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Injury Prevention | by Tiffany Steinke
According to American Council on Exercise, musculoskeletal injuries are the most common injuries that occur in active individuals and one of the most common reasons why people stop being active. This article describes musculoskeletal injuries, acute treatments, First Aid, and prevention of injuries.
Whether you are a personal trainer, coach, beginner or advanced exerciser, you should never try to diagnose an injury. When there is an injury, it is best to consult and refer your client to a reputable health practitioner who specializes in musculoskeletal health and injuries.
What are musculoskeletal injuries?
There are four tissue types of the body when discussing musculoskeletal injuries: muscle, tendon, ligament and bone-with four basic types of injuries: sprains, strains, dislocations and fractures.
What is the difference between a strain
and a sprain?
Muscle tissue is elastic and can absorb a tremendous amount of shock. A strain is a stretching and tearing of muscle tissue. The more severe strain may be called a rupture or complete tear. Strains are often caused by lifting something heavy, overuse or overtraining. Strains usually involve the muscles in the neck, back, thigh, or the back of the lower leg. Some strains can reoccur, especially in the neck or back. Scar tissue, known as collagen tissue, needs to be stretched in post-rehabilitation programs to enable the collagen tissue to “line up” in the direction of the surrounding muscle fibers to prevent reoccurring injuries.
A sprain is an injury to a ligament. Ligament tissue connects bone to bone. Ligaments are found around joints and are nonelastic. Unlike muscle tissue, ligament tissue does not contract when stretched. When this occurs, ligaments allow for greater joint motion. When joints are forced beyond a normal range of movement, ligaments stretch and tear. Strengthening of surrounding muscle groups is crucial. The severity of the injury is graded by degree: first degree-minimal damage; second degree-partial tearing of the ligament; third degree-complete ligament disruption (which is a separation of a bone from its position at a joint called a dislocation). A subluxation is an incomplete or partial dislocation of a joint.
What is tendinitis and bursitis?
Tendinitis and bursitis are the most common musculoskeletal conditions. Tendinitis is inflammation of a muscle tendon. Tendons lie at the ends of muscles where they attach to bones. Acute or chronic pain occurs with movement of the muscle or joint if a tendon is inflamed. The inflammation of a bursa is called bursitis. Bursas surround joints and muscle tendons. Bursas are a sac-like cavity filled with fluid. They guide and lubricate the muscles and joints, which enables a muscle or tendon to slide over bone. Signs of Bursitis include intense pain, sensitivity to touch or movement and limited range of motion. Health care professionals can diagnose tendinitis and bursitis by muscle testing, palpatation and determining the history of the injury.
What kind of things should I ask
my health care practitioner?
Do not settle for a general diagnosis. Ask for details; "is it a muscle strain or tear, a pulled tendon, a ligament sprain or an irritated bursa?" Ask for the specific treatment and get the name of the particular muscle, bursa or ligament involved.
What are stress fractures and how do I know if I have them?
Bone tissue can develop cracks from abnormal types and amounts of stress, resulting in stress fractures. There are four basic types of stress fractures. Oblique fracture-most common, compression fracture, transverse fracture and longitudinal fracture-least common. Signs and symptoms of a stress fracture include pain during the activity that is relieved by rest, though occasionally a stress fracture will present sudden acute pain. In the next stage, the pain continues for hours, possibly through the night or it might become worse during the night (pain that becomes worse at night is highly suggestive of bone pain). Swelling may occur, especially after activity. Localized tenderness is almost always present over the fracture.
What is the immediate treatment for minor strains, sprains, tendinitis, bursitis and stress fractures?
Ice can numb the area and reduce pain and inflammation by constricting blood vessels to limit the blood supply at the injured area. Ice can be used to decrease muscle spasms. Ice is recommended to use immediately after exercise if an area is painful or swollen. The Protocol for acute treatment of musculoskeletal injuries is known by the acronym, RICE, Rest, Ice, Compression and Elevation.
Rest: discontinue the activity that affects or may cause further injury.
