Presentation on theme: "ACE Personal Trainer Manual 5th Edition"— Presentation transcript:
1 ACE Personal Trainer Manual 5th Edition Chapter 15: Common Musculoskeletal Injuries and Implications for ExerciseLesson 15.1
2 LEARNING OBJECTIVESAfter completing this session, you will be able to:Identify the difference between muscle strains and ligament sprains and the grading system of eachUnderstand the main overuse conditions and how cartilage damage and bone fractures can occurDiscuss the healing process phases and recall signs and symptoms of inflammationExplain the conservative management of common musculoskeletal injuriesDiscuss the following injuries and recommend appropriate exercise programming:Shoulder strain/sprainRotator cuff injuriesElbow tendinitisCarpal tunnel syndromeGreater trochanteric bursitis
3 MUSCLE STRAINSMicroscopic tears of the muscle fibers cause swelling, discoloration (ecchymosis), or loss of function.Hamstring groupRisk factors – poor flexibility, poor posture, muscle imbalance, improper warm-up, and training errorsGroinRisk factors – muscle imbalance between the hip adductors and abductorsGastrocnemius and soleusRisk factors – muscle fatigue, fluid and electrolyte depletion, forced knee extension during dorsiflexion, and forced dorsiflexion during knee extension
5 LIGAMENT SPRAINSA joint injury that results in stretching or tearing of the stabilizing connecting tissues causing immediate pain, swelling, instability, decreased range of motion (ROM), and a loss of functionSprains occur most often with trauma, such as falling or during contact sports:AnkleKneeACL injuries – decelerating while twisting, pivoting, and sudden stopping or cutting motionsMCL injuries – impact to the outer knee with no twisting involved; or damaged at the same time as the ACLThumb or fingerShoulder
7 OVERUSE CONDITIONS Tendinitis – inflammation of the tendon: Commonly occurs in the shoulders, elbows, knees, and anklesInflammatory response from too much demand on a tendon caused by beginning new activities or programs too quicklyBursitis – inflammation of the bursa sac:Commonly affects the shoulders, hips, and kneesOccurs from acute trauma, repetitive stress, muscle imbalance, or muscle tightness on top of the bursaFasciitis – inflammation of the connective tissue called fascia:Commonly occurs in the bottom and back of the footNote: Some experts are now referring to tendinitis as tendinopathy.
8 CARTILAGE DAMAGEDamage to the joint surface of the knee involves damage to both:Hyaline cartilage – covers the articular surfaces of bonesMenisci cartilage – in between the femur and tibiaMeniscal injuries occur with:Loading or twisting of the joint and often with ACL or MCL tearsDegeneration – degenerative joints may lead to acute tears in older adultsSigns and symptoms of meniscal tears:Joint painSwellingMuscle weaknessStiffnessGiving wayLocking, clicking, or popping
9 CARTILAGE DAMAGEChondromalacia – a softening or wearing away of the cartilage under the patella:May occur from the patella not properly trackingHas been associated with:Improper training methodsSudden changes in training surfaceLower-extremity muscle weakness or tightnessFoot overpronationSigns and symptoms:Pain and inflammationPain behind the patella during activityPain that increases while walking up or down stairs
10 BONE FRACTURES Low-impact trauma: High-impact trauma: A short fall on a level surface resulting in a minor fractureRepeated microtrauma to a bone region resulting in a stress fractureSymptoms include:Progressive pain that is worse with weightbearing activityFocal painPain at restLocal swellingHigh-impact trauma:Occurs in motor vehicle accidents or during high-impact sportsRequires immediate medical attention and is often disablingPathological fractures – caused by infection, cancer, osteoporosis, or other medical conditions that can weaken bones
11 TISSUE REACTION TO HEALING Inflammatory phase – can typically last for up to 6 daysThe healing process begins and the injured area is immobilizedBlood flow increases to bring in oxygen and nutrients to rebuild the damaged tissueFibroblastic/proliferation phase – begins around day 3 and lasts until around day 21The wound fills with collagen and other cells, forming a scarWithin 2 to 3 weeks, the wound can resist normal stresses, but strength continues to build for several monthsMaturation/remodeling phase – begins around day 21 lasting for up to 2 yearsRemodeling of the scar, rebuilding of bone, and/or restrengthening of the tissueExercise progression must always be done cautiously when working with individuals recovering from a musculoskeletal injury.
12 SIGNS AND SYMPTOMS OF INFLAMMATION It is important to be aware of these signs, especially for clients who are post-injury or post-surgery:PainRednessSwellingWarmthLoss of functionThe goal is to give a client a challenging exercise program that will not cause further damage to an injured area.
13 MANAGING MUSCULOSKELETAL INJURIES Pre-existing injuries:Determine if the client can exercise or if they must be cleared by a physicianThe client may be able to participate in a modified program using the non-injured body partsAcute injuries:Must be handled quickly with cautionRefer to appropriate medical professionalsPerform RICE:R – Rest or restricted activityI – Ice applied hourly for 10–20 minutesC – Compression wrap the area to minimize swellingE – Elevate the injured area 6–10 inches above the heart to control swellingIf a client has a pre-existing condition, his or her exercise program may need to be modified. The client should be monitored for any changes in symptoms, including pain. The following are some commonly reported symptoms of post-injury/post-surgery overtraining (Brotzman & Manske, 2011):Soreness that lasts for more than 24 hoursPain when sleeping or increased pain when sleepingSoreness or pain that occurs earlier or is increased from the prior sessionIncreased stiffness or decreased ROM over several sessionsSwelling, redness, or warmth in healing tissueProgressive weakness over several sessionsDecreased functional usage
14 FLEXIBILITY AND MUSCULOSKELETAL INJURIES Decreased flexibility is associated with various injuries, including:Muscle strainsOveruse conditionsWhen a muscle becomes shortened and inflexible, it cannot lengthen appropriately or generate adequate force.A personal trainer can develop a stretching program to:Address inflexibilityHelp prevent further injuryThe following are contraindications to stretching that need to be considered to prevent injury:A fracture site that is healingAcute soft-tissue injuryPost-surgical conditionsJoint hypermobilityAn area of infectionA hematoma or other indication of traumaPain in the affected areaRestrictions from the client’s doctorProlonged immobilization of muscles and connective tissueJoint swelling (effusion) from trauma or diseasePresence of osteoporosis or rheumatoid arthritisA history of prolonged corticosteroid useIf a client presents with any type of contraindication, the personal trainer should get further clearance from a medical professional prior to beginning a stretching routine.
