Common Musculoskeletal Injuries and Implications for Exercise Flashcards
Grading System for Muscle Strains
- Grade 1: mild strain; few muscle fibers are torn; injured muscle is tender and painful with localized spasms
- Grade 2: moderate strain; large number of fibers injured and more severe pain; mild swelling, noticeable loss of function, and bruising
- Grade 3: complete tear; complete loss of function, severe pain, swelling, tenderness, discoloration, and palpable defect
risk factors for hamstring muscle strain
1) poor flexibility
2) poor posture
3) muscle imbalance
4) improper warm-up
5) training errors
sports where hip muscle strains are common
1) ice hockey
2) figure skating
3) sports that require explosive acceleration, deceleration, and change in direction with a lateral component
most prevalent risk factor for hip muscle strain
muscle imbalance between hip abductors and adductors
risk factors for calf muscle strains
1) muscle fatigue
2) fluid and electrolyte depletion
3) forced knee extension while foot is dorsiflexed
4) forced dorsiflexion while the knee is extended
most common joints for sprains (4 of them)
1) ankle
2) knee
3) thumb/finger
4) shoulder
Grading System for Ligament Sprains
- Grade 1: minimal tenderness and impairment; RICE acute care
- Grade 2: moderate tenderness and impairment with decreased ROM; RICE and physical evaluation for acute care
- Grade 3: significant swelling and impairment with instability; acute care is immobilization with air splint, RICE, and prompt physician evaluation
T/F: Males are at a two- to -ten-fold greater risk of ACL injury than females.
False
Females are at greater risk
T/F: ACL injuries are more prevalent than MCL injuries, although it is common for both to be injured at the same time.
True
how injury to the MCL is isolated
impact to the outer knee with no twisting involved
common medical conditions of overuse/overtraining
1) tendinitis
2) bursitis
3) fasciitis
inflammation of the tendon
tendinitis
common areas of the body where tendinitis is diagnosed
shoulders, elbow, knees, and ankles
inflammation of the bursa sac due to acute trauma, repetitive stress, muscle imbalance, or muscle tightness on top of the bursa
bursitis
common areas of the body where bursitis is diagnosed
shoulders, hips, and knees
inflammation of connective tissue (fascia)
fasciitis
common areas of the body where fasciitis is diagnosed
bottom and back of the foot
the two types of knee cartilage
1) hyaline - covers the bone
2) menisci - act as shock absorbers
the multiple functions of the menisci cartilage
1) shock absorption
2) stability
3) joint congruency
4) lubrication
5) proprioception
T/F: Meniscal injuries usually result from trauma, commonly associated with a combination of loading and twisting of the joint, or occur in conjunction with ACL tears (i.e., lateral meniscus) or MCL tears (i.e., medial meniscus).
True
a softening or wearing away of the cartilage behind the patella, resulting in pain and inflammation
chondromalacia
common causes of chondromalacia
1) improper training methods (e.g., overtraining)
2) sudden changes in training surface
3) lower-extremity muscle weakness and/or tightness
4) foot overpronation (i.e., flat feet)
common symptom of chondromalacia
knee pain that increases when walking up or down stairs
another term for low-impact bone fracture
stress fracture
another term for high-impact bone fracture
pathological fracture
signs and symptoms of stress fractures
1) progressive pain that worsens with weight-bearing activity
2) focal pain
3) pain at rest
4) local swelling
sports/athletes that commonly suffer from stress fractures
1) distance runners
2) track athletes
3) court sport athletes (e.g., basketball, volleyball)
persons that commonly suffer from pathological (high-impact) fractures
1) motor vehicle accident
2) high-impact sports (e.g., football, rugby)
medical conditions that can increase risks for fracture
1) infection
2) cancer
3) osteoporosis
3 phases of tissue healing
1) inflammatory phase
2) fibroblastic/proliferation phase
3) maturation/remodeling phase
time frame of the inflammatory phase of tissue healing
up to 6 days
focus of the inflammatory phase of tissue healing
immobilize the injured area and increase blood flow to bring oxygen and nutrients to rebuild the damaged tissue
time frame of the fibroblastic/proliferation phase
starts at day 3 and lasts approx until day 21
process of the fibroblastic/proliferation phase
wound is filled with collagen and other cells, eventually forming a scar; within 2-3 weeks the wound can resist normal stresses but wound strength continues to build for several months
time frame of the maturation/remodeling phase
begins approx at day 3 and can last up to 2 years
process of the maturation/remodeling phase
remodeling the scar, rebuilding the bone, and/or strengthening the tissue
signs and symptoms of tissue inflammation
1) pain
2) redness
3) swelling
4) warmth
5) loss of function
T/F: It is within the PT’s scope of practice to diagnose a client’s injury.
