Analysis of Injuries to Michael Campanaro and Steve Smith Sr.

Michael Campanaro and Steve Smith Sr. were each forced from last Thursday's game against the Steelers due to apparent low back injuries. Initial reports characterized each as fairly insignificant, though we have now learned that Smith suffered four fractures and Campanaro is out for the season with a herniated disc. This article will provide an overview of their injuries and a detailed look at the anatomy involved.

GENERAL ANATOMY

The spine is one of the most complex structures in the human body. It consists of 33 vertebrae along with a number of intervertebral discs, facet joints, spinal nerves, ligaments, tendons, and muscles. Each of these structures work together in an intricate and coordinated manner that is vital for allowing optimal mobility, stability, and function of the spine.

STEVE SMITH SR.'S INJURY

What was once described as a "back contusion" has now been diagnosed as four fractures in Smith's back. Some reports indicate that the fractures were sustained to his ribs, while others claim they are actually to the transverse processes of his vertebrae. Distinguishing between the two is fairly unimportant considering their anatomical location and the fact that they require the same treatment and healing timeframe. Regardless, the Ravens have clarified that his condition will not require surgery and his playing status is regarded as week-to-week.

When looking at the anatomy model above, you'll notice where the ribs articulate with the spine. These articulations occur at the transverse processes, which are small bony projections on both sides of each vertebrae (see below). The transverse processes also serve as a site of attachment for muscles and ligaments of the spine.

Playing with this type of injury does not put Smith at any increased or long-term risk. His return to the field depends entirely upon how much pain he can endure and tolerate. Still, it cannot be overstated just how painful this injury can be. The training staff will do their best to apply extra padding to further protect the area and, hopefully, Smith will be able to return in 2 to 3 weeks.

MICHAEL CAMPANARO'S INJURY

Yet another season for Campanaro has been plagued by injury as news broke that he would be out for the season due to a herniated disc in his back. Early reports have indicated that his condition will not require surgery, which is promising, though he still has a lengthy bout of rehabilitation ahead of him.

Between each vertebrae in the spine lies an intervertebral disc which acts as a shock absorber. Each disc is composed of a thick outer ring of cartilage called the annulus fibrosus, and a soft, gel-like center called the nucleus pulposus.

A disc herniation occurs when the nucleus pulposus pushes through the annulus fibrosus. This can occur for a variety of reasons, but in athletes, it is typically a result of repetitive motion or trauma from contact sports like football. When a disc becomes herniated it tends to compress and irritate the spinal nerves that exit from the spine. This is problematic because the nerves are responsible for innervating not only skin, but also muscle. Therefore, a disruption of the nerves can result in both numbness and weakness in the leg(s) in addition to low back and leg pain. It's important to note that the exact symptoms will vary because it entirely depends upon which spinal level is affected.

A disc herniation often requires surgical intervention, however, it seems that won't be necessary in Campanaro's case. In the beginning, his rehabilitation will focus on decreasing the pain through a combination of rest, medications, injections, and physical therapy. Early emphasis will be entirely on reducing inflammation and decreasing irritation to the involved nerve root(s). Once the pain is controlled, the physical therapist will work to restore proper range of motion, muscle length, muscle strength, and core stability.

- Bobby Esbrandt, PT, DPT, PES