17 SHOULDER STRAIN AND SPRAIN Soft-tissue structures (bursa and rotator cuff tendons) get abnormally stretched or compressed.Results from an impingement secondary to the compression and ends up as tendinitisCan eventually lead to rotator cuff tears if not managed properlySigns and symptoms:Local pain that radiates down the armSwelling, tenderness, pain, and stiffnessAggravated by lifting or reaching overhead or across the bodyManagement:Conservative management – Table 15-3Avoid aggravating movements (overhead, across, or behind the body)Strains/sprains are common in the shoulder as a result of this joint’s significant mobility and the sacrifice of stability to achieve it.
18 EXERCISE PROGRAMMING FOR SHOULDER STRAIN AND SPRAIN Improve posture and body positioningRegain strength in the scapular stabilizers and rotator cuff musclesRestore proper flexibility of the shoulder complexModify exercises as necessary to prevent further injuryOverhead activities:Will often need to be modified to avoid pain and further injuryModify the movement ROM (as to not fully extend arms)Use the scapular plane:The shoulder is positioned 30 degrees anterior of the frontal plane.
19 ROTATOR CUFF INJURIESAcute – related to trauma such as falling on the shoulder or raising the arm against overwhelming resistanceChronic – a result of a degeneration and gradual worsening of pain and weaknessManagement:The client should see a physician or physical therapistRestriction from performing certain activitiesSurgery may be indicatedSigns and symptoms:A feeling of sudden “tearing” followed by pain and a loss of motionPain when reaching overhead or behind the backPain at night or after activity
20 EXERCISE PROGRAMMING AFTER ROTATOR CUFF REPAIR Immobilization for six to eight weeks to allow the repair to healPassive ROM only to prevent re-tearingPotentially cleared for activity after approximately 16 weeks or discharged from physical therapyThe personal trainer should:Obtain specific guidelines for what “should” and “should not” be doneBe cautious with specific shoulder positions to avoid strain in the healing tissue, such as limiting:Performing overhead activitiesKeeping the arm straight during exercise (keep elbows bent for less torque)Modify exercises as necessary to prevent future injury
21 ELBOW TENDINITIS Lateral epicondylitis – “tennis elbow” Overuse or repetitive trauma injury of the wrist extensor muscle tendons near the origin on the lateral epicondyle of the humerusMedial epicondylitis – “golfer’s elbow”Overuse or repetitive trauma injury of the wrist flexor muscle tendons near the origin on the medial epicondyleSigns and symptoms:Nagging elbow pain during aggravating activitiesManagement:Conservative management – Table 15-3Avoid aggravating movements that include repetitive elbow and wrist flexion/extension activities
22 EXERCISE PROGRAMMING FOR ELBOW TENDINITIS Emphasize client education to avoid aggravating activitiesImprove posture and body positioningRegain strength and flexibility of the flexor/pronator and extensor/supinator muscles in the wrist and elbowThe client may be prescribed a wrist or elbow splintModify exercises as necessary to prevent further injuryAdditionally, clients should:Avoid high-repetition activity (e.g., 15–20 repetitions) at the elbow and wristBegin dumbbell biceps and wrist curls with low weight and repetitionsBe cautious with full elbow extension (i.e., locking the elbow) when performing shoulder exercises to prevent excessive loading
23 CARPAL TUNNEL SYNDROME Repetitive wrist and finger flexion when the flexor tendons are strainedResults in a narrowing of the carpal tunnel due to inflammation and median nerve compressionSigns and symptoms:Gradual pain, weakness, or numbness in the radial three-and-a-half digits and thumbAs the condition progresses, specific symptoms occur:Night or early-morning pain or burningLoss of grip strength and dropping of objectsNumbness or tingling in the palm, thumb, index, and middle fingersManagement:Conservative management – Table 15-3Wrist splints during activity, or surgical options
24 EXERCISE PROGRAMMING FOR CARPAL TUNNEL SYNDROME Emphasize client education to avoid aggravating activities.Improve posture and body positioningRegain strength and flexibility of the elbow, wrist, and finger flexors and extensors.The client may be prescribed a wrist splint.Modify exercises as necessary to prevent further injury.Additionally, clients should:Avoid movements that involve full wrist flexion or extension, which can further compress the carpal tunnel and increasing symptomsFocus on exercising in the mid-range of flexion or extension
25 SUMMARYAll personal trainers work with clients who have sustained, or will sustain, an injury in the course of their activities.Learning to recognize the signs and symptoms of inflammation and knowing the proper steps in acute injury care can allow the trainer to help the injured client recover more quickly.All trainers should receive as much training as is available in first aid and injury recognition.An understanding of how the body reacts to injury and resulting repair will help clients plan an appropriate program.