Chapter 15 Flashcards
Muscle Strains
When muscles are worked beyond their capacity resulting in microscopic tears
Characterized as a sudden tear or Pop sound, usually occurs from abrupt movement
Risk factors: poor flexibility, poor posture, muscle imbalance, improper warm-up, training errors, muscle fatigue, fluid and electrolyte depletion
Ligament Sprains
Usually from a fall during a contact sport or some other trauma
Common: ankle, knee, thumb/finger, shoulder
Symptoms: immediate pain followed by swelling, instability, decreased ROM, and loss of function
Overuse Injuries
Tendinitis
Bursitis
Fasciitis
(Basically all inflammatory responses)
Cartilage Damage
Common: menisci of the knee
Symptoms: clicking, popping, stiffness, giving way, catching, locking
Cause: trauma, degeneration
Bone Fractures
aka Stress Fractures
Causes: falls, trauma, repetitive overuse, car accidents
Common: distance runners, track athletes, volleyball, basketball
Symptoms: progressive pain during weight bearing activity, focal pain, pain at rest, local swelling
Tissue Reaction to Healing
- Inflammatory Phase: lasts for up to six days; immobilizes injured area and begins healing process ; increased blood flow to being nutrients and oxygen to rebuild the damaged tissue
- Fibroblastic/Proliferation Phase: begins 3 days after the injury and lasts 21 days; begin to fill wound with collagen and forms a scar
- Maturation/Remodeling Phase: begins near day 21 and can last for up to 2 years; remodeling of the scar, rebuilding of bone, and strengthening of tissue
Signs of Inflammation
- Pain
- Redness
- Swelling
- Warmth
- Loss of Function
Local Injuries
Exercise Programs should be modified to avoid loading the injured area until physician gives the A-OK to work on that area
Common Symptoms of post-injury/post- surgery overtraining
- Soreness that lasts 24 hours+
- Pain while sleeping
- Soreness or pain from prior session
- Increased stiffness, decreased ROM
- Swelling, redness, warmth in the healing tissue
- Progressive weakness over several sessions
- Decreased functional usage
RICE
The protocol for if an acute injury occurs
R (rest or restricted activity)
I (ice every hour for 10-20 minutes)
C (compression to reduce swelling)
E (elevate 6-10 inch above the heart)
Contraindications to Stretching
- a fracture site that is healing
- acute soft-tissue injury
- post surgical conditions
- Joint hypermobility
- infected area
- hematoma or other trauma
- pain in the affected area
- restrictions from doctor
- prolonged immobilization
- joint swelling from trauma/disease
- osteoporosis or rheumatoid arthritis
- history of prolonged corticosteroid use
Shoulder Strain/Sprain
Symptoms: pain in the shoulder that radiates down the arm
Management: avoid aggravating activities and movements (overhead movements that risk impingement)
Programming:
-educate client how to avoid aggravating movements by improving posture and body positioning
-emphasize regaining strength and flexibility in the shoulder complex by strengthening the scapular stabilizers and rotator cuff muscles
- modify overhead activities so that the exerciser only moves through a partial ROM. Safety is paramount. For example, OH press don’t fully extend the arms
Rotator Cuff Injuries
Symptoms: sudden tearing sensation. Trouble lifting arm overhead
Management: restrict overhead movements and lifting heavy objects
Programming: repair usually takes 6-8 weeks and physical therapy. Clients are usually cleared for the gym after 16 weeks. The goal should be to continue what has been done in physical therapy in a safe, progressive manner
Personal Trainer should receive guidelines as to what movements should and shouldn’t be done. Bending at the arms to create a short lever will create less torque and thus less strain on the healing tissue
Elbow Tendinitis
Cause: overuse of the flexor and extensor muscle tendons of the elbow
Tennis elbow; golfer’s elbow
Common: adults aged 30-55
Symptoms: nagging elbow pain
Management: avoid repetitive wrist flexion/extension activities
Programming: educate client how to avoid aggravating movements, maybe they wear a wrist splint, modify exercises, avoid high reps (15-20 reps) and avoid full elbow extension
Carpal Tunnel Syndrome
Definition: Repetitive wrist and finger flexion when the flexor tendons or strained resulting in a narrowing of the carpal tunnel due to inflammation, which eventually compresses the median nerve
Common: females aged 40-60; bilateral
Symptoms:
-Night/Morning burning
-Loss if grip strength
-Numbness/tingling pain
Management:
-cortisone injections
-wear wrist splints during activity
Programming:
-educate how to avoid aggravating activities
-emphasize regaining strength and flexibility of the elbow, wrist, finger flexors and extensors
-modify movements
-wear wrist splint
-exercise with limited ROM
Avoid:
Full wrist flexion/extension
Where is the scapular plane?