Ice: to avoid frostbite and/or nerve palsy, there should be an insulating layer between the skin and ice. Ice should be applied for 15 minutes every two hours following the injury. Never apply ice to an already numbed area. Ice two or three times a day for general irritation.
Compression: to prevent or reduce excessive swelling, use an elastic bandage. The elastic bandage should extend from the largest muscle area below the injury, to the largest group above the injury.
Elevation: the injured areas should be raised at level with, or slightly above the heart. The force of gravity can alleviate swelling.
When do I use heat versus ice?
When the injury immediately occurs, there is an increase in temperature. Damaged blood vessels and an increase of white blood cells attribute to the increase of blood flow to the injured area. Due to this “Local fever," heat, hot packs or hot soaks are not recommended for a new injury. Heat should only be used when an injury is at a more advanced stage of healing -usually after four or five days. Use microwavable heat packs or moist hot towels for 10 to 15 minutes several times a day. Always have an insulated layer in between the skin and the heating element chosen.
Can I still exercise when I have an injury?
Most likely yes, be sure to have your coach or trainer collaborate with your doctor to provide a safe post rehabilitation program. Exercise can be great therapy, but it can damage the existing injury if you are not strengthening or stretching the appropriate muscle groups. Training should be graduated so that enough time is allowed for healing to occur. Symptoms will reappear if training or exercise is resumed to quickly.
How do I know when my injury is healed?
If the injured area begins to swell, becomes painful or loses range of motion, you are not ready to return to that particular activity. Continue cross training or the post-rehabilitative program designed by a health care professional.
Generally minor injuries can heal in two to six weeks depending on the adherence of the client following their rehabilitative stretching and strengthening program. A dynamic rehabilitation program should also include proprioception exercises to enhance balance, stability and coordination.
How can I prevent injuries?
Take two to five minutes stretching before your five to ten minute warm-up and after five minute cool-down at the end of your workout. Stretching should be slow (15 to 30 seconds) and controlled through a full range of motion-no bouncing! A flexible muscle is better able to absorb shock and periodic overstretching than an inflexible muscle. Listen to your body-if you are placing too great of a physical demand on your body, stop exercising before you feel pain or discomfort. Be sure to wear the proper footwear for the sport you are choosing to engage in. Many running athletic shoe stores can watch you run or walk and help you to pick out a shoe or make an orthodox insert that will keep you from pronating or inverting. If you have an orthodox, brace or wrap, continue to wear them and be sure to RICE with any sign of inflammation or tenderness!
One way to avoid an overuse injury would be to modify your workout with cross training. To determine an effective cross training program, look at the joint action(s) and muscle group(s) being worked and replace it with an exercise that targets the same group(s). For example, cross training for running would be a stair climber and cross-country skiing, because these machines target similar muscle groups. Cross training can also be varying the type of intensity and changing the sequence of machines.
Are there different kinds of fractures?
A fracture can be a complete break, a chip, or a crack in a bone. Fractures are either open or closed. In a closed fracture, the skin is not broken. In an open (compound) fracture, there is an open wound and the fractured bone may or may not be visible. A fracture can be caused by a number of different forces:
Direct force-The bone is broken at the site of the force.
Indirect force-Trauma is inflicted at a distance from the resulting fracture. An example of this is falling on the outstretched hand and sustaining a fracture of the clavicle.
Avulsion force-A portion of the bone is pulled off by the attached muscle, tendon or ligament.
If a fracture is present, the main features are unnatural mobility of the body part, deformity, local tenderness over the bone and crackling sounds during movement. If your client complains of localized pain over a bone or can feel and/or hear a “snap”, you should consider the possibility of a fracture. Beware of the old tail, “if you can move it, it isn’t broken,” because this is not true.
How can I help someone who has a fracture, subluxation or a dislocation?
1. Call paramedics immediately if the following signs and symptoms appear:
Pale, cool and clammy skin; weak pulse; signs of shock; internal bleeding-vomiting
or coughing up blood; difficulty breathing, extreme pain or tenderness over area.
2. Remove or cut away clothing that covers the injury. This could reduce contamination of an open fracture. Open fractures are more dangerous because of the severe bleeding and chance of infection. The wound needs to be covered with a sterile dressing and control the bleeding.