False
The most important question and PT must answer when performing a client’s medical history and assessment
Is the client appropriate for exercise or should they be cleared by a medical professional?
T/F: If a client has a localized injury (e.g., ankle sprain), they should still be able to participate in a modified exercise program using non-injured parts of the body.
True
How often should ice be applied to an acute injury when using the RICE protocol?
10-20 min each hour until the tendency for swelling has passed
What does elevation of the acute injury help do and/or prevent?
1) control and reduce swelling
2) reduce hemorrhage
3) reduce inflammation
4) reduce pain
the joint with the largest ROM
shoulder joint
Conservative Management of Common Musculoskeletal Injuries
1) avoid aggravating activities or movements
2) physical therapy
3) modalities (e.g., ice and heat)
4) oral anti-inflammatory medication
5) cortisone injections
exercise protocols for a client recovering from a shoulder strain and/or sprain
1) strengthen scapular stabilizers (rhomboids, middle trapezius, and serratus anterior) and rotator cuff
2) stretching major muscle groups around the shoulder to restore proper length to these muscles
T/F: A common modification of the overhead press is having the client not fully extend the arms and position the shoulders more toward the front of the body (scapular plane, 30 degrees anterior to the frontal plane) which helps prevent impingement (pinching) of shoulder structures.
True
exercise programming for a client recovering from a rotator cuff injury
typically immobilized for 6-8 weeks (only passive activity) and can be cleared for gym activity after 16 weeks (transition from physical therapy) - exercise guidelines come from a physical therapist or surgeon
two common elbow tendinitis injuries
1) lateral epicondylitis
2) medial epicondylitis
commonly called “tennis elbow”; overuse or repetitive-trauma injury of the wrist extensor muscle tendons
lateral epicondylitis
commonly called “golfer’s elbow”; overuse or repetitive-trauma injury of the wrist flexor muscle tendons
medial epicondylitis
goal of exercise programming for elbow tendinitis
regaining strength and flexibility of the flexor/pronator and extensor/supinator muscles of the wrist and elbow
exercise protocol for clients with elbow tendinitis
1) avoid high-rep activity
2) low weight and reps for biceps and wrist curls
3) use caution with full elbow extension exercises (e.g., dumbbell front raises)
goal of exercise programming for carpal tunnel
regaining strength and flexibility in the elbow, wrist, and finger flexors and extensors
exercise protocol for clients with carpal tunnel
avoid movement with full wrist flexion or extension
athletes commonly affected by greater trochanteric bursitis
female runners, cross-country skiers, and ballet dancers
major sign/symptom of greater trochanteric bursitis
walking with a limp (e.g., Trendelenberg gait)
goal of exercise programming for greater trochanteric bursitis
regaining flexibility and strength at the hip through:
1) stretching the IT band, hamstrings, and quads
2) strengthening the gluteals and deeper hip rotator muscles
3) proper gait techniques in walking and running
exercise protocol for clients with greater trochanteric bursitis
1) avoid side-lying positions that compress the lateral hip
2) higher-loading activities for the legs
3) possible benefit for aquatic exercise
5 recommendations for proper footwear
1) get fitted either at end of the day or at time of exercise
2) width of index finger is the appropriate space between longest toe and end of the shoe
3) ball of the foot matches the widest part of the shoe
4) shoes should not pinch or rub any area of the foot or ankle
5) wear the same socks that would be worn for exercise
