Chronic MSK injuries Flashcards
what are the three challenges with chronic MSK injuries?
1) diagnosis
- requires comprehensive history of onset, nature, and pain
- as well as an assessment of risk factors such as training and technique
2) understand exactly how the injury occurred (etiology)
- can be quite evident or very subtle
- causes can normally be divided into extrinsic or intrinsic factors
3) treatment
- address the cause
- as well as activity modification, specific exercises to promote tissue repair, and manual therapy
7 extrinsic predisposing factors for chronic MSK injuries
1) training errors
- excessive volume or intensity
- rapid increase
- sudden change in type
- excessive fatigue
- inadequate recovery
- faulty technique
2) surfaces
- hard/soft
3) inappropriate/worn out shoes
4) inappropriate equipment
5) environmental conditions
6) psychological factors
7) inadequate nutrition
6 intrinsic predisposing factors to MSK injuries
1) malalignment
- pes planus/cavus, rearfoot varus
- genu valgum/varum
- patella alta
- femoral neck anteversion
- tibial torsion
2) leg length discrepancy
3) muscle imbalance/weakness
- can lead to pelvic rotation/ quad/hamstring balance
4) lack of flexibility
- general muscle tightness
- focal areas of muscle thickening
- restricted joint ROM
5) sex, size, and body composition
6) other:
- genetic factors
- endocrine factors
- metabolic conditions
muscle cramp - def./etiology
def: painful involuntary muscular contractions that occur suddenly and are temporarily debilitating
- most common in muscle that are overloaded and fatigued during high demand activities (calf, hamstrings, quadriceps, or abdomen)
Due to altered NM control rather than fluid/electrolyte imbalance:
- increased muscle spindle activity, and decreased GTO activity (mechanoreceptors) - over fatigued muscles
- causes continued muscle contraction
muscle cramps: treatment
- regular stretching
- correct muscle imbalances and posture
- good fitness levels (S and C program)
- incorporate plyometric exercises into training
- CHO diet
- massage or trigger pointing therapy
muscle guarding - def.
muscle surrounding an injury site contract to splint and protect the area
-minimize pain my limiting movement
-common in whiplash and low back pain
muscle soreness - def
result of unaccustomed or repetitive activity participation
-older athletes are more susceptible
what are the two types of muscle soreness?
1) acute onset: accompanies fatigue; immediate and transient
2) delayed onset (DOMS): most intense 24-48 hours after activity
- appears 12 hours after activity, can last for 3-4 days
- S&S: pain leading to increased muscle tension, swelling, and stiffness/resistance to stretching
what are the causes of DOMS?
- very small tears in the muscle tissue, due to eccentric isometric contractions
- disruption of the connective tissue surrounding muscle.tendon fibers
how can we prevent DOMS?
- properly planned training program (periodization)
- proper warm up/cool down
how can we treat DOMS?
-massage, cryotherapy, stretching and active recovery
tendinopathy - def.
any pathology in a tendon
tendinitis - def
inflammation of a tendon
tendinosis - def
tendon degeneration without inflammation
tenosynovitis - def
inflammation of the synovial sheath of a tendon
what are the three stages of tendon pathology
1) reactive tendinopathy
- non inflammatory response to tendon cells and matrix proteins; proliferation of tendon cells to get short term thickening to reduce stress
2) tendon dys-repair
- matrix breakdown; tendon cells that are present in larger numbers and changed appearance; protein production increases (collagen and matrix); collagen separates and matrix become disorganized
3) degenerative tendinopathy
- tendon cells and matrix continue to change (cell death); matrix becomes more disorganized; collagen is weak (type 3) and decreased
tendinitis - etiology and S and S
etiology: with repeated movements, a tendon becomes irritated or inflamed from sliding over other structures
S&S: pain on movement, swelling, warmth, and crepitus
what are the common injury sites of tendinitis?
achilles tendon in runners, shoulder in swimmers, and elbow in racquet sports
how can we treat tendinitis?
REST
- allow the normal healing process (inflammatory phase) to occur
- perform cross-training activities
-swimming takes stress off tendons, don’t need to be completely sedentary
tendinosis - etiology and S&S
etiology: when repetitive overuse movement continues and the inflamed tendon fails to heal
S&S:
- pain after exercise, or more frequently, the following morning
- pain-free at rest and becomes more painful with activity
- pain disappears when warm up, but returns after cool down
- in early stages, can still full train (although it interferes with healing)
- local tenderness and or thickening on examination
- swelling and possibly crepitus (crepitus more typical of tendinitis)
tendinosis: treatment
1) strengthening
- progressive loading
- isometric - eccentric - plyometric
2) stretching
- static, dynamic of PNF (proprioceptive neuromuscular facilitation) depending on the individual and activity participation
tenosynovitis: etiology and treatment
etiology: tendons that have a tight space through which they move are surrounded by a synovial sheath
- hand and wrists, feet and ankles, proximal biceps tendon
- repetitive movements cause inflammation when tendon rubs over the bony prominence
treatment: similar to tendinitis (rest)
- anti-inflammatory drugs
osteoarthritis - def
degeneration of the articular (hyaline) cartilage
-most common in weight bearing joints (knees, hips, and lumbar spine)
what are the causes of osteoarthritis?