3. If there is an open fracture, dislocation or subluxation, do not attempt to push protruding ends of bone back into place.
4. If the injury is not too serious, splint the limb to immobilize it. However if there is a gross deformity or you are untrained, merely prevent the limb from moving until medical attention arrives. Only apply a splint if you can do it without causing further pain or discomfort. The fracture needs to be immobilized and elevated if possible, but splint an injury in the position that you find it. To immobilize a bone, a splint must include the joints above and below the fracture. To immobilize a joint, a splint must include the bones above and below the injured joint . Be sure to check for proper circulation before and after splinting by barely touching the end of their toes or fingers.
Remember you should never try to diagnose an injury. When there is an injury, it is best to consult a reputable health practitioner who knows about musculoskeletal health and injuries. Contact your local American Red Cross and become certified in Community First Aid and Safety. It’s worth it-you could save a life!
In the subsequent articles, I will be discussing some of the most common injuries of the upper and lower extremities. I would like to answer your questions about specific injuries. Send your questions and comments to Tisteinke@iquest.net, or write to UltraFitt. •
What are your thoughts? If you have any comments or questions regarding this article or have questions about fitness in general, please write to Ask The Trainer, Tiffany Steinke at UltraFitt. 7462 East Fishers, Station Drive Suite 437, Fishers, IN 46038 or Email: editor@ultrafitt.com
Tiffany Steinke has always had a passion for fitness and enjoys sharing it with others. She has a Master's degree in Kinesiology from Indiana University in Bloomington. Her emphasis is in Rehabilitation and Conditioning of Special Populations and Sport Athletes. She is also a certified instructor of Community CPR and First Aid by the Red Cross. Tiffany is an accomplished marathon runner, and is currently training for future marathons and triathlons. She is Team Captain for Team-N-Training for the Indiana Chapter Leukemia Society of America. Tiffany is Head Trainer at Family Fun & Fitness in Greenfield.
Join the FREE Fitness Club Now for Weight loss, Strength and Fat Burning Workouts!
BACK TO ARTICLES
According to American Council on Exercise, musculoskeletal injuries are the most common injuries that occur in active individuals and one of the most common reasons why people stop being active. This article describes musculoskeletal injuries, acute treatments, First Aid, and prevention of injuries.
Whether you are a personal trainer, coach, beginner or advanced exerciser, you should never try to diagnose an injury. When there is an injury, it is best to consult and refer your client to a reputable health practitioner who specializes in musculoskeletal health and injuries.
What are musculoskeletal injuries?
There are four tissue types of the body when discussing musculoskeletal injuries: muscle, tendon, ligament and bone-with four basic types of injuries: sprains, strains, dislocations and fractures.
What is the difference between a strain
and a sprain?
Muscle tissue is elastic and can absorb a tremendous amount of shock. A strain is a stretching and tearing of muscle tissue. The more severe strain may be called a rupture or complete tear. Strains are often caused by lifting something heavy, overuse or overtraining. Strains usually involve the muscles in the neck, back, thigh, or the back of the lower leg. Some strains can reoccur, especially in the neck or back. Scar tissue, known as collagen tissue, needs to be stretched in post-rehabilitation programs to enable the collagen tissue to “line up” in the direction of the surrounding muscle fibers to prevent reoccurring injuries.
A sprain is an injury to a ligament. Ligament tissue connects bone to bone. Ligaments are found around joints and are nonelastic. Unlike muscle tissue, ligament tissue does not contract when stretched. When this occurs, ligaments allow for greater joint motion. When joints are forced beyond a normal range of movement, ligaments stretch and tear. Strengthening of surrounding muscle groups is crucial. The severity of the injury is graded by degree: first degree-minimal damage; second degree-partial tearing of the ligament; third degree-complete ligament disruption (which is a separation of a bone from its position at a joint called a dislocation). A subluxation is an incomplete or partial dislocation of a joint.
What is tendinitis and bursitis?