a repetitive overuse condition that occurs when the distal portion of the IT band rubs against the lateral femoral epicondyle and is caused primarily by training errors
iliotibial band syndrome (ITBS)
athletes commonly affected by ITBS
runners, cyclists, volleyball players, and weight lifters
signs and symptoms of ITBS
tightness, burning, or pain at the lateral aspect of the knee during activity
goal of exercise programming for ITBS
regaining flexibility and strength at the hip and lateral thigh
exercise protocol for clients with ITBS
avoid higher-loading activities such as lunges or squats; lunges and squats may be limited to 45 degrees of knee flexion and gradually progress to 90 degrees
often called “anterior knee pain” or “runner’s knee”
patellofemoral pain syndrome (PFPS)
3 categories/causes of patellofemoral pain syndrome (PFPS)
1) overuse
2) biomechanical
3) muscle dysfunction
signs and symptoms of patellofemoral pain syndrome (PFPS)
experience pain when ascending or descending stairs, squatting, prolonged sitting, running
goal of exercise programming for patellofemoral pain syndrome (PFPS)
restoring proper flexibility and strength in hip, knee, and ankle, as well as hamstrings and calves
exercise protocol for clients with patellofemoral pain syndrome (PFPS)
focus on closed-chain exercises (e.g., squats and lunges) and avoid open-chain exercises (e.g. leg extensions)
often called “jumper’s knee” and is an inflammation of the patellar tendon at the insertion of the distal part of the patella and proximal tibia
infrapatellar tendinitis
goal of exercise programming for infrapatellar tendinitis
restore flexibility and strength in the lower extremity
inflammation of the periosteum (connective tissue covering the bone) and also called posterior shin splints
medial tibial stress syndrome (MTSS)
most common type of ankle sprain
lateral (inversion) ankle sprain
amount of time before a client can exercise post ankle sprain (dependent upon grade)
- Grade 1: 1-2 weeks
- Grade 2: 4-8 weeks
- Grade 3: 12-16 weeks
goal of exercise programming for ankle sprains
restore proprioception, flexibility, stability, and strength
exercise progression for clients recovering from ankle sprains
1) straight-plane motions (e.g., forward running)
2) side-to-side motions (e.g., sidestepping)
3) multidirectional motions (e.g., carioca)
intrinsic risk factors for achilles tendinitis
1) age
2) pes cavus
3) pes planus
4) leg-length disparities
5) lateral ankle instability
extrinsic risk factors for achilles tendinitis
1) training errors
2) prior injuries
3) poor footwear
4) muscle weakness
5) poor flexibility
T/F: Controlled eccentric strengthening of the calf complex has been shown to be beneficial in helping relieve symptoms.
True
intrinsic factors of plantar fasciitis
1) pes planus
2) pes cavus
extrinsic factors of plantar fasciitis
1) overtraining
2) improper footwear
3) obesity
4) unyielding surfaces
exercise programming for clients with plantar fasciitis
integrating specific foot exercises, but do not excessively overload the foot; stretching the gastrocnemius, soleus, and plantar fascia and self-myofascial release using a golf ball, baseball, or dumbbell
the nerve most commonly compressed due to carpal tunnel syndrome
median nerve
where a client with IT band syndrome may have issues
1) weakness in hip abductors
2) IT band shortening
3) tenderness throughout the IT band complex
muscles to be stretched to help relieve symptoms of medial tibial stress syndrome and/or anterior shin splints
soleus and anterior compartment of the lower leg
type of injury that can be classified as longitudinal, oblique, transverse, or compression
stress fractures
most commonly reported knee injury involves damage to the…
menisci
