Recognising Back and Spinal Injury

The spine is made up of a number of small bones called vertebrae. These form the backbone or spinal column, through which run the spinal cord, the part of the central nervous system connecting all parts of the body with the brain, and major blood vessels. Injuries to the back are caused in a number of ways: through direct impact (such as a heavy blow to the neck or back); indirect impact (landing on the head or feet without bending the legs, thus allowing the force to travel up the body); and when the head is violently thrown forwards and backwards (common in car accidents).

Complications with back injury

The biggest danger with back injuries is the risk of nerve damage. The spinal cord containing the spinal nerves runs down the centre of the vertebrae and fractures can sever or pinch these nerves, leading to partial or full paralysis. If the fracture is high in the neck, breathing may stop. Displaced vertebrae or swelling due to blood loss can also apply pressure to the spinal cord, leading to nerve damage.

Not all broken backs result in immediate damage to the spinal cord. However, the risk of spinal cord injuries is greatly increased if bones are broken, and any suspected fracture of the spine should be treated with extreme care.

Suspect a broken back or potential nerve damage if the accident involved:

• Rapid slowing down of movement.
• A fall from a height.
• A sharp blow directly to the back.
• Injury to the face or skull (as this often results from the head being thrown backwards and forwards).

Signs and symptoms of a broken back

• Dent or step in the spine, which may indicate a displaced vertebra
• Bruising or swelling over the backbone
• Complaint of pain in the back
• Tenderness over the area of the break

First Aid Treatment

Any spinal injury is potentially serious and you should seek emergency assistance immediately. The treatment for injuries to the back is to keep the injured person still while monitoring and maintaining airway and breathing. The general rule for dealing with broken bones or spinal cord damage is to keep the casualty in the position that you found him until a doctor arrives, taking particular care to ensure the head is immobilised

Unless the person is in danger or becomes unconscious and requires resuscitation, do not move him from the position in which he was found. If you have been trained to do so, you can move the head into the neutral position before immobilisation. Remain in this position until emergency help arrives.

1. If the casualty is conscious and already lying down, leave him where he is. If the casualty is still walking around, support him in lying down on the ground. If you can, put a blanket or coat underneath before you lie the person down.
2. Ensure that an ambulance has been called at the earliest opportunity.
3. Tell the person to keep still until medical help arrives and reassure him.
4. Hold the casualty's head still by placing your hands over the ears and your fingers along the jawline.
5. Do not remove your support from the head until help arrives.

If the casualty is unconscious, maintaining a clear airway is your first priority.

Back pain

There are many causes of back pain. Among the most serious is damage to the spinal cord, which may lead to paralysis or meningitis. More commonly, neck or lower back pain can be caused by muscle strain or damage to the ligaments or the discs between the vertebrae (the back bones). Broken ribs or damage to the muscles between the ribs at the back may also cause back pain.

Signs and symptoms

• Dull or severe pain, usually made worse by movement
• Tension in the neck or shoulders
• Pain travelling down limbs

First Aid Treatment

• Check the nature of the incident carefully ­ if the pain is related to a recent heavy fall or other accident, assume that there may be spinal cord damage and treat as for a broken back.
• Help the casualty to lie down. Usually the most comfortable position will be flat on the back on a hard surface.
• If the symptoms do not ease, advise the casualty to see a doctor.

If back pain is accompanied by signs of spinal cord damage, such as numbness, pins and needles, or by headaches, nausea, vomiting, fever, or a deterioration in the level of consciousness (e.g. increasing drowsiness), call an ambulance.

The spine

Signs and symptoms of spinal cord damage

• Loss of movement below the site of the break
• Pins and needles in the fingers or toes or throughout the body
• Feeling strange, perhaps 'jelly-like'
• Numbness

If any of these signs and symptoms is present, or if the nature of the accident indicates a potential fracture, assume that a bone is broken and keep the person still until help arrives.

Warning

• Do not give anything to eat or drink - the casualty may need a general anaesthetic in hospital.
• Do not move the casualty unless he is in danger or needs resuscitation.