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ACE Personal Trainer Manual 5 th Edition Chapter 15: Common Musculoskeletal Injuries and Implications for Exercise Lesson 15.1
© 2014 ACE After completing this session, you will be able to: Identify the difference between muscle strains and ligament sprains and the grading system of each Understand the main overuse conditions and how cartilage damage and bone fractures can occur Discuss the healing process phases and recall signs and symptoms of inflammation Explain the conservative management of common musculoskeletal injuries Discuss the following injuries and recommend appropriate exercise programming: o Shoulder strain/sprain o Rotator cuff injuries o Elbow tendinitis o Carpal tunnel syndrome o Greater trochanteric bursitis LEARNING OBJECTIVES
© 2014 ACE Microscopic tears of the muscle fibers cause swelling, discoloration (ecchymosis), or loss of function. Hamstring group Risk factors – poor flexibility, poor posture, muscle imbalance, improper warm-up, and training errors Groin Risk factors – muscle imbalance between the hip adductors and abductors Gastrocnemius and soleus Risk factors – muscle fatigue, fluid and electrolyte depletion, forced knee extension during dorsiflexion, and forced dorsiflexion during knee extension MUSCLE STRAINS
© 2014 ACE MUSCLE STRAINS GRADING SYSTEM
© 2014 ACE LIGAMENT SPRAINS A 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 function Sprains occur most often with trauma, such as falling or during contact sports: Ankle Knee o ACL injuries – decelerating while twisting, pivoting, and sudden stopping or cutting motions o MCL injuries – impact to the outer knee with no twisting involved; or damaged at the same time as the ACL Thumb or finger Shoulder
© 2014 ACE LIGAMENT SPRAINS GRADING SYSTEM
© 2014 ACE OVERUSE CONDITIONS Tendinitis – inflammation of the tendon: Commonly occurs in the shoulders, elbows, knees, and ankles Inflammatory response from too much demand on a tendon caused by beginning new activities or programs too quickly Bursitis – inflammation of the bursa sac: Commonly affects the shoulders, hips, and knees Occurs from acute trauma, repetitive stress, muscle imbalance, or muscle tightness on top of the bursa Fasciitis – inflammation of the connective tissue called fascia: Commonly occurs in the bottom and back of the foot
© 2014 ACE CARTILAGE DAMAGE Damage to the joint surface of the knee involves damage to both: Hyaline cartilage – covers the articular surfaces of bones Menisci cartilage – in between the femur and tibia Meniscal injuries occur with: Loading or twisting of the joint and often with ACL or MCL tears Degeneration – degenerative joints may lead to acute tears in older adults Signs and symptoms of meniscal tears: Joint pain Swelling Muscle weakness Stiffness Giving way Locking, clicking, or popping
© 2014 ACE CARTILAGE DAMAGE Chondromalacia – a softening or wearing away of the cartilage under the patella: May occur from the patella not properly tracking Has been associated with: Improper training methods Sudden changes in training surface Lower-extremity muscle weakness or tightness Foot overpronation Signs and symptoms: Pain and inflammation Pain behind the patella during activity Pain that increases while walking up or down stairs
© 2014 ACE BONE FRACTURES Low-impact trauma: A short fall on a level surface resulting in a minor fracture Repeated microtrauma to a bone region resulting in a stress fracture Symptoms include: o Progressive pain that is worse with weightbearing activity o Focal pain o Pain at rest o Local swelling High-impact trauma: Occurs in motor vehicle accidents or during high- impact sports Requires immediate medical attention and is often disabling Pathological fractures – caused by infection, cancer, osteoporosis, or other medical conditions that can weaken bones
© 2014 ACE TISSUE REACTION TO HEALING Inflammatory phase – can typically last for up to 6 days The healing process begins and the injured area is immobilized Blood flow increases to bring in oxygen and nutrients to rebuild the damaged tissue Fibroblastic/proliferation phase – begins around day 3 and lasts until around day 21 The wound fills with collagen and other cells, forming a scar Within 2 to 3 weeks, the wound can resist normal stresses, but strength continues to build for several months Maturation/remodeling phase – begins around day 21 lasting for up to 2 years Remodeling of the scar, rebuilding of bone, and/or restrengthening of the tissue
© 2014 ACE SIGNS AND SYMPTOMS OF INFLAMMATION It is important to be aware of these signs, especially for clients who are post-injury or post-surgery: Pain Redness Swelling Warmth Loss of function The goal is to give a client a challenging exercise program that will not cause further damage to an injured area.
