Chapter 15 - Musculoskeletal Issues

Question 1

Pain vs Discomfort

Answer 1

Personal trainer needs to learn the difference between normal discomfort during exercise and pain from injury

Question 2

Acute vs Chronic Injuries

Answer 2

Acute - quick onset, one point in time

Chronic - slow onset, harder to pinpoint

Question 3

Three stages of healing

Answer 3

1. Inflammation 3-4 days, non-weight bearing, ROM
2. Repair 3 days - 6 weeks, weight bearing as tolerated
3. Remodeling 3 weeks - 2 years, progress pain free exercise

Question 4

Muscle Strain definition & Grades

Answer 4

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

Question 5

Ligament Sprains definition & Grades

Answer 5

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

Question 6

Bone Fracture Considerations

Answer 6

Rare in PT setting but consider that osteoporosis, infection, cancer, radiation treatment and less conditioned bones are more susceptible to fractures

Question 7

Concussion Considerations

Answer 7

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

Question 8

Common Overuse Conditions

Answer 8

Tendinitis, bursitis, fasciitis, plantar fasciitis, IT Band friction syndrome. “Itis” means inflammation of

Question 9

Stress Fracture definition

Answer 9

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.

Question 10

Periodization definition & purpose

Answer 10

Systematic application of overload through variation of program components to optimize gains in strength while minimizing overuse, staleness, overtraining and plateaus.

Question 11

Pain Scale

Answer 11

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

Question 12

Chronic Pain Considerations

Answer 12

Chronic pain takes an emotional toll as well as physical. Remain empathetic and avoid judgment

Question 13

Goal of Warm Up

Answer 13

Increase connective tissue elasticity in all planes of motion while stimulating proprioception

Question 14

Cool Down

Answer 14

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

Question 15

Recovery

Answer 15

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

Question 16

Shoulder - Impingement Syndrome

Answer 16

Compression and inflammation of the supraspinatus tendon and subacromial bursa. Can lead to rotator cuff muscle tendon tear.

Question 17

Shoulder Dysfunction Considerations

Answer 17

Avoid exercises requiring overhead movement - these movements require stability and strength beyond capability of compressed shoulder

Question 18

Program Design for Shoulder

Answer 18

1. Address postural imbalances
2. Strengthen scapular stabilizing muscles incl. rotator cuff
3. Improve anterior shoulder muscles & pecs w/controlled pushing motion
4. Lastly, introduce overhead activities, overhead press

Question 19

Elbow - Lateral Epicondylitis

Answer 19

Tennis Elbow - overuse injury of the wrist extensor muscle tendons near their origin on the lateral epicondyle of the humerus.

Question 20

Elbow - Medial Epicondylitis

Answer 20

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

Question 21

Carpal Tunnel Syndrome

Answer 21

Inflammation of the flexor tendons that pass under the flexor retinaculum at the wrist. Eventually compresses the medial nerve.

Question 22

Program Design for Elbow, Wrist, Hand

Answer 22

1. Limit overuse by using various grips for comfort or gloves
2. Increase ROM through gentle stretches in all planes
3. Improve strength of wrist & hand w/wall push ups, wrist flexion and extension
4. Remove gloves and slowly introduce volume to pulling exercises as tolerated

Question 23

Neck Program Design

Answer 23

1. Observe neck position in relation to spine. Address faulty position. Typically, Kyphosis.
2. Introduce gentle movement and stretching that client can do anytime discomfort occurs. Include lateral and rotational movement.
3. Refer to physician if pain is severe

Question 24

Low Back Program Design

Answer 24

1. Address imbalance between right and left sides
2. Address anterior/posterior imbalance
3. Increase functional internal and external rotation of the hip (wood chopper exercise
4. Strengthen posterior chain especially hamstrings, & glutes

Cat/Cow
Modified Curl up
Bird Dog
Side plank

Question 25

Low Back Issue considerations

Answer 25

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

Question 26

Piriformis Syndrome definition

Answer 26

Tight or inflamed piriformis muscle causing compression of the sciatic nerve that runs between it and the gemelli. Program design includes stretching.

Question 27

Program Design for Hips

Answer 27

1. Address imbalance between right and left sides
2. Improve ROM of internal & external hip rotation and single leg stance stability
3. Improve hip hinge mobility and stability
4. Strengthen posterior chain
   (Include static stretching early in the workout to inhibit tight muscles and increase ROM)

Question 28

Knee Joint Type

Answer 28

Hinge joint but also has limited rotation ability 2-23 degrees)

Question 29

IT Band Friction Syndrome definition & cause

Answer 29

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.

Question 30

Types of knee tendonitis

Answer 30

Patella - just below patella (most common, tight quads)
Pes Anserine - medial side of knee, below patella
Quadriceps - above at front of knee

Question 31

Program Design for Knees

Answer 31

1. Address imbalances from left to right sides
2. Address any tightness & instability in hip, ankle, foot
3. Improve hip hinge mobility and stability
4. Improve strength of posterior chain

Question 32

Genu Valgum definition

Answer 32

Knock knees. If knees move inward during squat cue client to push harder into the floor

Question 33

Ankle Sprains

Answer 33

Lateral sprain most common, inversion ankle sprains. Often lead to repetitive sprains. Exercises in frontal plane help, lateral lunges.

Question 34

Program Design for Foot

Answer 34

1. Address stability and mobility of foot and ankle
2. Improve strength of muscles in the sagittal plane
3. Improve strength of muscles in the transverse plane
4. Improve strength of muscles in the posterior chain