30 degrees anterior to the frontal plane
Tennis Elbow
Entry of the wrist extensor muscle near their origin on the lateral epicondyle of the humerus
Golfers elbow
Injury of the wrist flexor muscle tendons near their origin on the medial epicondyle
Risk factors of Low Back Pain
- Heavy lifting, pushing, pulling, with twisting of the spine
-Obesity
-Stress
-Depression
-Poor Physical Fitness
-Inherited disc disease
-Smoking
-Pregnancy
-Osteoarthritis and other diseases
Mechanical Low Back Pain
Pain that is produced with movement of specific anatomical structures. This pain originates from abnormalities or deviations in the vertebrae, intervertebral discs, or facet joints
Degenerative Disc Disease and Sciatica
DDD comes with aging, wear and tear, and is associated with disc herniation and bulging
If the nerves coming out of the spinal cords get pinched, the client may develop signs of sciatica (pain or tingling sensation)
Greater Trochanteric Bursitis
Characterized by painful inflammation of the greater trochanteric bursa between the greater trochanter of the femur and the gluteus medius tendon/proximal iliotibial band complex
Symptoms:
Tingling, prickling, pain from the lateral hip down the iliotibial tract to the lateral knee. Symptoms often related to overuse, Trendelenberg gait (limp) due to pain or weakness, which results in decreased muscle length and Myofascial tightness
Management:
Use a cane as needed
Programming:
-When client returns to the gym, use proper technique, proper footwear, and teach early injury recognition
-Focus on regaining strength and flexibility at the hip
-Stretching of the IT Band complex, hamstrings, and quadriceps
-Strengthening of the gluteals and deeper hip rotator muscles
-Proper gait technique during running and walking
-Avoid side-lying if tender; squats and lunges may be too much at first; may benefit from aquatic exercise
Iliotibial Band Syndrome
Happens when the distal portion of the iliotibial band rubs against the lateral femoral epicondyle
Common: 15-50 year old runners, cyclists, volleyball players, and weight lifters
Caused by:
-Overtraining
-Improper Footwear or equipment use
-Changes in running surface
-Muscle Imbalances
-Structural Abnormalities
-Failure to stretch correctly
Symptoms:
-Gradual onset of tightness, burning, or pain at the lateral aspect of the knee. Pain may be localized but generally radiates to the outside knee and/or up the outside of the knee. Snapping, popping, or pain at the lateral knee during flexion/extension.
Symptoms are often resolved with rest
Programming:
-Focus on regaining strength and flexibility at the hip and lateral thigh
-May not tolerate lunges or squats at first; start with 45 degrees of knee flexion and progress to 90 degrees; aquatic exercises may be beneficial
Patellofemoral Pain Syndrome aka Anterior Knee Pain aka Runners Knee
Causes:
-Overuse
-Changes in training intensity/frequency/duration
-Biomechanical Abnormalities (flat foot or high arches)
-Muscle Dysfunction such as tightness in the IT Band, tightness in the hamstrings, tightness in the calf muscles, weakness of the quadriceps, or hip abductor
Symptoms:
-Pain while running, stairs, squatting, or prolonged sitting (gradual achy pain behind or underneath the patella)
Management:
-Avoid aggravating activities such as prolonged sitting, deep squats, running downhill
-Modify training variables (intensity, frequency, duration)
-Proper Footwear
-Orthodics
-Physical Therapy
-Patellar Taping
-Knee Bracing
-Client Education
-Oral anti-inflammatory
-Modalities (ice or heat)
Programming:
-Address tightness in the IT Band complex (gluteals) using stretching and foam rolling, stretching of the hamstrings and calves
-Restore proper strength throughout the hip, knee, and ankle (improving femoral control through strengthening of the hip muscles will help control the forces imposed on the knee joint
-Closed Chain exercises such as squats and lunges may be beneficial, caution should be taken with open-chain exercises because they stress the patella.
