ACE CPT Chapter 15 - Common Musculoskeletal Injuries and Implications for Exercise
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    Common injuries and tissues

    • Muscle strains
      1. These are small microscopic tears within muscle fibers
      2. 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
          1. It’s noticeable to see bruising and a loss of function as well as mild swelling
        • Grade level III strain: complete tear
          1. This is accompanied by severe swelling, pain, discoloration, tenderness, and palpable defect. A complete loss of muscle function.
      3. 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
      4. 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
      5. 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
      1. The grading system
        • Grade level I: Micro tearing of collagen fibers, swelling, mild tenderness, impairment
          1. Care – RICE
        • Grade level II: Swelling, impairment, moderate tenderness, reduced range of motion, possible instability, Some collagen fibers with complete tears
          1. Care – Physical evaluation, RICE
        • Grade level III: Significant tenderness and swelling, instability, severe impairment, complete rupture/tear of the ligament
          1. Care – Physician evaluation, RICE, immobilization with a splint
        • ACL injury – The most common sports-related knee injury
          1. Injury mechanism: Quick deceleration combined with pivoting, twisting or sidestepping maneuvers
        • MCL injury
          1. Injury mechanism: In impact to the outside of the knee (no twisting is involved)
          2. Most frequently associated with medial meniscal injuries or ACL injuries
    • Overuse
      1. Tendinitis – Information of tendon
      2. 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
      3. Fasciitis – Inflammation of connective tissue
        • Most commonly found in the back and bottom of the feet
    • Cartilage damage
      1. Hyaline cartilage – Covers the bone
      2. Menisci cartilage – Absorbs sharks
      3. 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
      4. The role of the menisci – To absorb shocks, provide stability, lubrication, congruency, and proprioception
        • Clicking/popping during weight-bearing exercises, stiffness, catching, locking and giving away
      5. 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
      1. 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
      2. High-impact traumas: mostly from high-impact sports and car accidents
        • Requires immediate medical attention and is disabling

    Reaction to healing

    • Three Phases
      1. The inflammatory phase
        • last approximately six days
        • Immobilize the injury to let the healing begin
        • Increase the blood flow to bring nutrients and oxygen for rebuilding
      2. 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
      3. 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
      4. Inflammation
        • Swelling, redness, warmth, pain, loss of function

    Managing injuries

    • Pre-existing injuries
      1. Is the client ready to exercise?
      2. Does the client need clearance from a medical professional?
    • Modification of program
    • Management of acute injuries
      1. RICE
        • Rest and restricted activity
        • Ice
        • Compression
        • Elevation

    Musculoskeletal injuries and flexibility

    • Injury prevention and contraindications to consider
      1. Effusion (joint swelling)
      2. Rheumatoid arthritis and osteoporosis
      3. A history with corticosteroids
      4. A healing fracture site

    Injuries to the upper extremity

    • Shoulder strain or sprain
      1. Overhead exercise modification for an acceptable range of motion percentage based on their injury
      2. Preventing impingement of shoulder structures
    • Injuries of the rotator cuff
    • Elbow tendinitis
      1. Tennis elbow (Lateral and medial epicondylitis)
      2. Stay away from high repetition sets
    • Carpal tunnel syndrome
      1. Strained flexor tendons
      2. Repetitive finger and wrist flexion
      3. inflammation causes narrowing of carpal tunnel
      4. More commonly found in women
      5. Compresses the median nerve

    Injuries to the lower extremity

    • Pes cavus – High arches in feet
    • Pes planus – flat feet
    • Greater trochanteris bursitis
      1. Inflammation and pain of the greater trochanteric bursa
      2. Common in ballet dancers, cross-country skiers, and female runners
      3. Symptoms and signs
        • Tightness of myofascial
        • Client walks with a limp from weakness and pain
        • Decreased strength
      4. The client may benefit from aquatic exercises
    • IT (iliotibial) band syndrome
      1. Condition from repetitive overuse
      2. Happens when the distal portion of the iliotibial band brushes against the lateral femoral epicondyle
      3. 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)
      1. Also known as runners knee and anterior knee pain
      2. Frequently confused with chondromalacia
      3. This accounts for approximately 16% to 25% of all injuries related to running
    • Infrapatellar tendinitis
      1. Also known as jumpers knee
      2. Inflammation at the patellar tendon
      3. Common with volleyball players, basketball players and track and field athletes
      4. Management:
        • Heat or ice
        • Changing the training variables
        • Avoid aggravating exercises (sitting for prolonged periods, running, deep squats and plyometrics)
    • Shin splints
      1. 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
      2. Anterior shin splints
        • Extensor digitorum longus, Tibialis anterior, extensor halluces longus, periosteal lining, facia
    • Ankle Sprains
      1. Lateral structures and mechanism of injury
        • Inversion with plantarflexed foot (usually)
        • Injuries to lateral structures account for approximately 85% of ankle
      2. Medial ankle sprains (Eversion)
        • These are rare
        • Mechanism – Forced eversion and dorsiflexion of the ankle
    • Achilles tendinitis
    • Plantar fasciitis
      1. Bottom of the foot inflammatory condition
      2. The most common cause of heel spur formation and heel pain
      3. approximately 10% of running pain
      4. Intrinsic factors
        • Pes cavus and Pes planus
      5. Extrinsic factors
        • Bad footwear, bad surfaces, overtraining and obesity

    Keeping records

    • Exercise record
    • Medical history
    • Incident reports
    • Correspondence
      1. HIPPA

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