Chapter 15 – Common Musculoskeletal Injuries and Implications for Exercise

    Check out our Audio Lectures, Practice Tests and Study Guide for the ACE CPT to see the specific topics that make it onto the ACE CPT Test from this chapter.

     

    1. Tissues and common injuries
      1. Muscle strains
        1. Microscopic tears of the muscle fibers
        2. Grading system
          1. Grade 1 strain: mild strain, tender and painful with possible localized spasms
          2. Grade 2 strain: moderate strain, large number of fibers are injured with more severe pain and tenderness.
            1. Mild swelling, noticeable loss of function and possible bruising
          3. Grade 3 strain: complete tear
            1. Complete loss of muscle function, severe pain, swelling, tenderness, discoloration, and palpable defect
        3. Hamstring strains
          1. Common among athletes in running and jumping sports
          2. Risk factors: poor flexibility, poor posture, muscle imbalance, improper warm-up, training errors
        4. Hip strains
          1. Common with explosive sports that require acceleration, deceleration, and change of direction w/ lateral movements
          2. Risk factors: muscle imbalances between hip adductors and abductors
        5. Calf strains
          1. Running and jumping athletes
          2. Risk factors: muscle fatigue, fluid and electrolyte depletion, forced knee extension while foot is dorsiflexed, and forced dorsiflexion while knee is extended
      2. Ligament sprains
        1. Grading system
          1. Grade 1: minimal tenderness, swelling, and impairment. Micro tearing of collagen fibers
            1. Care: RICE
          2. Grade 2: moderate tenderness, swelling, and impairment, decreased ROM, possible instability. Complete tears of some collagen fibers
            1. Care: RICE, physical evaluation
          3. Grade 3: significant swelling and tenderness. Severe impairment. Instability. Complete tear/rupture of ligament.
            1. Care: immobilization w/air splint, RICE, physician evaluation
          4. ACL injury = most common sports-related injury of the knee
            1. Mechanism of injury: deceleration of body combined with twisting, pivoting, or side-stepping maneuver
          5. MCL injury
            1. Mechanism of injury: impact to outer knee with no twisting involved
            2. Most often associated with ACL or medial meniscal injuries
      3. Overuse
        1. Tendinitis: inflammation of the tendon
        2. Bursitis: inflammation of the bursa sac due to acute trauma, repetitive stress, muscle imbalance, or muscle tightness on top of bursa
          1. Common in shoulders, hips, and knees
        3. Fasciitis: inflammation of the connective tissue
          1. Most common in bottom and back of foot
      4. Cartilage damage
        1. Hyaline cartilage: covers the bone
        2. Menisci cartilage: shock absorbers
        3. Meniscal injuries = most common knee injury
          1. Combination of loading and twisting of the joint
          2. Occur sometimes with ACL or MCL injuries
        4. Role of menisci: shock absorption, stability, joint congruency, lubrication, and proprioception
          1. Stiffness, clicking or popping with weightbearing activities, giving away, catching, and locking
        5. Chondromalacia: softening or wearing away of the cartilage behind the patella, resulting in inflammation and pain
          1. Caused by posterior surface of patella not properly tracking in the femoral groove
      5. Bone fractures
        1. Stress fracture: minor fracture due to low-impact trauma or repeated microtrauma to a bone region
          1. Commonly confused with shin splints
          2. Signs & symptoms: progressive pain that is worse with weightbearing activity, focal pain, pain at rest, local swelling
        2. High-impact trauma: most common during car accidents or high impact sports
          1. Disabling and require immediate medical attention
    2. Reaction to healing
      1. 3 phases
        1. Inflammatory phase
          1. Last up to 6 days
          2. Immobilize injured area and begin healing process
          3. Increased blood flow (brings O2 and nutrients to rebuild)
        2. Fibroblastic/proliferation phase
          1. Begins approx.. at 3 days
          2. Lasts roughly 21 days
          3. Fills wound with collagen + other cells to eventually form a scar
        3. Maturation/remodeling phase
