Musculoskeletal injuries are probably the most common injuries that occur in active individuals. They also are one of the most common reasons people stop being active. To help prevent musculoskeletal injuries, you must focus on the following areas when developing a total fitness program. strength, flexibility, muscular endurance and balance. Even when programs are designed properly, injuries can happen. However, a properly conditioned athlete can rehabilitate an injured area quickly and more completely.
Types of tissue
Four tissues of the body are of concern when discussing musculoskeletal injuries: muscle, tendon, ligament and bone. Each has individual characteristics that, when understood, can help you prevent Musculoskeletal injuries.
Muscle tissue is elastic and able to withstand an enormous amount of stress. Muscle tissues act as springs for the body by absorbing a tremendous amount of shock. They also facilitate movement. Preventing injuries to the muscles and the joints is dependent upon a muscle being strong and flexible. Flexibility in any exercise program is important for preventing injuries.
An injury to muscle tissue is called a strain. Strains are classified as mild, moderate or severe. A severe strain may be called a rupture or complete tear. These injuries heal with scar tissue, known as collagen tissue that is not elastic. The collagen tissue goes to the injury site and is laid down in an unorganized pattern. If left in this unorganized state, the tissue will be very weak. Therefore, it is important that some stretching be initiated to help the collagen tissue organize. Stretching and the gradual addition of strengthening exercises will cause the tissue to “line up” in the direction of the surrounding muscle fibers. This organization increases the strength of the collagen tissue. However, even in an organized state, this tissue will not be as strong or flexible as the surrounding uninjured tissue.
Ligaments are made up of nonelastic tissue designed to connect bone to bone. They are found around joints, and when injured, they do not contract as muscle tissues do to protect the area. Once stretched, the ligaments allow for unwanted motion at the joint, thereby necessitating increased strengthening of surrounding muscle tissues.
Joint capsules, larger versions of ligaments that surround joints, provide stability. They may be injured in more severe sprains and can result in serious dislocations and subluxations.
Bone is the only tissue in the body that, when injured, repairs itself with exactly the same type of tissue. Bone can develop cracks from abnormal types and amounts of stress, resulting in stress fractures. Complete breaks in the bone also are called fractures. They result from excessive stresses and usually involve a large amount of trauma. When a client complains of pinpoint pain over a bone, or of hearing or feeling a “snap”, you should consider the possibility of a fracture and refer him or her to a physician. It is not true that “if you can move it. It isn’t broken”.
Tissue Reaction To Injury – Inflammation and the Healing Process.
When tissue is injured or damaged, the body immediately begins the repair process, beginning with inflammation, which acts as a protective, as well as a healing, mechanism. Some relate the process to an army fixing a weak spot in a line that has been penetrated by the enemy. The body’s main transportation system is the circulatory system. It transports the foot soldiers, the white blood cells, to the area of injury. Here, the white blood cells encircle the injury containing it and thereby preventing damage to other tissues.
Injuries can often be recognized by the swelling, black and blue colour (ecchymosis), pain, and decreased range of motion that accompanies them. These are just a few of the signals that the body is defending itself from the injury and is repairing the damage. You must recognize these signs and symptoms and provide proper referral to a medical professional. In addition, if appropriate, you must provide the proper instruction for participating in exercise that will not make the injury worse.
Signs and Symptoms of Inflammation
The body is a predictable machine when handling injuries. Tissue that is injured relies on the inflammatory reaction for its early defense and to begin the healing process. It is important for you to be able to recognize the following signs and symptoms of inflammation:
Increased temperature is the result of an increase in blood flow to the injured area due to damaged vessels and the need to supply the area with increased umbers of white blood cells. Much as the body develops a generalized fever when ill, and injury to a soft tissue of the body causes a “ local fever”. This is why heat, hot packs or hot soaks are not used on a new injury. Why turn up the heat under a boiling kettle?
Redness is due to increase in blood flow to the area.
Swelling also is due to the increase in blood flow to the area. Additionally, damage to the cells, small capillaries, and lymphatic vessels in the area may allow the leaking of some fluid.
Pain is often due to pressure or nerve endings from increased swelling.
Loss of function is caused by swelling in the area and “guarding” of the muscles surrounding the injury. This also produces an increase in pain.
Acute Treatment of Musculoskeletal Injuries
The acronym RICE is the most important method of describing the acute treatment for musculoskeletal injuries. This acronym stands for Rest, Ice, Compression and Elevation, the four steps of the accepted first aid standard for the treatment of these types of injuries.
Though swelling is a key protective mechanism and a part of the healing process, it is still important to reduce swelling. Little can be done to stop initial swelling but the RICE principle can be applied to reduce secondary, which occurs when injuries are not properly treated. Secondary swelling slows the healing process and decreases one’s ability to safely participate in activity.
Remember that it may not always be prudent to actually apply treatment to an injury. Check with local governing associations for the most current standards for providing emergency treatment. Of course, the more education you have in first aid and injury management, the more comfortable you will feel if an injury situation develops. Therefore, the guidelines for RICE are included below:
Rest: avoid continuing the activity that has caused injury or will make the injury worse.
Ice: ice should be applied for 20 to 30 minutes. There should be some sort of insulating layer between the skin and the ice to prevent frostbite. Never apply ice to an already numb area.
Compression: elastic bandages can help prevent or reduce excessive swelling. The elastic bandage should always reach from the largest muscle area below the injury to the largest muscle group above the injury.
Elevation: the force of gravity can reduce swelling. After applying the first three steps, raise the injured area as high as possible while still being comfortable. The injured areas should be raised at least level with, or slightly above the heart.
Flexibility and Musculoskeletal Injuries
Some as the key to longevity describes flexibility. A flexible muscle is better able to absorb shock and periodic over stretching than an inflexible muscle. Unfortunately, some believe that if a little flexibility is good then more must be better. When it comes to injury prevention, however, this is not always the case.
A client’s flexibility should be compared to that of the average population. If their measurements fall below what is considered normal for flexibility (hypo flexible), they should be instructed in a solid, well-designed flexibility program. These clients are more prone to muscle injuries, strains and ruptures. Conversely, if their measurements are above normal (hyper flexible), their program should place more emphasis on strength development. These clients are at increased risk of joint dislocations and subluxations.
Exercise Technique and Pre-Existing Joint Injuries
Working with athletes who have pre-existing joint injuries is often a challenge. Postural conditions such as “knock knee” and “sway back” often make certain activities difficult. Athletes who are loose jointed or have joint injuries may not be able to perform all exercises using traditional methods and body positions. It is critical that you strictly reinforce the importance of proper technique essential to a safe, effective, and enjoyable exercise experience.
Pre-Existing Conditions and Exercise Selection
An athlete who has had previous injuries, finds it a bit more difficult to design safe and effective personalized programs. The medical history form each athlete should list previous injuries, surgeries, or conditions that have made exercise difficult in the past. The medical staff working with the athlete will dictate when it is safe to begin exercising again. They may provide additional information or suggestions for the exercise program. With this information and guidance, you can design a safe, effective and personalized program for athletes .