can increase muscle strength and flexibility. Yoga can also help stretch and strengthen muscles and improve posture. Ask your physician or orthopedist for a list of low-impact exercises appropriate for your age and designed to strengthen lower back and abdominal muscles.

§  Always stretch before exercise or other strenuous physical activity.

§  Don’t slouch when standing or sitting. When standing, keep your weight balanced on your feet. Your back supports weight most easily when curvature is reduced.

§  Sit in a chair with good lumbar support and proper position and height for the task. Keep your shoulders back. Switch sitting positions often and periodically walk around the office or gently stretch muscles to relieve tension. A pillow or rolled-up towel placed behind the small of your back can provide some lumbar support. If you must sit for a long period of time, rest your feet on a low stool or a stack of books.

§  Wear comfortable, low-heeled shoes.

§  Sleep on your side to reduce any curve in your spine. Always sleep on a firm surface.

§  Ask for help when transferring an ill or injured family member from a reclining to a sitting position or when moving the patient from a chair to a bed.

§  Don’t try to lift objects too heavy for you. Lift with your knees, pull in your stomach muscles, and keep your head down and in line with your straight back. Keep the object close to your body. Do not twist when lifting.

§  Maintain proper nutrition and diet to reduce and prevent excessive weight, especially weight around the waistline that taxes lower back muscles. A diet with sufficient daily intake of calcium, phosphorus, and vitamin D helps to promote new bone growth.

§  If you smoke, quit. Smoking reduces blood flow to the lower spine and causes the spinal discs to degenerate.

Well did we cover it all for you?? I hope you can take this information and apply it to your problems that you have experienced or hopefully do not get to experience in the future. The low back is not a laughing matter when it comes to riding that motorcycle on the weekends. Whether you’re a weekend warrior or a serious racer, listen to your body when an injury occurs. I want you to be able to go to work the next morning and come back ride next weekend!!! Enjoy!!!!!!!!

August 2008

FEMUR FRACTURES

Trey Canard unfortunately broke his femur at Washougal last month. You or someone you know may have experienced this injury but you still have some unanswered questions. This can be a very serious injury if it’s not taken care promptly and properly. The healing and rehabilitation process takes several months as well. Let’s take a look at a few simple facts and some explanations of just what we are dealing with here.

What is a femur fracture?

The thighbone (femur) is the longest and the strongest bone in the body. To break the thighbone across its length (shaft) takes a great deal of force, as in Trey’s case occur in a motocross accident, a high speed collision or a fall from a high place. Because of this, a broken thighbone is often associated with potentially life-threatening injuries to other body systems. Due to the blood supply to the area, the possibility of DVT (deep vein thrombosis – blood clotting) and PE (pulmonary embolism – blockage of the artery) can occur but more commonly due to preexisting conditions such as heart disease, obesity, carcinoma, diabetes, and hypertension.

Types of fractures include the following:

 - SIMPLE - There is only one fracture line, and the bone is broken into 2 pieces.

 - COMMINUTED - There is more than one fracture line, and there are more than 2 bone fragments at the

   fracture site.

 - CLOSED - The skin in the fracture area is not broken, and the break is not exposed to the outside.

 - OPEN (COMPOUND) - The skin over the fracture is broken, exposing the broken bone.

 - PATHOLOGICAL - The bone has been weakened or destroyed by disease so that it breaks easily.

 - STRESS - There is a hairline crack in a bone, sometimes not even visible on an x-ray, that is caused by 

   repeated injury or stress on the bone.

What are the symptoms?

Symptoms of a femur fracture include:

 - severe pain

 - swelling and bruising

 - inability to walk

 - visible deformity at the site of fracture

 - the feeling that the bone in your thigh is moving.

 - When you break your femur, you may lose a lot of blood in the thigh. You may feel

   numbness, coldness, or tingling in your foot or lower leg if the blood supply to these

   areas is injured.

How is it diagnosed?

A fractured femur is usually obvious, even if the bone does not break through the skin. Severe pain, inability to move the leg, deformity, and swelling are characteristic. The injured thigh may be shorter than the uninjured one because the strong thigh muscles may force the broken edges of bone out of alignment (displacement). The injury may disrupt the rich blood supply to the muscles of the thigh, resulting in extensive bruising and loss of blood. 

If the fracture resulted from a high-energy trauma, such as a the case with Trey Canard, the individual might not be conscious and may have other injuries. It is important that medical personnel tend to the injury and transport the individual to a hospital. 

The physician will examine the injury and evaluate the circulatory and nervous systems, as well as the fracture. Several X-rays may be required, including X-ray of the leg, knee, hip, and pelvis, to determine the extent of injury to the adjacent joints.

How is it treated?

Most femur fractures need to be fixed in surgery. Your leg may be placed in traction in the hospital before surgery is done. But for the most part the emergency medical personnel usually place the leg in traction at the scene.

Methods used to fix a femur fracture include surgery to insert:

 - steel screws

 - steel plates and steel screws

 - steel rods, which can be placed down the center of the shaft of the femur.

Fractures that occur at or near the knee joint usually require plates and screws or just the screws. Shaft fractures, as in the midthigh, are usually fixed with a rod.

You will need to use crutches for 8 to 12 weeks after surgery. Your orthopedic surgeon will tell you whether or not you should put weight on your injured leg, which will depend on how bad the fracture is and how it has been treated.

While you are still healing after surgery, you will begin physical therapy to regain strength in your muscles and to loosen up your joints. (Muscles are usually injured in a femur fracture, and your hip and knee become stiff due to the injury and surgery.)

