Ch 9 Flashcards
Traumatic Injuries
• Strain
• Sprain
• Both occur in response to ____x stress on the musculoskeletal system
Strains
• ______unit (MTU) serves to generate force by either concentric contraction to create movement, or by eccentric contraction to resist a load
• Injury to muscle or tendon
• Most common in muscles of the ____
Strains • Degree of strain graded I to III, with III (most severe) – Proper gradation performed by a professional • PRICE: – P\_\_\_\_\_ – R\_\_\_\_ – I\_\_\_\_\_ – C\_\_\_\_\_ – E\_\_\_\_
MTU strains Chart
Sprains
• Injury to _____
• Ligaments are collagenous fibrous
structures that connect _____
– Provide soft-tissue _____ of bone-to-bone contact
• Most common site of a sprain is____
– Most common mechanism is ____ (versus ____)
• Sprains use the same graded scale as strains.
Ligament sprain table
Tissue repair table
Preventive Strategies for Risk of Injury
• Warm-up _____minutes prior to vigorous exercise – walking, jogging, cycling, or rowing ergometry
• Static or dynamic____ after the general warm-up
– ______ stretching preferred before competition
– Mixed evidence on stretching on injury prevention
• Incorporate resistance exercise
• If possible, avoid exercise/sport when fatigued
– _____ increases with fatigue
Medication overuse table
Medication for Overuse Injuries
• _____ may be used to decrease pain and inflammation
• Some analgesics such as NSAIDS may cause GI bleeding
and reduce kidney function with chronic use
• Note all medications accompanied by risk of toxicity and side effects
• Recommendation of OTC medications best made by qualified health care providers
– E.g., physicians, NPs, PAs
Overuse Injuries: ______
• a pathological change in the tendon due to repeated stress or microtraumas
• Common sites for tendinopathies: – _____
– common ____ flexor and extensor tendons
– _____ tendon
– _____ tendon
. unaccustomed, muscle tendon, calf/thigh
Protection, rest, ice, oppression, elevation
Ligament, bone to bone, restraint, ankle
Inversión, eversión, 5-7, stretch, dynamic,
Injury risk, analgesics, tendinopathy, rotator cuff,
wrist, patellar, Achilles,
Overuse Injuries: Tendinopathy
• Tendinopathies often result from overload injuries that disrupt the MTU
• Often present with swelling (if acute) and pain particularly with contraction or stretch of the muscle
• Assessment of tendinopathy includes evaluating strength and extensibility of the muscle and palpation of the involved tendon to determine tenderness
• Two categories:
– _______
– _______
Overuse Injuries: Tendinopathy
• ________: acute inflammation of tendon
– results from force that is too heavy and/or sudden
• ________:
– degeneration of tendon collagen from chronic overuse
– absence of an inflammatory response
Which is more common?
Practicing Safe Exercise
• Until pain has subsided, individuals should reduce activity of the affected muscle to decrease repetitive loading of the damaged tendon
• Most tendinopathies improve with conservative treatment that includes ______, ________, and/or use of_____
•might take up to 6 mo for symptoms to subside
• Once symptoms have decreased, strengthening of the affected area is appropriate
Overuse Injuries: Bursitis
• Bursitis: inflammation of the bursa sac
– fluid-filled sac that reduces friction between ________
• Common areas for bursitis are shoulders, hips, knees, and elbows
• Symptoms include sharp pain, swelling and tenderness
• Best managed conservatively with rest, ____ modalities, and NSAIDS
– Stretching and strengthening can be done within pain-free ROM
Overuse Injuries: ______
• (PF) occurs most commonly with repeated trauma to origin of plantar fascia on the medial calcaneal tubercle
– Results from repeated _____ of fascia during weight-bearing exercise
– Common in _____
• Classic symptoms include pain with first weight-bearing steps in the morning and/or during a run (usually subsides w/ _____)
.tendinitis, tendinosis, tendinitis, tendinosis , tendinosis
PRICE, Stretching, Analgesics,
,muscles tendons and joints, thermal,
Plantar fasciitis, stretching, runners, activity
Overuse Injuries: Plantar Fasciitis (cont.)
