Chapter 15: Common Musculoskeletal injuries & implications for exercise Flashcards
Muscle strains
Small microscopic tears within muscle fibers
The grading system:
Grade level I strain: Painful and tender with the possibility of localized spasms, mild strain
Grade level II strain: More fibers are damaged, more tenderness and severe pain, moderate strain
It’s noticeable to see bruising and a loss of function as well as mild swelling
Grade level III strain: complete tear
This is accompanied by severe swelling, pain, discoloration, tenderness, and palpable defect. A complete loss of muscle function.
Common Muscle Sprains
HAMSTRING STRAINS
- This is common with athletes that perform jumping and running movements within their sport
Risk factors: muscular imbalances, training errors, poor flexibility, improper warm-up practices, and poor posture
HIP STRAINS
- This is common within sports that require explosive movements such as quick deceleration, acceleration, lateral movements and overall change in direction
Risk factors: muscular imbalances between the abductors and adductors of the hips
CALF STRAINS
- Mostly applies to jump and running athletes
Risk factors: Electrolyte and fluid depletion, muscle fatigue, knee extension (while the foot is dorsiflexed), forced to dorsiflexion (with knee extended).
Ligament Sprains
The grading system:
Grade level I: Micro tearing of collagen fibers, swelling, mild tenderness, impairment
Care – RICE (rest, ice, comp., elevate)
Grade level II: Swelling, impairment, moderate tenderness, reduced range of motion, possible instability, Some collagen fibers with complete tears
Care – Physical evaluation, RICE
Grade level III: Significant tenderness and swelling, instability, severe impairment, complete rupture/tear of the ligament
Care – Physician evaluation, RICE, immobilization with a splint
COMMON LIGAMENT SPRAINS
ACL injury – The most common sports-related knee injury
Injury mechanism: Quick deceleration combined with pivoting, twisting or sidestepping maneuvers
MCL injury
Injury mechanism: In impact to the outside of the knee (no twisting is involved)
Most frequently associated with medial meniscal injuries or ACL injuries
Overuse Injuries
Tendinitis – Inflammation of tendon
- typically occurs when new PA is adopted too quickly, and tendons cannot adjust quickly enough and fail to handle the new stressors
Bursitis – Inflammation of bursa sac from acute trauma, muscular imbalances, repetitive stress or muscular tightness on the top of the bursa
- Most commonly found in hips, shoulders, and knees
Fasciitis – Inflammation of connective tissue (fascia)
- Most commonly found in the back and bottom of the feet
Cartilage Damage
Hyaline cartilage – Covers the bone
Menisci cartilage – Absorbs shocks
Meniscal injuries – The most common injury of the knee
A combination of twisting and loading of the joint
Sometimes happens with MCL or ACL injuries
The role of the menisci – To absorb shocks, provide stability, lubrication, congruency, and proprioception
SIGNS OF A MENISCAL TEAR
- Clicking/popping during weight-bearing exercises, stiffness, catching, locking and giving away
Chondromalacia – Wearing away or softening of cartilage that sits behind the patella. Results and pain and inflammation
Is caused by the posterior surface of the patella not tracking correctly in the femoral groove
Bone fractures
Stress fractures – Minor fractures from lower impact trauma or microtrauma that is repeated in the bone area
- Shin splints are commonly confused with bone fractures
Symptoms and signs: Focal pain, local swelling, pain while resting, progressive pain that gets worse during weight-bearing exercises/activities
High-impact traumas: mostly from high-impact sports and car accidents
Requires immediate medical attention and is disabling
3 Phases of Tissue Healing
- THE INFLAMMATORY PHASE
- lasts approximately six days
- Immobilize the injury to let the healing begin
- Increase the blood flow to bring nutrients and oxygen
for rebuilding - PROLIFERATION/FIBROBLASTIC PHASE
- Starts approximately on the third day
- Approximate 21-day duration
- Fills the wound with cells and collagen that will turn into
a scar - REMODELING/MATURATION PHASE
- Starts at the 21 days mark approximately
- Can last up to two years
- The rebuilding of the bone
- Tissue strengthening
- Scar remodeling
INFLAMMATION (SIGNS, SYMPTOMS)
Swelling redness warmth pain loss of function
MANAGING INJURIES
Pre-existing injuries
- Is the client ready to exercise?
- Does the client need clearance from a medical professional?
Modification of program
Management of acute injuries RICE Rest and restricted activity Ice Compression Elevation
Injuries to the upper extremity
Shoulder strain or sprain:
- Overhead exercise modification for an acceptable range of motion percentage based on their injury
- Preventing impingement of shoulder structures
Injuries of the rotator cuff:
- Must seek medical treatment, and recovery and training after recovery will be done with medical guidelines
Elbow tendinitis:
- Tennis elbow (Lateral and medial epicondylitis)
- Stay away from high repetition sets
Injuries to Lower Extremity
- Pes cavus – High arches in feet
- Pes planus – flat feet
- Greater trochanteric bursitis
- Inflammation and pain of the greater trochanteric bursa
- Common in ballet dancers, cross-country skiers, and female runners
Symptoms and signs
- Tightness of myofascial
- Client walks with a limp from weakness and pain
- Decreased strength
- The client may benefit from aquatic exercises
- IT (iliotibial) band syndrome
- Condition from repetitive overuse
- Happens when the distal portion of the iliotibial band brushes against the lateral femoral epicondyle
- Caused by errors in training in volleyball players, weightlifters, cyclists, and runners
- Bad footwear, bad equipment, overtraining, changes in running surface, structural abnormalities (knee valgus, pes planus, the discrepancy in leg length), muscular imbalances or a failure to stretch properly - PFPS (patellofemoral pain syndrome)
- Also known as runners knee and anterior knee pain
- Frequently confused with chondromalacia
- This accounts for approximately 16% to 25% of all injuries related to running
- Infrapatellar tendinitis
- Also known as jumpers knee
Inflammation at the patellar tendon
Common with volleyball players, basketball players and track and field athletes
Management:
Heat or ice
Changing the training variables
Avoid aggravating exercises (sitting for prolonged periods, running, deep squats and plyometrics)
Shin splints
Medial stress syndrome (Posterior shin splints/MTSS)
Pes planus is associated with this
Can be triggered by a quick change in activity
Periostitis (Periosteum inflammation)
Military individuals, dancers, and runners
Anterior shin splints
Extensor digitorum longus, Tibialis anterior, extensor halluces longus, periosteal lining, facia
Ankle Sprains
Lateral structures and mechanism of injury
Inversion with plantarflexed foot (usually)
Injuries to lateral structures account for approximately 85% of ankle
Medial ankle sprains (Eversion)
These are rare
Mechanism – Forced eversion and dorsiflexion of the ankle
Achilles tendinitis
Plantar fasciitis
Bottom of the foot inflammatory condition
The most common cause of heel spur formation and heel pain
approximately 10% of running pain
Intrinsic factors
Pes cavus and Pes planus
Extrinsic factors
Bad footwear, bad surfaces, overtraining and obesity
