Chapter 15 - Musculoskeletal Issues Flashcards
Pain vs Discomfort
Personal trainer needs to learn the difference between normal discomfort during exercise and pain from injury
Acute vs Chronic Injuries
Acute - quick onset, one point in time
Chronic - slow onset, harder to pinpoint
Three stages of healing
- Inflammation 3-4 days, non-weight bearing, ROM
- Repair 3 days - 6 weeks, weight bearing as tolerated
- Remodeling 3 weeks - 2 years, progress pain free exercise
Muscle Strain definition & Grades
The muscle works beyond its capacity resulting in tears of the muscle fibers. A result of unprepared exertion.
Grade 1 - minor, tender but strength the same
Grade 2 - moderate, painful, swollen, weaker
Grade 3 - extreme, complete tear of muscle
Ligament Sprains definition & Grades
Result of an external force applied, stretching the ligament to injury
Grade 1 - Minor, tiny collagen tears, RICE
Grade 2 - Moderate, complete tear of some collagen fibers, RICE & Dr eval
Grade 3 - Severe, complete ligament rupture, RICE, immobilize, prompt medical attention
Bone Fracture Considerations
Rare in PT setting but consider that osteoporosis, infection, cancer, radiation treatment and less conditioned bones are more susceptible to fractures
Concussion Considerations
Remove from activity if concussion is suspected. Symptoms are confusion and disorientation, memory loss, slurred speech, dizzy. Second Impact Syndrome can be life threatening and occurs after an initial impact. Get written return-to-activity from dr. before returning to activity
Common Overuse Conditions
Tendinitis, bursitis, fasciitis, plantar fasciitis, IT Band friction syndrome. “Itis” means inflammation of
Stress Fracture definition
Compression forces that put repetitive stress on a bone that is not strong enough to withstand these forces. Most frequently in tibia. Continued activity can worsen symptoms and lead to complete fracture.
Periodization definition & purpose
Systematic application of overload through variation of program components to optimize gains in strength while minimizing overuse, staleness, overtraining and plateaus.
Pain Scale
0 - 10 where 0 is no pain and 10 is worst pain possible
Explain scale to client
Discontinue exercise if pain exceeds 3
Encourage client to communicate any amount of pain
Ask client to assess pain level throughout exercise session
Chronic Pain Considerations
Chronic pain takes an emotional toll as well as physical. Remain empathetic and avoid judgment
Goal of Warm Up
Increase connective tissue elasticity in all planes of motion while stimulating proprioception
Cool Down
Static stretching is used at the end of a workout because studies have demonstrated neural inhibition and a decrease in strength after a prolonged stretch
Recovery
Recovery days should be spent addressing the health of the tissue along with ROM of the joints. Including self-myofascial release and stretching after light activity may promote recovery
Shoulder - Impingement Syndrome
Compression and inflammation of the supraspinatus tendon and subacromial bursa. Can lead to rotator cuff muscle tendon tear.
Shoulder Dysfunction Considerations
Avoid exercises requiring overhead movement - these movements require stability and strength beyond capability of compressed shoulder
Program Design for Shoulder
- Address postural imbalances
- Strengthen scapular stabilizing muscles incl. rotator cuff
- Improve anterior shoulder muscles & pecs w/controlled pushing motion
- Lastly, introduce overhead activities, overhead press
Elbow - Lateral Epicondylitis
Tennis Elbow - overuse injury of the wrist extensor muscle tendons near their origin on the lateral epicondyle of the humerus.
Elbow - Medial Epicondylitis
Golfers Elbow - overuse injury of wrist flexor muscle tendons near their origin on the medial epicondyle of the humerus. Common in adults 30-55 years old
Carpal Tunnel Syndrome
Inflammation of the flexor tendons that pass under the flexor retinaculum at the wrist. Eventually compresses the medial nerve.
Program Design for Elbow, Wrist, Hand
- Limit overuse by using various grips for comfort or gloves
- Increase ROM through gentle stretches in all planes
- Improve strength of wrist & hand w/wall push ups, wrist flexion and extension
- Remove gloves and slowly introduce volume to pulling exercises as tolerated
Neck Program Design
- Observe neck position in relation to spine. Address faulty position. Typically, Kyphosis.
- Introduce gentle movement and stretching that client can do anytime discomfort occurs. Include lateral and rotational movement.
- Refer to physician if pain is severe
Low Back Program Design
- Address imbalance between right and left sides
- Address anterior/posterior imbalance
- Increase functional internal and external rotation of the hip (wood chopper exercise
- Strengthen posterior chain especially hamstrings, & glutes
Cat/Cow
Modified Curl up
Bird Dog
Side plank
Low Back Issue considerations
80% of adults will experience low back pain
Most often occurs in adults 30-50 years old
Caused by: muscle strain, faulty posture (lordosis), poor fitness, disc disease, osteoarthritis, RA,
ankylosing Spondylitis (arthritis of spine), cancer
Piriformis Syndrome definition
Tight or inflamed piriformis muscle causing compression of the sciatic nerve that runs between it and the gemelli. Program design includes stretching.
Program Design for Hips
- Address imbalance between right and left sides
- Improve ROM of internal & external hip rotation and single leg stance stability
- Improve hip hinge mobility and stability
- Strengthen posterior chain
(Include static stretching early in the workout to inhibit tight muscles and increase ROM)
Knee Joint Type
Hinge joint but also has limited rotation ability 2-23 degrees)
IT Band Friction Syndrome definition & cause
Repetitive overuse condition caused by the distal portion of the IT Band rubs against the lateral femoral epicondyle causing pain in the lateral aspect of the knee. Primarily caused by poor training form, lack of recovery, or poor technique.
Types of knee tendonitis
Patella - just below patella (most common, tight quads)
Pes Anserine - medial side of knee, below patella
Quadriceps - above at front of knee
Program Design for Knees
- Address imbalances from left to right sides
- Address any tightness & instability in hip, ankle, foot
- Improve hip hinge mobility and stability
- Improve strength of posterior chain
Genu Valgum definition
Knock knees. If knees move inward during squat cue client to push harder into the floor
Ankle Sprains
Lateral sprain most common, inversion ankle sprains. Often lead to repetitive sprains. Exercises in frontal plane help, lateral lunges.
Program Design for Foot
- Address stability and mobility of foot and ankle
- Improve strength of muscles in the sagittal plane
- Improve strength of muscles in the transverse plane
- Improve strength of muscles in the posterior chain