• Tight plantar flexor muscles along with either pes planus (flat foot) or pes cavus (high arch) may predispose an individual to PF
• At the acute stage, PF is best managed with control of pain and minimal exercise
• Pain management is often accomplished with ice massage, minimizing excess stress on the fascia (i.e., avoiding barefoot walking), and NSAIDS
Practicing Safe Exercise
• As the acute phase subsides, important to introduce stretching of the plantar fascia as well as the plantar flexors and toe flexors
• Functional weight bearing exercises can be beneficial
– Appropriate functional weight bearing exercises include toe and heel raises (extrinsics) and short foot exercises (intrinsics)
• Orthotic intervention and taping may be beneficial in supporting the involved structures during weight bearing exercises
Table
Low Back Pain (LBP)
• Low back pain could be considered – traumatic
– acute
– chronic
• Estimated to affect 60% - 80% of adult population at
some point in their lives
• Many causes of LBP including disc compression, degenerative changes in the lumbar spine, various joint and bone pathologies, and muscle imbalances
Strengthening the core can provide a stable base of support for the lumbar spine, decreasing low back pain
Practicing Safe Exercise
• Core stabilization activities should be incorporated into an individual’s exercise regimen and occur in 3 stages.
• The exercise must be stopped when stabilization cannot be maintained.
• “Connecting your abdominals”
– Critical component of core stabilization
– Initially learned during stage I of core training
– Learned in the supine position
Stage I: tighten pelvic floor muscles; draw lower abdomen up; zipper zipping up from pelvis to ribs
“Connecting your abdominals”
– Engage small, deep stabilizing muscles
– Critical component of core stabilization
– Initiallylearned during stage I of core training
– Learned in the supine position
.
Stage II: Co-contraction of deep muscles plus movement of extremities
Copyright © 2018 American College of Sports Medicine
Stage III: Both of the above plus recruiting larger stabilizers in more functional positions.
Low back exercise table
Chronic Conditions
• Chronic conditions are prolonged in duration, do not resolve spontaneously, and are rarely cured completely.
• It is estimated that more than 75% of health care costs are due to treating chronic conditions.
• Two most common: – Arthritis
– Osteoporosis
Arthritis
• Arthritis is an inflammation of a joint • Twotypes:
– rheumatoidarthritis(RA) – Osteoarthritis(OA)
Rheumatoid Arthritis
• Rheumatoid arthritis (RA) – autoimmune
– chronic inflammatory disease
– Affects synovial lining of joints and connective tissue.
Picture
Rheumatoid Arthritis
• Clinical presentation
– severe joint pain and inflammation
– reduced muscle mass
– decreased muscular strength and endurance
– decreased mobility and impaired physical activity
– cachexia (physical wasting) creates hypermetabolism and protein degradation
– increased risk of CVD
Practicing Safe Exercise
• Regular dynamic and isometric exercises are effective for improving muscular strength, cardiorespiratory function, and cardiovascular health in individuals with RA.
• Exercise can also reduce pain, morning joint stiffness, and fatigue.
• Individuals with RA can perform moderate intensity exercises with little or no joint damage.
• Individuals with RA should be encouraged to pursue activities of daily living that require movement, as the benefits of an exercise program are lost when no longer continued.
Osteoarthritis (OA)
• Common chronic degenerative joint disease
• More prevalent with age
• First presents as deficits in articular cartilage of synovial joints
• As OA evolves, bone remodeling and overgrowth at the joint margins also occur
• OA results from mechanical injury due to excessive loading or repeated low force stressors
.