Complete recovery may take many months, depending on how bad the fracture was and the extent of any other injuries. The break itself should heal in about 4 months. X-rays are taken regularly to see how the bone is healing. Full recovery, however, requires the muscles and joints to heal as well. Your therapist will assess the recovery of your muscles and joints by measuring joint mobility and the return of muscle strength, flexibility, and coordination. Your health care provider may decide to remove the plates, screws, or rods sometime after your leg has fully healed.

When can I return start riding again ?

Everyone recovers from an injury at a different rate. Return to your activities and riding will be determined by how soon your leg recovers, not by how many days or weeks it has been since your injury has occurred. The goal of rehabilitation is to return you to your normal activities (as well as riding) as soon as is safely possible. If you return too soon you may worsen your injury.

The following list gives some general requirements that you might be expected to meet to return safely to your normal activities:

 - You have full range of motion in the injured leg compared to the uninjured leg.

 - You have full strength of the injured leg compared to the uninjured leg.

 - You can walk straight ahead without pain or limping.

How can I prevent a femur fracture?

Ok here’s the big topic of discussion lately on a lot of the message boards/forums. Femur fractures are usually caused by accidents/forces that cannot be prevented. You cannot blame the femur fracture due to wearing knee braces. The forces of the impact are placed above the  thigh cuff on the braces with most of these injuries pertaining to motocross, which is a good thing. If a fracture were to occur below mid-shaft and down towards the knee, it could lead a rider into early retirement. However, it is important to use good judgment in the sport that we love to participate in each weekend. It is also important to have a good diet with enough calories and calcium for our bones to be healthy.

July 2008

ROTATOR CUFF / LABRAL INJURIES

Since Ben Townley just had surgery to repair a rotator cuff / labral injury to his shoulder, I thought this might be a good opportunity to explain what they are and the differences between the two.

WHAT IS A ROTATOR CUFF INJURY ?

A rotator cuff injury is a strain or tear in the group of tendons and muscles that hold your shoulder joint together and help move your shoulder.

HOW DOES IT OCCUR ?

A rotator cuff injury may result from the following:

 * using your arm to break a fall (like we do in racing)

 * falling onto your arm

 * lifting a heavy object

 * use of the your shoulder in sports with a repetitive overhead movement, such as swimming, baseball (mainly pitchers), football,  and tennis, which gradually strains the tendon.

 * any type of manual labor requiring overhead work.

WHAT ARE THE SYMPTOMS ?

The symptoms of a torn rotator cuff are:

 * arm and shoulder pain

 * shoulder weakness

 * shoulder tenderness

 * loss of shoulder movement

HOW IS IT DIAGNOSED ?

An orthopedic doctor will perform a physical exam and check your shoulder for pain, tenderness, and loss of motion as you move your arm in all directions. He/she will ask you whether your shoulder pain began suddenly or gradually. An x-ray may be done to rule out fractures and bone spurs. Based on these results, he/she may order other tests and procedures including:

* an arthrogram – an x-ray that is taken after a special dye has been injected into your shoulder joint to outline its soft structures.

 * MRI (magnetic resonance imaging) – this creates images of your shoulder and surrounding structures with sound waves.

 * Arthroscopy – a surgical procedure in which a small instrument is inserted into your shoulder joint so your doctor can look directly at your rotator cuff.

WHAT IS THE TREATMENT ?

A tendon in your shoulder can be inflamed, partially torn, or completely torn. What is done to the injury depends on the size of the tear and how much it hurts. If the tear is a minor, it can be left to heal by itself if it doesn’t interfere with your everyday activities. A large tear will need to be repaired by arthroscopy. This is also used to perform surgery on a joint, not only for seeing inside the shoulder. The larger tears can be fixed and stitched back together.

After surgery, your treatment plan will consist of physical therapy to help with ROM (range of motion) and strengthen your shoulder as it heals. Full recovery depends on what is torn and how it is treated. The goal of rehabilitation is to return to racing as soon as it is safely possible. Strength is the key to returning to racing. Keep in mind that everyone recovers from an injury at a different rate.

WHAT IS A LABRAL TEAR OF THE SHOULDER ?

The shoulder joint is a ball and socket joint. The labrum is a lip of connective tissue where the shoulder ligaments connect to the edge of the socket that holds the ball of the upper arm bone (humerus bone) into the socket of the shoulder blade (scapula).

HOW DOES IT OCCUR ?

The labrum can be torn by the same mechanisms as a rotator cuff tear. But it can also include the following:

 * having your arm jerked away from your body

 * direct blow to the front/back of your shoulder

WHAT ARE THE SYMPTOMS ?

The symptoms of a labral tear also can be related to the rotator cuff tear as well. But it can also include the following:

 * clicking or grinding when moving your shoulder

 * a sense of the shoulder “going out of place”

HOW IS IT DIAGNOSED ?

The same way that the rotator cuff was examined can also be performed to check out the labrum as well. Many times labral tears are finally diagnosed when the arthroscopy is performed to look inside the painful or symptomatic shoulder.

WHAT IS THE TREATMENT ?

Large tears usually need to be fixed in surgery. The tear in the labrum may be re-attached or trimmed away. If there is scar tissue, it may be removed as well. Torn ligaments may be re-attached too. Small labral tears may become painless by avoiding those activities that make the shoulder feel uncomfortable.

After surgery, your treatment plan will consist of physical therapy to help with ROM (range of motion) and strengthen your shoulder as it heals. Full recovery depends on what is torn and how it is treated. The goal of rehabilitation is to return to racing as soon as it is safely possible. Strength is the key to returning to racing. Again keep in mind that everyone recovers from an injury at a different rate. With a labral repair, the return time back to racing may be longer than the rotator cuff repair. If you return too soon, you can worsen the injury and could lead to permanent damage.Many labral tears are caused by accidents that cannot be prevented. It is always important to have good strength and always use proper form during training and rehabilitation to ensure a safe and prosper return to racing.

June 2008