1. Outline Musculoskeletal injuries Heat Illnesses
Risks
Classification
Treatment
Heat Illnesses
Evaluation of test quality
Field tests
Anaerobic
Aerobic

2. Musculoskeletal Injuries
Risk increases for all levels of participation with increasing
Activity, intensity and duration
Incidence and severity can be reduced by understanding
Risks, preventative measures and care
Risks
35-60% of runners report injuries that reduce running or require medical attention
Patellar femoral articulation and foot
High impact aerobic dance 45 % of students 75% of instructors
Lower leg injuries with high frequency (> 3 times per week)

3. Injuries intrinsic and extrinsic factors interact Box 34.4 ACSM
Poor biomechanics, past physical activity, poor baseline fitness, present level of training and weight load affect incidence of injury

5. Injuries
Repetitive bouts of micro trauma leading to overt tissue injury cause overuse injuries
Running
injury increases exponentially with frequency and total volume of training
Beginning jogger - one day rest
Progress to low impact activity on off days
Training errors are causal in % of running injuries
Eg. high progression rates and hill running

6. Warm up / Flexibility Low flexibility is a risk factor
Muscle strain and musculoskeletal injury
Research study - most and least flexible had higher risk
Improper warm up - inc risk for injury
Warmth - inc elasticity of connective tissue, speeds metabolism, inc magnitude and speed of contraction
Muscle stretches more and can resist injury at greater force
Studies are inconclusive on warm up and injury - may be more important for performance

7. Orthopedic Factors
Past injury and low physical activity are associated with risk
Excessive weight - acute and overuse injuries - hip and knee
Vigorous activity may predispose to osteoarthritis due to mechanical trauma
Inc risk with competitive but not recreational running
Low back pain risk factors
Obesity, poor sitting posture, frequent flexion, loss of back extension and low activity
Poor lifting posture and fatigue
Usually related to acute trauma or overuse

8. Recommendations
Alter predisposing risk factors through education and clinical intervention
Early detection of symptoms and overuse - full rehabilitation
Do not recommend strenuous exercise for those with:
Acute joint injury
Chronic joint inflammation (osteoarthritis)
Uncontrolled systemic joint disease (rheumatoid arthritis)
For those with joint disease;
Progression needs to be individualized
Prevent debilitation due to inactivity
Improve endurance, strength and flexibility and exercise tolerance

9. Preventing Injuries Prescreening
Well rounded physical training program
Warm up / cool down
General and specific
Flexibility, strength and aerobic conditioning
Follow principles
Specificity, overload, progression
Proper equipment and techniques

10. Recognition
Exercise professionals will often be asked for advice regarding injuries or the need for referral
We are not physiotherapists or doctors but an awareness can help us assist clients in making educated choices when dealing with injury
Common injury symptoms and causes ACSM Table 57.4 and 57.5
Runners knee - patellar femoral pain syndrome
Shin splints - tibial stress syndrome (periostitis)
Plantar fasciitis
Achilles tendonitis

13. Running Injuries

14. Running Injuries
Plantar fasciitis -inflammation of plantar fascia tendon
tingling, ripping in AM
stiff/hard midsoles (old shoes)
poor arch support
running in court shoes

15. Running Injuries Runner knee - pain around pattelo-femoral joint
excess pronation - increases force holding patella against femur
inc. internal rotation - alignment off
orthotics - motion control in rear foot
Build endurance of vastus medialis

17. Injury Management HOPS Evaluate for Physiology of Injured tissue
History, Observation, Palpation and Special tests
Evaluate for
Immediate first aid and referral to physician
Advice about training and program modifications
Physiology of Injured tissue
Macro trauma - tension, shear or compression
Micro trauma - overuse, cyclic loading
Damaged cell unable to process O2, nutrients, waste - leads to cell necrosis
Blood vessel damage - hemorrhage, coagulation and decreased blood flow to area
Primary injury - direct trauma
Secondary injury - additional swelling and tissue damage - more with improper care
results from reduced O2 supply adjacent to primary injury
further necrosis, swelling - hours after injury

18. RICES Rest Ice Compression Elevation Stabilization
range form complete to relative rest
Allows time to control effects of trauma and avoid additional tissue damage
Ice
Slows cell metabolism - healthy tissue survives diminished blood flow and hypoxia
Reduce pain and spasm
Apply for minutes every 2 hrs during the day for first 24 hrs post injury
Compression
Controls edema and prevent fluid accumulation in the injured area
Elevation
Above level of heart - limits swelling and increases venous return - reducing tissue damage
Stabilization
Supports injured area allowing musculature to relax - reducing pain-spasm cycle