wear and tear from normal ADLs (common in older individuals)
-mechanical changes to the joint due to acute or chronic trauma
stage I osteoarthritis
-minimum disruption, there is already 10% cartilage loss
stage II osteoarthritis
joint space narrowing
- the cartilage begins to break down
- occurrence of osteophytes
stage III osteoarthritis
moderate joint space reduction
-gaps in the cartilage can expand until they reach the bone
stage IV osteoarthritis
joint space greatly reduced
- 60% of the cartilage is already lost
- large osteophytes
what are the S&S of osteoarthritis
- pain with activity, relieved with rest
- stiffness, especially in the morning) decrease with activity)
- localized tenderness, creaking, and grating sensations
osteoarthritis: treatment
- decrease body weight (puts more force on the joint - more wear and tear)
- anti-gravity treadmill (decreases a person’s weight so they can exercise with less pain)
- glucosamine sulfate (promotes healthy cartilage)
- joint replacement (partial or full)
capsulitis and synovitis - etiology
- chronic inflammatory following repeated joint injuries or improperly managed injury
- joint capsule tightens
- synovium irregularly thickened and exudation present (joint edema)
-typically comes from another injury, when immobilized for long periods of time
what are the S&S of capsulitis and synovitis?
-restricted joint ROM, grinding or creaking noises
capsulitis/synovitis: treatment
-joint mobilization, ROM exercises, and stretching surrounding musculature
stress fracture
- inability of bone to withstand repetitive mechanical loading (osteoCLASTIC activity surpasses the osteoBLASTIC activity)
- resulting in structural fatigue (micro damage) and bone marrow edema
- body will try to form new periosteal bone to reinforce (stress reaction, to stress fracture, to complete bone fracture
stress fracture: S&S
- swelling
- focal tenderness
- pain with activity, but not at rest - later pain is constant, including at night
what are the 4 main causes of a stress fracture?
1) overtraining
- frequency, volume, or intensity
2) faulty posture and biomechanics
- leads to abnormal bone loading
3) training surface
- recent changes to a surface the athlete is unaccustomed to
- less compliant, very compliant, downhill, or altered terrains
4) footwear and equipment
- old or worn out shoes lose shock absorption
- orthotics influence mechanics of foot, ankle, and kinetic chain
stress fracture classification: low risk
usually just requires rest or activity modification
- pelvis
- femoral shaft
- medial tibia
- calcaneus
- metatarsals (1-4)
stress fracture classification: high risk
can experience non-union or complete fractures
- femoral neck
- anterior tibia
- medial malleolus
- talus
- navicular
- 5th metatarsal
- sesamoid bones of big toe
stress fracture: diagnosis
-early detection is difficult
Clinically:
- complaint of localized pain during or after activity and persists if activity is continued
- review of training history (volume or intensity), surfaces and equipment (i.e. footwear)
- physical examination looking for point tenderness and special tests (percussion fracture test)
- bone reaction can take several weeks to detect via imaging
- X-ray may appear normal, might require a bone scan or an MRI
stress fracture: treatment
- rest and activity modification
- gradual RTP to adapt to loads or stress once pain free and no point tenderness upon palpation
- maintain fitness levels without impact
- correct any training or biomechanical errors
- consider cushioned shoes or rigid orthotics (if abnormal biomechanics in foot)
Therapy options:
- electric stimulation or shockwave therapy
- drugs (i.e. pamidronate)
what are the locations in which a stress fracture would require specific treatment other than rest?
femoral neck, talus, navicular, metatarsal - 2nd base, sesamoid bone of the foot, metatarsal - 5th base, and anterior tibial cortex
periostitis - def
- inflammation of the periosteum (outer layer of bone)
- at the interface between the muscle and the bony attachment
- most common condition: medial tibial stress syndrome (MTSS)
- “shin splints”
- pain on lower medial aspect of tibia
apophysitis - def
- irritation and inflammation of the apophysis, a secondary ossification center which acts as an insertion site for a tendon
- common overuse injury in young athletes (susceptible because of repetitive stress or an acute avulsion injury) (before you’ve reached full growth potential - skeletally mature)
what are two examples of apophysitis?
1) Osgood Shlatter’s disease: inflammation of the patellar ligament at the tibial tuberosity
2) Sever’s disease: inflammation of the growth plate in the heel of growing children (calcaneal apophysitis)
neuritis - def
- inflammation of a nerve
- symptoms can range from minor to severe
minor: pain, paresthesia (pins and needles), paresis (weakness), hypoesthesia (numbess)
severe: anesthesia (sensory loss), paralysis (motor loss), muscle wasting, and disappearance of the reflexes
blisters - def
- collection of fluid below or within the epidermis
- due to horizontal shearing and compressive forces
- common on hands, feet, depending on sport
bursitis - def
Inflammation of bursa
- bursa facilitates movement of tendons over bony prominences, reducing friction
- excessive shearing and/or compressive forces causes inflammation
common in knee, hip, and shoulder