Tendinitis and bursitis are the most common musculoskeletal conditions. Tendinitis is inflammation of a muscle tendon. Tendons lie at the ends of muscles where they attach to bones. Acute or chronic pain occurs with movement of the muscle or joint if a tendon is inflamed. The inflammation of a bursa is called bursitis. Bursas surround joints and muscle tendons. Bursas are a sac-like cavity filled with fluid. They guide and lubricate the muscles and joints, which enables a muscle or tendon to slide over bone. Signs of Bursitis include intense pain, sensitivity to touch or movement and limited range of motion. Health care professionals can diagnose tendinitis and bursitis by muscle testing, palpatation and determining the history of the injury.
What kind of things should I ask
my health care practitioner?
Do not settle for a general diagnosis. Ask for details; "is it a muscle strain or tear, a pulled tendon, a ligament sprain or an irritated bursa?" Ask for the specific treatment and get the name of the particular muscle, bursa or ligament involved.
What are stress fractures and how do I know if I have them?
Bone tissue can develop cracks from abnormal types and amounts of stress, resulting in stress fractures. There are four basic types of stress fractures. Oblique fracture-most common, compression fracture, transverse fracture and longitudinal fracture-least common. Signs and symptoms of a stress fracture include pain during the activity that is relieved by rest, though occasionally a stress fracture will present sudden acute pain. In the next stage, the pain continues for hours, possibly through the night or it might become worse during the night (pain that becomes worse at night is highly suggestive of bone pain). Swelling may occur, especially after activity. Localized tenderness is almost always present over the fracture.
What is the immediate treatment for minor strains, sprains, tendinitis, bursitis and stress fractures?
Ice can numb the area and reduce pain and inflammation by constricting blood vessels to limit the blood supply at the injured area. Ice can be used to decrease muscle spasms. Ice is recommended to use immediately after exercise if an area is painful or swollen. The Protocol for acute treatment of musculoskeletal injuries is known by the acronym, RICE, Rest, Ice, Compression and Elevation.
Rest: discontinue the activity that affects or may cause further injury.
Ice: to avoid frostbite and/or nerve palsy, there should be an insulating layer between the skin and ice. Ice should be applied for 15 minutes every two hours following the injury. Never apply ice to an already numbed area. Ice two or three times a day for general irritation.
Compression: to prevent or reduce excessive swelling, use an elastic bandage. The elastic bandage should extend from the largest muscle area below the injury, to the largest group above the injury.
Elevation: the injured areas should be raised at level with, or slightly above the heart. The force of gravity can alleviate swelling.
When do I use heat versus ice?
When the injury immediately occurs, there is an increase in temperature. Damaged blood vessels and an increase of white blood cells attribute to the increase of blood flow to the injured area. Due to this “Local fever," heat, hot packs or hot soaks are not recommended for a new injury. Heat should only be used when an injury is at a more advanced stage of healing -usually after four or five days. Use microwavable heat packs or moist hot towels for 10 to 15 minutes several times a day. Always have an insulated layer in between the skin and the heating element chosen.
Can I still exercise when I have an injury?
Most likely yes, be sure to have your coach or trainer collaborate with your doctor to provide a safe post rehabilitation program. Exercise can be great therapy, but it can damage the existing injury if you are not strengthening or stretching the appropriate muscle groups. Training should be graduated so that enough time is allowed for healing to occur. Symptoms will reappear if training or exercise is resumed to quickly.
How do I know when my injury is healed?
If the injured area begins to swell, becomes painful or loses range of motion, you are not ready to return to that particular activity. Continue cross training or the post-rehabilitative program designed by a health care professional.
Generally minor injuries can heal in two to six weeks depending on the adherence of the client following their rehabilitative stretching and strengthening program. A dynamic rehabilitation program should also include proprioception exercises to enhance balance, stability and coordination.
How can I prevent injuries?
Take two to five minutes stretching before your five to ten minute warm-up and after five minute cool-down at the end of your workout. Stretching should be slow (15 to 30 seconds) and controlled through a full range of motion-no bouncing! A flexible muscle is better able to absorb shock and periodic overstretching than an inflexible muscle. Listen to your body-if you are placing too great of a physical demand on your body, stop exercising before you feel pain or discomfort. Be sure to wear the proper footwear for the sport you are choosing to engage in. Many running athletic shoe stores can watch you run or walk and help you to pick out a shoe or make an orthodox insert that will keep you from pronating or inverting. If you have an orthodox, brace or wrap, continue to wear them and be sure to RICE with any sign of inflammation or tenderness!
