ACE 6th Edition Chapter 15: Considerations for Clients with Musculoskeletal Issues
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ACE 6th Edition Chapter 15: Considerations for Clients with Musculoskeletal Issues 1

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    Chapter Goals:

    • Be able to talk about the role and scope of practice of a personal trainer in working with their clients who have or have once had musculoskeletal injuries. 
    • Be able to discuss the role of pain and how to communicate with clients that are in pain.
    • Recognize acute injuries and respond through the application of emergency response protocols. 
    • Find the signs of chronic injuries or conditions.
    • Be able to find when a referral to a healthcare professional is warranted. 
    • Be able to make a safe and effective exercise program for clients who have historically had common musculoskeletal injuries. 
    • Use the right exercise programming to avoid injuring when training.

    Introduction

    Through the career of a personal trainer, trainers may have clients that report pain when exercising in order to arrive with a new injury. Through the careful design of exercise programs and the implementation of these programs, trainers can have a significant impact on clients that have musculoskeletal issues. 

    It is important for trainers to keep in mind that the scope of practice of trainers does not include the evaluation, assessment, and diagnosis of muscle or joint pains. When these situations do occur, it is important to refer clients to a medical professional. 

    Physicians are able to use their tools like MRI, x-ray, and computed tomography. To find the illnesses and identify injuries. 

    Common Injuries and Reactions to Healing

    Exercise is going to be quite important to the overall health and wellness of individuals and people will often seek out a trainer with the expectation of learning the safe and effective exercising techniques. 

    Acute and Chronic Injuries The Physiology of Healing

    Injuries are possible to occur instantly, or they may manifest themselves over time. Acute injuries can be identified as occurring in one single instance, and chronic injuries are the form that occurs and builds up over the long term. 

    The phases of healing are what will always occur in the body to help heal and recover.

    Phase one of healing is the inflammation phase. This is when there is acute inflammation lasting 3 – 4 days following the injury and may depend on the severity of the injury. There is a lot of swelling and redness and the body uses this to restrict motion and remove things in the tissues that should not be there. 

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    Phase two of healing is the repair phase, and here we have the body repairing the damaged tissues and regenerating them. The phase is possible to overlap with the last phase of inflammation and this phase may last 6 weeks. 

    Phase 3 of healing id the remodeling phase, and this is where the tissues are reorganizing themselves along the lines of stress and getting back to the level of function they had prior to being injured. 

    The Essential Role of Pain

    The body makes use of pain as a quick and clear signal to whatever we are doing to be stopped, as it may hurt us. 

    Common Acute Injuries

    Exercise and sports have many risks for injuries, and trainers must be able to see when a client gets injured and must discontinue the session when warranted. 

    Muscle strains are common injuries during any form of exertion. These are present when the working muscle is worked beyond its ability, and results in the tearing of fibers. 

    • Grade one strains have some local soreness and cramping as a result and it only really has a few fibers being torn. 
    • Grade two strains are those that are moderate and has around half the muscle being torn. The results are more severe pain and swelling and greatly reduced range of motion. 
    • Grade three strains are the most severe and result in the muscle being completely torn and may require some surgery to fix it. 

    Ligament sprains are like the muscle strains, but they happen when the ligaments are stressed to the point of tearing. They follow the same grades as the muscle strains as far as their severity. Often these can be seen in non-contact injuries. 

    There is the possibility for cartilage damage due to them being between and around these muscles and ligaments, and when there is damage to joints, these may occur. 

    Bone fractures are possible, but of course much less common in the personal trainer settings. It is important to note the possibility for osteoporosis and the effects it has on the bones of your clients, more so with the older adults. 

    Head, neck, and back injuries can occur in the training sessions. Sometimes this is seen in the form of concussions and have to do with falling or dropping something in the session.

    Common Overuse Injuries

    Overuse conditions are then ones where tissues are unable to heal from the stresses we place on them throughout the days of our lives. 

    Tendinitis, bursitis, and fasciitis are all three forms of overuse that result in inflammation of the tendons, bursa, and fascia, respectively. 

    Stress fractures are common when there is an imbalance in bone formation and bone resorption. The fractures happen as a result of compression forces putting repetitive stress on bones that aren’t strong enough to withstand the forces. 

    Preventing Musculoskeletal Injury

    Knowing how to design programs well and periodize them effectively is going to be essential for preventing injuries to clients. 

    Flexibility and elasticity are both factors that when decreased levels are present, they increase the risk for injury. It can work as the cause or the consequence of injury. Flexibility should be included as part of a regular exercising program. 

    Warmups are essential to the prevention of musculoskeletal injuries, as these work to ensure the body has warmed up the right parts and is ready to go through the workout. These warmups should be 5 – 10 minutes in total. 

    Recovery is one essential part of preventing these injuries, especially when it comes to overuse injuries since they build up over time and are the result of not being able to properly heal. 

    Programming Considerations for Clients with Musculoskeletal injuries

    The scope of practice for trainers allows us to assess movements and create exercise programs. Trainers should be mindful of the main considerations to be outlined in this chapter. 

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    When pain is present, some extra considerations should be taken to avoid this. Sometimes movements may hurt in a designed program, and this means that trainers should have modifications ready to go when training. 

    Acute injuries will sometimes require return to activity protocols from physicians and physical therapists. These say that it is ok to return to working out, and it is always better to be safe than be sorry. 

    Chronic injuries and conditions need to be taken into account when we are designing programs, as these will need to be addressed and not aggravated further. 

    Common Conditions of the Upper Extremity

    The shoulder is the most mobile and least stable joint in the body, and this means that it is often injured. Its large range of motion can lead to injuries of many surrounding tissues. 

    When modifying exercises to improve the function of a client’s shoulder, we should:

    • First, we should address any posture imbalances that are present that may cause decreases in space between the acromion process and the humeral head. This is like rounding of the shoulders or kyphosis.
    • Second, we should focus on strengthening the stabilizing muscles connecting to the scapula like the muscles of the rotator cuff.
    • Next, we need to improve the anterior muscles of the shoulder and the pec major through controlling the pushing movements. 
    • The last thing to do is introduce activities of overhead movement and to do these in the scapula plane to prevent impingement.

    The elbow, wrist, and hand all have issues mostly regarding repetitive and overuse injuries like carpel tunnel syndrome and similar issues. There are also the possibility of fractures for the small bones of the hand. 

    Common Conditions of the Spine

    A lot of clients will be found to suffer from neck, mid-back, and lower back problems. This is especially true with the lower back, as we see this as one of the most popular conditions in the US for adults. 

    Each of these three locations have issues that often involve the vertebrae of the spine, or the surrounding muscles. 

    Disc injuries can be common, especially lower down in the spine. 

    It is important that we address the imbalances between the right and left sides and then postural deviations. Follow this u with internal and external rotation movements and strengthening the posterior chain. 

    Common Conditions of the Lower Extremity

    The lower extremities control the transmission of all of the ground reaction forces through the body. the main body parts to consider for these conditions will be the hip, knee, and the ankles and lower leg. 

    The knee and ankle make up some of the most common injuries when training and in sports. 

    Preventing these injuries will require us to ensure clients have worked on flexibility, mobility, and strength required to do movements as we progress throughout training.

    ACE 6th Edition Chapter 15: Considerations for Clients with Musculoskeletal Issues 2
    ACE CPT Chapter 1: Role and scope of practice for the personal trainer 2
    ACE 6th Edition Chapter 15: Considerations for Clients with Musculoskeletal Issues 3

     

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