          1. Begins approx. at day 21
          2. Can last up to 2 years
          3. Remodeling the scar
          4. Rebuilding of bone
          5. Strengthening of tissue
      2.  Inflammation
        1. Pain, redness, swelling, warmth, loss of function
    3. Managing injuries
      1. Pre-existing injuries
        1. Are they ready for exercise?
        2. Do they need to be cleared by a medical professional?
      2. Program modification
      3. Acute injury management
        1. RICE
          1. Rest/restricted activity
          2. Ice
          3. Compression
          4. elevation
    4. Flexibility and musculoskeletal injuries
      1. Contraindications to consider for injury prevention
        1. Joint swelling (effusion)
        2. Osteoporosis or rheumatoid arthritis
        3. History of corticosteroid use
        4. Fracture site that is healing
    5. Upper-extremity injuries
      1. Shoulder strain/sprain
        1. Modify overhead activates to acceptable % of ROM for their injruy
        2. Prevent impingement of shoulder structures
      2. Rotator cuff injuries
      3. Elbow tendinitis
        1. Lateral and medial epicondylitis or “tennis elbow”
        2. Avoid high repetition activity
      4. Carpal tunnel syndrome
        1. Repetitive wrist and finger flexion
        2. Flexor tendons are strained
        3. Narrowing of carpal tunnel due to inflammation
        4. Compresses median nerve
        5. More common in females
    6. Lower-extremity injuries
      1. Pes cavus: high arches of feet
      2. Pes planus: flat feet
      3. Greater trochanteric bursitis
        1. Painful inflammation of the greater trochanteric bursa
        2. Common in female runners, cross-country skiers, and ballet dancers
        3. Signs and symptoms
          1. Walking with a limp due to pain and weakness
          2. Myofascial tightness
          3. Decreased muscular strength
        4. May benefit from aquatic exercise
      4. Iliotibial band (IT) syndrome
        1. Repetitive overuse condition
        2. Occurs when distal portion of IT band rubs against lateral femoral epicondyle
        3. Caused by training errors in runners, cyclists, volleyball players, and weight lifters
          1. Overtraining, improper footwear or equipment use, changes in running surface, muscle imbalance, structural abnormalities (pes planus, knee valgus, leg-length discrepancy), failure to stretch correctly
      5. Patellofemoral pain syndrome (PFPS)
        1. “anterior knee pain” or “runner’s knee”
        2. Often confused with chondromalacia
        3. 16-25% of all running injuries
      6. Infrapatellar tendinitis
        1. “jumpers knee”
        2. Inflammation of patellar tendon
        3. Common in basketball, volleyball, and track and field
        4.  Management
          1. Avoid activities that will aggravate (plyo’s, sitting for long periods of time, deep squats, running)
          2. Modify training variables
          3. Ice or heat
      7. Shin splints
        1. Medial stress syndrome (MTSS/posterior shin splints)
          1. Associated with pes planus
          2. Triggered by sudden change in activity
          3. Periosititis (inflammation of the periosteum)
          4. Runners, dancers, and military personnel
        2. Anterior shin splints
          1. Tibialis anterior, extensor digitorum longus, extensor halluces longus, fascia, periosteal lining
      8. Ankle sprains
        1. Mechanism of injury to lateral structures
          1. Inversion with a plantarflexed foot (typically)
          2. About 85% of injuries are to lateral structures of ankle
        2. Medial (eversion) ankle sprains
          1. Rare
          2. Mechanism: forced dorsiflexion and eversion of ankle
      9. Achilles tendinitis
      10. Plantar fasciitis
        1. Inflammatory condition of bottom of foot
        2. Most common cause of heel pain and heel spur formation
        3. Accounts for 10% of running pain
        4. Intrinsic factors
          1. Pes planus and pes cavus
        5. Extrinsic factors
          1. Overtraining, poor footwear, obesity, unyielding surfaces
    7. Record keeping
      1. Medical history
      2. Exercise record
      3. Incident report
      4. Correspondence
        1. HIPPA

     

    Check out our Audio Lectures, Practice Tests and Study Guide for the ACE CPT to see the specific topics that make it onto the ACE CPT Test from this chapter.