19. Healing Inflammation, Repair, Remodeling
Time to fully recover depends on injury and treatment during each phase
Inflammation - redness, local heat, swelling, pain and loss of function
Sliverthorn table 24.2, Berne and Levy fig 45.19
Protection and prepare for repair
Lasts up to 2-3 days
Chronic inflammation may occur when cause of injury in not eliminated - delaying rehabilitation process
- Treatment goal - prevent damage of healthy tissue, create good environment for new tissue growth
- RICE, ultrasound, electrical stimulation
- maintain health of rest of body through modified training

20. Healing
Repair - within initial hours - depending on resolution of inflammation (2-3 days)
Proliferation and regeneration of collagen fiber leads to scar formation - not as structurally sound
May last up to two months
Treatment goal - prevent excessive atrophy and joint deterioration
gradually introduce low load stresses to increase collagen synthesis and prevent loss of joint motion - ultrasound, electrical stimulation and ice
Maintain fitness of uninjured areas through modified activity
Proprioception and neuromuscular control - stability, vision and speed
Remodeling - realignment of collagen according to tensile forces
Scar tissue becomes stronger, regeneration of collagen slows
With increased loading the collagen fibers begin to hypertrophy and align themselves along the lines of stress
Ligament repair can take up to a year
Duration of remodeling extended with excessive strain or re-injury
Treatment Goal - optimize tissue function through progressive loading
Move from general to sport specific, functional exercises

21. Follow up treatment Cold effective in reducing chronic swelling
Heat - should not be applied until after acute inflammation phase
After first hours
May “flush” injured area by increasing circulation
May reduce pain, increasing mobility
Contrast baths - anecdotal support
Exercise is most important follow-up treatment
Treatment should be directed by physician or physiotherapist

25. Evaluation of Test Quality
You must decide if a test is;
Valid?
Reliable?
Objective?
Safe?
Comparable to Norms?
Appropriate?
Economically your best choice?
Objectivity - accuracy of scoring system - long jump vs figure skating
Intra judge (often masks errors, ok test retest)
Inter judge - standardization, certification

26. Validity
How well does a test measure what it is intended to measure - most important aspect of test design
There are several types of validity
Logical Validity
degree to which a test measures an underlying attribute based on existing knowledge
Old CSTF sit-up test - legs held, hands behind neck, rate of 60 / min
Inappropriately tests psoas muscles at high contraction rate
Partial curl ups now put focus on endurance of abdominal muscles
Construct validity - degree to which a test measures an attribute or trait that cannot be directly measured
Athletic ability, anxiety, percent body fat
Content validity
Is the test battery measuring all the component abilities for performance
List ability components for sport, and ensure they are all represented
Eg soccer - speed, agility, coordination, kicking power…

27. Validity (cont.)
Criterion-Referenced Validity - includes concurrent and predictive
Concurrent Validity
Used when a test is proposed as a substitute for another valid test
Degree of correlation with a original test should be reported
over .8 correlation coefficient is acceptable.
eg. Coopers Test and VO2 Max (.897) (see next slide)
SEE - standard error of estimation - should also be small
However, Cooper used adults who were well trained and motivated
? Applicability to other groups ?
Predictive validity - amount by which test score corresponds to future behavior or performance
Does prior fitness actually reduce injury in demanding jobs?
Do fitness scores relate to sport performance measures? (goals, rebounds, assists)

29. Reliability Definition 1 - Consistency or repeatability of a test
a test must be reliable to be valid
test can be reliable but invalid
Eg. 60 sec sit up test
Definition 2 - ability of the test to detect reliable differences between subjects
Pass/Fail tells us very little if everyone gets the same result
Important when comparing to norms
Ensure test is being administered as it was designed
Single test, test retest, individual test score vs group of subjects (BMI)
Factors influencing reliability
Type of test, level and range of ability, Length
Consistency of client preparation

30. Objectivity Accuracy in scoring a test
Quantitative vs qualitative
Long jump vs gymnastics
Intrajudge objectivity - errors often masked,
Can be ok for test re test situations after months of training
Interjudge objectivity - degree to which different testers agree
Standardization of training and certification important
Sources of error
Skill of administrator (eg. skin folds)
Calibration of equipment
Personality of subject (motivation)

