ACE Personal Trainer Manual 5th Edition

Chapter 15: Common Musculoskeletal Injuries and Implications for Exercise

Lesson 15.1

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• 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 injurieso Elbow tendinitiso Carpal tunnel syndrome o Greater trochanteric bursitis

LEARNING OBJECTIVES

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• 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

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MUSCLE STRAINS GRADING SYSTEM

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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 Kneeo ACL injuries – decelerating while twisting, pivoting, and

sudden stopping or cutting motionso MCL injuries – impact to the outer knee with no

twisting involved; or damaged at the same time as the ACL

Thumb or finger Shoulder

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LIGAMENT SPRAINS GRADING SYSTEM

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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

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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

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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

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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 paino 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

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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

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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 function

• The goal is to give a client a challenging exercise program that will not cause further damage to an injured area.

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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

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FLEXIBILITY AND MUSCULOSKELETAL INJURIES

• Decreased flexibility is associated with various injuries, including:Muscle strainsOveruse 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 inflexibilityHelp prevent further injury

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CONSERVATIVE MANAGEMENT

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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

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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)

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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.

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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

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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 activitieso Keeping the arm straight during exercise (keep

elbows bent for less torque)o Modify exercises as necessary to prevent future

injury

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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

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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

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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

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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

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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.