Obesity and Osteoarthritis (OA)
• Obesity is associated with OA
• Most common locations for OA:
– hip and knee joints
– cervical and lumbar spine
• However, mechanisms beyond the biomechanical might
also exist
• OA in distal interphalangeal joints of the fingers and the carpo-metacarpal joint of the thumb
Regardless, exercise training important to maintain optimal BMI to minimize effect of body mass on OA
Osteoarthritis (OA) Clinical presentation • Pain • Joint stiffness • Decreased strength • Decreased flexibility • Decreased CRF
Practicing Safe Exercise
• Improved flexibility, muscular strength, cardiovascular fitness and quality of life, along with decreased pain are reported with exercise.
• Individuals should exercise at times when pain from OA is minimal or when pain medication is at peak effectiveness.
• Aquatic exercise may benefit those for whom land-based exercise is painful or those who are obese.
• Exercise when pain is minimal or medication is at peak effectiveness
• Discomfort during or immediately after exercise is possible, but should subside. Otherwise, reduce intensity and/or duration.
Table
Osteoporosis: The Silent Disease
• Characterized by low bone density or bone mass and deterioration of the bone microarchitecture and/or geometry that increases skeletal fragility and risk of fracture.
• Osteoporosis is largely preventable, yet is a serious public health problem.
• Most prevalent forms of osteoporotic fracture are of the hip, spine, and forearm.
Diagnosis via DXA Scan; A bone density T-Score:
• >-1.0 SD units
• -1.0 to -2.5 SD units • ≤-2.5 SD units
Normal bone density
Low bone density (osteopenia) Osteoporosis
Osteoporosis
• Osteoporosis is classified as primary or secondary
• Primary osteoporosis is age-related
• Secondary osteoporosis is due to other factors such as female athlete triad or drug regimens for treating other diseases
• Men and women lose bone at about the same rate until females begin to approach menopause, which occurs around the age of 52 years
• Particular attention should be paid to lifestyle behaviors during the critical prepubertal years (10 to 12 years) when bone is most responsive to the exercise stimulus.
Table
Inactivity and Bone Health
• Research indicates that exercise-induced bone gains in males and females, particularly during childhood and adolescence, confers benefits later in life
• For older adults who seek to maintain bone or minimize bone loss with age, it is important to continue to exercise
.
Exercise for Bone Health
• Physical activity prevents osteoporosis by increasing bone-forming osteoblast cell activity and reducing the bone-resorbing osteoclast activity
• Bone adaptation to stressors is site- and load-specific
– I.e., that only bone that is stressed appropriately will
adapt favorably
• Appropriate forms of resistance-type exercise are necessary to stimulate bone at any age
Exercise for Bone Health
• To enhance bone growth/reduce bone loss, exercises: – shouldbesite-specific
– should provide moderate–high compressive forces
– should provide resistance
– shouldbemulti-directionalandpain-free
Copyright © 2018 American College of Sports Medicine
Strategies to Prevent Osteoporosis
• Maximize bone mass
• Maximize peak bone mass
• Reduce age-related bone loss
• Prevent falls
• Avoid other risk factors for osteoporosis and fracture • Reduce pain
• Reduce disability
Contraindicated Exercises
• Exercise for which the risk of performance outweighs perceived or derived benefit.
• Use prudence when determining whether exercise is contraindicated
• Factors to consider for a particular client:
– Proper exercise mechanics (critical element!)
– Client fitness level
– Client tissue health
– JointROM
– Exercise Load (type, intensity, frequency)
Contraindicated Exercises • Yoga Plough • Neck circles with hyperextension • Bridging • Straight-leg situp • Double leg-lift • Hip twists
Contraindicated Exercises • Full Squat • Lat Pull-down behind neck • Upright Row with Barbell • Back hyperextension • Standing toe touch • hurdle stretch
Summary
• Musculoskeletal injuries are a very serious problem affecting a majority of the population
• With appropriate exercise, many of these problems can be prevented
• For those with current musculoskeletal injuries, proper recovery and exercise progression are crucial to the healing process
• The EP-C should understand the etiology of and special considerations related to these injuries, in order to prescribe and supervise exercise in response to these unfavorable conditions
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