31. Referenced Tests Norm-referenced test: Criterion-referenced test:
the test score is compared to a norm so the person can be compared against others in the same age and gender category
Criterion-referenced test:
the test score is compared to a standard. This target could be set appropriately for the age and gender
Eg police and fire fighter standard tests
validating a criterion (pass/fail) is a difficult task, while using a normative database and just reporting a percentile ranking is easier.
most criterions are based on normative data originally, could also be based on assessment of requirements for successful performance

32. Field-Tests Laboratory Aerobic and Anaerobic Tests
Advantages and Disadvantages
allow examiners to test numerous participants at once without the need for sophisticated and expensive equipment.
Validity of Field-Tests
Field-tests are not as accurate as the original test they are designed to emulate
Field-tests are usually used as motivational tools rather than in scientific studies, so the lower level of accuracy is often quite acceptable
Care must be taken however to use the field test on the population group it was designed for (may have concurrent validity for a certain age population but not for another)

33. Field Test Reliability Normative Databases
If the field-test does not have a skill component they will usually be very reliable
e.g. Cooper test requires pacing skill
Simple tests of maximal strength, like the grip strength, have very high reliability
Objectivity
Field-tests usually have excellent objectivity (e.g. timed runs, laps completed in set amount of time)
Normative Databases
Field-tests often have large databases, in part because so many people can be tested easily
Care should be taken to use the appropriate database for the clients whom you have tested

34. Safety of Field Tests
Most aerobic tests are sub maximal and less likely to put excessive strain on subject
20m aerobic shuttle is maximal
Screening during test often difficult
ECG, BP
Rely on prescreening tests
Anaerobic tests require maximal effort - select clients carefully
High risk of muscle strain in sprint tests if not fully warmed-up or inexperienced with sprinting

35. Field Tests Virtually all field-tests are very inexpensive to run
test numerous subjects at the same time, reducing personnel costs
minimal equipment is required
There are numerous field-tests available so finding an appropriate test for your client(s) should not be a problem.

36. Lab Organization
Warm Up (done in the 10 min prior to test participation)
2 laps of 400m track
Stretching (optional)
2 X 50 m sprints at % max (optional)
Purpose
to have you complete, administer and/or observe some common filed tests
Decide after outline which you will participate in as a subject
one aerobic
one anaerobic if you are used to sprinting

37. Anaerobic Lactic acid and Alactic Systems
Usually reserved for specific sports groups
does not contribute to cardiovascular/respiratory fitness
can be associated with muscle strain
600 m and 100 m shuttle tests
norms are for elite athletes
useful on test/retest basis only
require good warm up/stretching
T-Test
Test of agility (approximately seconds)
Two trials

38. Anaerobic cont. 600m Run 100m shuttle 50 yard sprint
Lactic acid System
2 trials (one in 343)
4 runners max. use inside lane
warm up essential
100m shuttle
alactic/lactic acid systems
sprint 5 times between 20m lines
practice trial at 75 %
50 yard sprint
alactic system

39. Aerobic System Coopers Test
Target subjects - large groups, assumed to be healthy, experience running as pacing is important
Normative data for Swim and Bike Coopers tests are also available
warm up important
12 minutes around 400 m track
pacing is important (experience)
up to 30 runners, keep to inside lane
use table p. 12 for miles and VO2 max estimates
administrator calls out times and records completed laps - to nearest quarter or tenth
good correlation to VO2 max test results

41. Aerobic cont. 20 m Aerobic shuttle Target subjects warm up in protocol
Healthy subjects of any age
warm up in protocol
avoids pacing problem
pace increases progressively from brisk walk
If subject fails to keep pace
by two steps on two consecutive laps
the last number called out is their stage level
MET estimated by stage and age
MET is Metabolic Equivalent
1 MET = 3.5 ml O2 kg-1 min-1

42. Aerobic cont. Rockport Fitness Walking Test Target group
sedentary, older individuals, those not accustomed to running
walk at fast, comfortable pace
record time for four laps
timer can use lap function for more than one subject
record 10 second heart rate at finish using stop watch
Compare results to age and gender specific graphs in lab book

43. Aerobic Tests (cont) 1.5 mile run Target subjects
Large groups
Prior experience running this test distance as pacing is important
Timed test - 6 laps of 400 m track
Moderate warm up and stretch
One administrator can time up to four subjects, keeping track of completed laps
Compare time to age and gender specific fitness scale