One way to avoid an overuse injury would be to modify your workout with cross training. To determine an effective cross training program, look at the joint action(s) and muscle group(s) being worked and replace it with an exercise that targets the same group(s). For example, cross training for running would be a stair climber and cross-country skiing, because these machines target similar muscle groups. Cross training can also be varying the type of intensity and changing the sequence of machines.
Are there different kinds of fractures?
A fracture can be a complete break, a chip, or a crack in a bone. Fractures are either open or closed. In a closed fracture, the skin is not broken. In an open (compound) fracture, there is an open wound and the fractured bone may or may not be visible. A fracture can be caused by a number of different forces:
Direct force-The bone is broken at the site of the force.
Indirect force-Trauma is inflicted at a distance from the resulting fracture. An example of this is falling on the outstretched hand and sustaining a fracture of the clavicle.
Avulsion force-A portion of the bone is pulled off by the attached muscle, tendon or ligament.
If a fracture is present, the main features are unnatural mobility of the body part, deformity, local tenderness over the bone and crackling sounds during movement. If your client complains of localized pain over a bone or can feel and/or hear a “snap”, you should consider the possibility of a fracture. Beware of the old tail, “if you can move it, it isn’t broken,” because this is not true.
How can I help someone who has a fracture, subluxation or a dislocation?
1. Call paramedics immediately if the following signs and symptoms appear:
Pale, cool and clammy skin; weak pulse; signs of shock; internal bleeding-vomiting
or coughing up blood; difficulty breathing, extreme pain or tenderness over area.
2. Remove or cut away clothing that covers the injury. This could reduce contamination of an open fracture. Open fractures are more dangerous because of the severe bleeding and chance of infection. The wound needs to be covered with a sterile dressing and control the bleeding.
3. If there is an open fracture, dislocation or subluxation, do not attempt to push protruding ends of bone back into place.
4. If the injury is not too serious, splint the limb to immobilize it. However if there is a gross deformity or you are untrained, merely prevent the limb from moving until medical attention arrives. Only apply a splint if you can do it without causing further pain or discomfort. The fracture needs to be immobilized and elevated if possible, but splint an injury in the position that you find it. To immobilize a bone, a splint must include the joints above and below the fracture. To immobilize a joint, a splint must include the bones above and below the injured joint . Be sure to check for proper circulation before and after splinting by barely touching the end of their toes or fingers.
Remember you should never try to diagnose an injury. When there is an injury, it is best to consult a reputable health practitioner who knows about musculoskeletal health and injuries. Contact your local American Red Cross and become certified in Community First Aid and Safety. It’s worth it-you could save a life!
In the subsequent articles, I will be discussing some of the most common injuries of the upper and lower extremities. I would like to answer your questions about specific injuries. Send your questions and comments to Tisteinke@iquest.net, or write to UltraFitt. •
What are your thoughts? If you have any comments or questions regarding this article or have questions about fitness in general, please write to Ask The Trainer, Tiffany Steinke at UltraFitt. 7462 East Fishers, Station Drive Suite 437, Fishers, IN 46038 or Email: editor@ultrafitt.com
Tiffany Steinke has always had a passion for fitness and enjoys sharing it with others. She has a Master's degree in Kinesiology from Indiana University in Bloomington. Her emphasis is in Rehabilitation and Conditioning of Special Populations and Sport Athletes. She is also a certified instructor of Community CPR and First Aid by the Red Cross. Tiffany is an accomplished marathon runner, and is currently training for future marathons and triathlons. She is Team Captain for Team-N-Training for the Indiana Chapter Leukemia Society of America. Tiffany is Head Trainer at Family Fun & Fitness in Greenfield.
Join the FREE Fitness Club Now for Weight loss, Strength and Fat Burning Workouts!
BACK TO ARTICLES