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Lecture 7

KIN 427 Lecture 7.docx

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KIN 427
Stuart Mc Gill

KIN 427- Lecture 7- January 29, 2013 endplate fracture with intrusion - underlying tubecular bone also breaks - discs are hydrophillic→ very osmotic therefore more flexion at the end at night because less hydration and more hydration→ pre-stressed therefore breaks at lower loads (water balloons) compression tolerance modulators: when in neutral posture: - superhydrated (after rising from bed) - 18% loss in strength - more prone to central endplate fractures - therefore very silly to wake up in the morning and do heavy weight lifting/ sit ups (going for jog is ok not that compressive) Compression fracture Induced end plate damage leads to disc "degeneration" - injury to one tissue leads to a complete change in a joint - kawchuk would drill into the spine and hit the end plate to simulate this fracture and look at it a year later - it becomes stiff because the immune attacks the nucleus - implication: initiation of the degenerative cascade - radial bulging results from endplate damage - disc bulges everywhere and can trap all sorts of nerves Summary: compression damages bony elements first ten subsequent tissues become susceptible (how come back injury doesn't heal in 6 weeks?) What is injury? - decapitation of the scotty dog→ pars inticularis - spondylolisthesis (have this fracture) - if you keep concentrating on bending of spine (stress strain reversals) in the same spot causes the pars inticularis fracture (it is not due to shear) Neural arch - adolescents: 6 deg deflect during a gymnast manoeuver - adults: 1 deg Summary: shear damages endplates, neural arch Planar x-rays - negative findings do not rule out massive bony injury - x-rays don't always show the injuries (ie. endplate avulsions seen if traction is applied) - radiology report: " unremarkable findings with limbus vertebra" - endplate still intact and strong and what breaks is the underlying bone - why do some peoople consider these conditions to be degenerative→ don't want to give her pension - floppy disc and shear displacement of vertebra→ NOT degenerative disc disease Dynamic MR or Fluro> recumbent and upright→ different views of spine some argue that the imaging is new and not reliable yet (bull....) → when you get them to stand you see a huge problem with spine Image does not match the pain - joint deteriorates, stiffens and gristles (stabilizes)→ won't complain about bad backs - the pain is gone (burned out) - the image shows much deterioration Ligament failure - load-rate dependency what really causes injury? - repeated flexion (people have to understand the difference between flexion motion or flexion torque) - how do you cause disc herniation→ repeated flexion - bending is a different mechanism→ creates worms from nucleus Herniation process - the endplate and underlying trabecular bone also appears damaged -injury mechanism - spine load - function motion/ motor patterns - back extensio
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