© 2014 ACE MANAGING MUSCULOSKELETAL INJURIES Pre-existing injuries: Determine if the client can exercise or if they must be cleared by a physician The client may be able to participate in a modified program using the non-injured body parts Acute injuries: Must be handled quickly with caution Refer to appropriate medical professionals Perform RICE: R – Rest or restricted activity I – Ice applied hourly for 10–20 minutes C – Compression wrap the area to minimize swelling E – Elevate the injured area 6–10 inches above the heart to control swelling
© 2014 ACE FLEXIBILITY AND MUSCULOSKELETAL INJURIES Decreased flexibility is associated with various injuries, including: Muscle strains Overuse conditions When a muscle becomes shortened and inflexible, it cannot lengthen appropriately or generate adequate force. A personal trainer can develop a stretching program to: Address inflexibility Help prevent further injury
© 2014 ACE CONSERVATIVE MANAGEMENT
© 2014 ACE UPPER- AND LOWER-EXTREMITY INJURIES Upper-extremity injuries: Shoulder strain/sprain Rotator cuff injuries Elbow tendinitis Carpal tunnel Lower-extremity injuries: Greater trochanteric bursitis Iliotibial band syndrome Patellofemoral pain syndrome Infrapatellar tendinitis Shin splints Ankle sprains Achilles tendinitis Plantar fasciitis
© 2014 ACE 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 tendinitis Can eventually lead to rotator cuff tears if not managed properly Signs and symptoms: Local pain that radiates down the arm Swelling, tenderness, pain, and stiffness Aggravated by lifting or reaching overhead or across the body Management: Conservative management – Table 15-3 Avoid aggravating movements (overhead, across, or behind the body)
© 2014 ACE EXERCISE PROGRAMMING FOR SHOULDER STRAIN AND SPRAIN Improve posture and body positioning Regain strength in the scapular stabilizers and rotator cuff muscles Restore proper flexibility of the shoulder complex Modify exercises as necessary to prevent further injury Overhead activities: Will often need to be modified to avoid pain and further injury Modify the movement ROM (as to not fully extend arms) Use the scapular plane: The shoulder is positioned 30 degrees anterior of the frontal plane.
© 2014 ACE ROTATOR CUFF INJURIES Acute – related to trauma such as falling on the shoulder or raising the arm against overwhelming resistance Chronic – a result of a degeneration and gradual worsening of pain and weakness Management: The client should see a physician or physical therapist Restriction from performing certain activities Surgery may be indicated Signs and symptoms: A feeling of sudden “tearing” followed by pain and a loss of motion Pain when reaching overhead or behind the back Pain at night or after activity
© 2014 ACE EXERCISE PROGRAMMING AFTER ROTATOR CUFF REPAIR Immobilization for six to eight weeks to allow the repair to heal Passive ROM only to prevent re-tearing Potentially cleared for activity after approximately 16 weeks or discharged from physical therapy The personal trainer should: Obtain specific guidelines for what “should” and “should not” be done Be cautious with specific shoulder positions to avoid strain in the healing tissue, such as limiting: o Performing overhead activities o Keeping the arm straight during exercise (keep elbows bent for less torque) o Modify exercises as necessary to prevent future injury
© 2014 ACE 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 humerus Medial epicondylitis – “golfer’s elbow” Overuse or repetitive trauma injury of the wrist flexor muscle tendons near the origin on the medial epicondyle Signs and symptoms: Nagging elbow pain during aggravating activities
© 2014 ACE EXERCISE PROGRAMMING FOR ELBOW TENDINITIS Emphasize client education to avoid aggravating activities Improve posture and body positioning Regain strength and flexibility of the flexor/pronator and extensor/supinator muscles in the wrist and elbow The client may be prescribed a wrist or elbow splint Modify exercises as necessary to prevent further injury Additionally, clients should: Avoid high-repetition activity (e.g., 15–20 repetitions) at the elbow and wrist Begin dumbbell biceps and wrist curls with low weight and repetitions Be cautious with full elbow extension (i.e., locking the elbow) when performing shoulder exercises to prevent excessive loading
© 2014 ACE CARPAL TUNNEL SYNDROME Repetitive wrist and finger flexion when the flexor tendons are strained Results in a narrowing of the carpal tunnel due to inflammation and median nerve compression Signs and symptoms: Gradual pain, weakness, or numbness in the radial three-and-a-half digits and thumb As the condition progresses, specific symptoms occur: Night or early-morning pain or burning Loss of grip strength and dropping of objects Numbness or tingling in the palm, thumb, index, and middle fingers
© 2014 ACE EXERCISE PROGRAMMING FOR CARPAL TUNNEL SYNDROME Emphasize client education to avoid aggravating activities. Improve posture and body positioning Regain 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 symptoms Focus on exercising in the mid-range of flexion or extension
© 2014 ACE SUMMARY All 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.
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