Chapter 15: Common Musculoskeletal Injuries and Implications for Exercise

Question 1

Muscle Strains:

1. Injury Definition
2. Impact on Exercise

Answer 1

1. muscle works beyond its capacity, resulting in microscopic tears of the muscle fibers; mild cases are when there is tightness or tension, severe is when there ia a sudden tear or “pop” that leads to immediate pain and weakness in the muscle; swelling, discoloration (ecchymosis), and loss of function often occur after the injury; they are frequent in the lower extremity and primarily occur in major muscle groups such as the hamstrings, grow, and calf
2. Hamstring strains are most common in running and jumping sports (severe stretch or rapid, forceful contraction…can result from poor flexibility, poor posture, muscle imbalance, improper warm-up, and training errors; strains of the hip are common in sports like ice hockey and figure skating that require explosive acceleration, deceleration, and change of direction with a lateral movement component (an initial “pull” of the muscles inside the thigh followed by intense pain and loss of function…can be causes by muscle imbalance between hip adductors and abductors); strains in calf are common among athletes in most running and jumping sports (risk factors include muscle fatigue, fluid and eletrolyte depletion, forced knee extensions while the foot it dorsiflexed, and forced dorsiflexion while the knee is extended

Question 2

Ligament Sprains:

1. Injury Definition
2. Impact on Exercise

Answer 2

1. often occur with trauma, such as a fall or contact during sports; most common joints for sprains includes the knee, ankle, thumb/finger, and shoulder; client reports s “popping” sound followed by immediate pain, swelling, instability, decreased ROM and a loss of function

Question 3

Common overuse conditions:

1. Injury Definition
2. Impact on Exercise

Answer 3

1. when the body is put through excessive demands during activity, it can result in overuse (tendinitis-inflation of the tendon/usually in the shoulders, elbows, knees, and ankles, bursitis- inflammation of the bursa sac due to acute trauma, repetitive stress, muscle imbalance, or muscle tightness on top of the bursa-usually in shoulders, hips, and knees, and fasciitis-inflammation of the connective tissue called fascia-most commonly occurs in the bottom and back of foot)

Question 4

Cartilage damage:

1. Injury Definition
2. Impact on Exercise

Answer 4

1. in the knee; most common is damage to the menisci; usually associated with a combo of loading and twisting of the joint or occur in conjunction with traumatic injuries such as ACL tears or MCL injuries; cartilage under the patella can also be damaged and can result in chondromalacia (softening or wearing away of the cartilage behind the patella, resulting in inflammation and pain)
2. may complain of stiffness, clicking or popping with weight-bearing activities, giving way, catching, and locking (in more severe ways); symptoms can include joint pain, swelling, and muscle weakness; chrond. is associated with improper training (over training or poor running style), sudden changes in training surface, lower extremity weakness and/or tightness, and foot overpronation(flat feet), knee may appear swollen and warm, and pain occurs behind the patella during activity

Question 5

Bone fractures:

1. Injury Definition
2. Impact on Exercise

Answer 5

1. low impact: come from short fall on a level surface or retreated micro traumas to a bone region, can result i a minor fracture or stress fracture, can occur in long distance runners, track athletes, and court sports; symptoms include progressive pain that is worse with weight-bearing activity, focal pain, pain at rest in some cases, and local swelling
2. High impact: high impact traumas like a car accident or high impact sports like football; often disabling; other medical conditions like infection, cancer, or osteoporosis can weaken bone and increase the risks for fracture

Question 6

(Tissue Reacting to Healing) Inflammatory Phase

Answer 6

1.can last up to six days, depending on the severity of the injury; focus is to immobilize the injured area and begin the healing process; increase blood flow occurs to bring in oxygen and nutrients to rebuild the damaged tissue
2.

Question 7

(Tissue Reacting to Healing) Fibroblastic/proliferation phase

Answer 7

1. begins at approx. 3 days and lasts approx. until day 21; begins with the wound filling with collagen and other cells, which will eventually form a scar; within 2-3 weeks, the wound can resist normal stresses, but would strength continues to build for several months

Question 8

(Tissue Reacting to Healing) Maturation/remodeling phase

Answer 8

1. begins at approx. day 21 and can last for up to two years; begins the remodeling of the scar, rebuilding of the bone, and/or restrengthening of tissue into a more organized structure; exercise progression must always be cautious when working with musculoskeletal injuries

Question 9

Signs and Symptoms of Tissue Inflammation

Answer 9

1. Pain
2. Redness
3. Swelling
4. Warmth
5. Loss of function

Question 10

Pre-existing injuries and their impact on exercise

Answer 10

PTs must respect the defined scope of practice and refrain from diagnosing injury; conduct a thorough medical history and assessment; does the client need to be cleared by a medical professional?can conduct a program if the client has local injuries (ankle sprain); after given clearance, the PT can begin to exercise the injured area

Question 11

Program modification for inflamed tissues

Answer 11

if a client has a pre-existing condition, the program may need to be modified; symptoms needed for change may include soreness that lasts for more than 24 hours, pain when sleeping or increased pain when sleeping, increased stiffness or decreased ROM over several sessions, swelling, redness, or warmth in healing tissue, progressive weakness over several sessions, decreased functional usage

Question 12

Acute injury management

Answer 12

refer them to a doctor asap; apply RICE:

1. rest or restricted activity (especially weight-bearing) until cleared by doc
2. Ice should be applied every hour for 10-20min until the tendency for swelling has passed
3. compression involves placing a compression wrap on the area to minimize local swelling
4. elevation of injury 6-10 inches above the level of the heart will help control the swelling

Question 13

Flexibility and musculoskeletal injuries

Answer 13

decreased flexibility has been associated with various musculoskeletal injuries, including muscle strains and overuse conditions; when a muscle become shortened and inflexible, it cannot lengthen appropriately or generate adequate force…this can lead to injury; PTs can develop a stretching program to help clients with flex. here are some contraindications that should be considered before stretching program (need medical clearance for stretching):

• a fracture that is healing
• acute soft-tissue injury
• post-surgical conditions
• joint hypermobility
• an area of infection
• a hematoma or other indication of trauma
• pain in the affected area
• restrictions from the client’s doc
• prolonged immobilization of muscles and connective tissue
• joint swelling from trauma or disease
• presence of osteoporosis or rheumatoid arthritis
• a history of prolonged corticosteroid use