-Strengthen ankle muscles to establish stability to allow the knee to function properly (resistance bands)
-Mid range (45 degrees) ROM using closed chain exercises may be the most comfortable
Infrapatellar Tendinitis aka Jumpers Knee
An overuse syndrome characterized by inflammation of the patellar tendon at the insertion into the distal part of the patella and the proximal tibia. Happens with poor running style, overuse, improper training methods, sudden change in training surface, lower-extremity inflexibility, or muscle imbalance
Common: volleyball players, basketball, track and field
Symptoms: Pain at the distal kneecap into the infrapatellar tendon. Pain has also been reported with Running, walking stairs, squatting, or prolonged sitting
Management:
-Avoid aggravating movements such as Plyometrics, prolonged sitting, deep squats, and running
-Modify Training Variables (IFD)
- Proper Footwear
-Physical Therapy
-Patellar Taping
-Knee Bracing
-Arch Support
-Foot Orthodics
-Client Education
-Oral Anti-Inflammatory medication
-Modalities (Ice and Heat)
Programming:
-Restore proper flexibility and strength and the lower extremity
-Stretching and foam rolling of the quadriceps, IT band, hamstrings, and calves
-Restore strength throughout the hip, knee, and ankle
-May not be able to do activities such as plyometrics and running at first; a slow return to loading activity is recommended
-For example, Have the client jog on a trampoline before progressing to grass and eventually to a court
Shin Splints
-Exertional leg pain
-Medial Tibial stress syndrome (Often triggered by sudden change in activity) Common in Dancers, runners, and military personnel
-Anterior Shin Splints (also common in runners and military personnel)
Symptoms: dull ache elicited by initial activity, but diminishes as activity continues, then the pain returns after hours of inactivity
Management:
-Modify training by lowering impact/lower – mileage conditioning and cross training (aquatic exercises). The best intervention may be REST
-Modalities (Ice and Heat
-Anti-inflammatory Medication
-Cortisone Injections
-Heel Pads
-Bracing
-Physical Therapy
Programming:
-Slowly introduce the client back to full unrestricted activity without exacerbating the symptoms. Cross training to maintain adequate levels of fitness at early stages
-Stretching and strengthening of the calf muscles especially the Soleus
Ankle Sprains
Common: Basketball, volleyball, soccer, ice-skating, over-pronators
Symptoms: popping or tearing sound
Management:
-Ankle Brace
-Cast or Boot
-Physical Therapy
Programming:
-Client can still exercise…just avoid working the ankle
-Restoring proper proprioception, balance, flexibility, and strength
-stretching of the gastrocnemius and Solias muscles, in addition general stretches for the lower extremity
-Strengthening the lower leg will also be beneficial with particular emphasis on the muscles that control the foot and ankle
-Target the peroneal muscle group for inversion ankle sprains to prevent re-injury, for example exercises such as sidestepping with a band
-Carioca (Karaokes)
Achilles Tendinitis
Symptoms:
-Pain above the calcaneous
Management:
-Ice and Heat
-Weight Loss
-Anti-inflammatory medication
-Orthotics in proper footwear
-Strengthening and stretching
Programming:
-Controlled eccentric strengthening of the calf complex has been shown to reduce symptoms, for example start with calf raises on the floor and then progress to calf raises on a step
-Stretching of the Gastrocnemius, Soleus using the wall or bands
-Careful not to over pronate or supinate during calf stretching
Plantar Fasciitis
An inflammatory condition of the plantar fascia of the foot, this condition has been reported to be the most common cause of heel pain and heel spur formation, and is more common in obese individuals
Causes:
-Overtraining
-Improper footwear
-Obesity
-Unyielding surfaces
Symptoms;
Pain in the medial side of heel
Worse pain at the end of the day
Management;
-Ice and Heat
-Anti-inflammatory medication
-Heel pad or plantar arch
-Stretching
-Strengthening exercises
-Physical therapy
-Cortisone shot
-orthotics
Programming:
-Stretching of the Gastrocnemius, Soleus, and plantar fascia. Self myofascial release techniques such as rolling the foot over a ball may help enhance ROM in plantar fascia
-Strengthening the foot intrinsic muscles may help improve arch stability and decrease stress imposed on the plantar fascia
-Strengthening of the gastrocnemius, peroneal’s, tibialis anterior, and tibialis posterior muscles may need to improve strength of the ankle
-Bending toes against the wall is a good stretch to isolate the plantar fascia
How often should you update your clients medical files?
About every 3 months
Incident Report
- Client needs immediate medical attention
- A formal written report of the incident needs to be documented
- Trainer needs to keep his or her own account of what occurred and maintain any pertinent documentation
1996 Health Insurance Portability and Accountability Act (HIPAA)
All medical records at the personal trainer has on each client are confidential. Trainer must obtain written consent from the client before discussing this information with any third-party
