Injury Prevention and Management

Posterior Tibial Tendinopathy

(Tendinitis means that the tendon is inflamed.) (Tendinosis means there are un-healing micro tears in the tendon.) -Tendinopathy is both. This causes pain along the inner side of the lower leg, ankle or foot. The posterior tibial tendon helps point the foot downward. -over pronation. -pain or tenderness on the inner leg, ankle or foot. Pain while lifting up the foot, walking or running. -RICE, ice massage, healthcare provider may recommend insoles, crutches.

Groin Strain

(stretch or tear in muscle fibers or tendons) The muscles that are mainly involved are the adductor magnus and the sartorius. - Most commonly happens when running or jumping. Also push off starts - You will experience pain and tenderness up the inner thigh. It will be difficult to bring your legs together. - Treat with RICE, anti-inflammatory, wearing a thigh wrap and doing rehab exercises. Exercises: Hip adductor stretch, hamstring stretch on the wall, side lying leg lift, straight leg raise, resisted hip flexion, adduction, abduction and resisted hip extension.

patellofermoral pain syndrome How does it occur? Symptoms? Treatment, rehabilitation?

-Pain behind the kneecap. Also called patellofemoral disorder, pateller malalignment and runners knee. -Can occur from overuse of the knee in sports and cardio. You can irritate the inside surface of the kneecap and cause pain. It may also be an issue with alignment in the hips, legs, knees and feet. For example: being knock knee'd , having underdeveloped thigh muscles, or having feet that over pronate. -Ice pack for 20-30 minutes, every 3-4 hours for 2 or 3 days. take an antiflammatory. -You may return to sport when you can full straighten with no pain and regain full strength.

carpal tunnel syndrome

-compression of the median nerve as it passes between the ligament and the bones and tendons of the wrist -can be caused by repetitive motion of the wrist and hand creating pressure on the median nerve. Can also be caused by swelling, inflammation from injury, disease, pregnancy, balance and random -can cause pain and numbness/tingling in the thumb, pointer and middle fingers that may radiate up the forearm. =weak grip -can prevent by changing the way your wrist and hand moves and restricting movement. may need surgery if case is severe. avoid over use and elevated arm with pillow while laying down, avoid prolonged resting of wrists on hard surfaces. Exercises include: Wrist ROM, Wrist stretch, scapular squeeze, tendon glide

Pes Anserine (knee) Bursitis Symptoms? Treatment?

-inflammation of the bursa of your knee. (fluid filled sac between tendons, bones and skins) is most common in swimmers. -causes pain to the inner side of your knee, just below the joint. Pain when you bend and straighten your leg as well. -ice 20-30 minutes every 3-4 hours for 2-3 days. You can also wrap an elastic bandage around it to prevent swelling, shot of cortisone or other medicine into the bursa, leg stretching and strengthening exercises. PSA proper warmup prevents a hurt bursa.

Peroneal Tendon Strain How does it occur? Symptoms? Treatment?

-muscle fibers are stretched or torn, outside of lower leg. -During an inverse movement of the foot the tendons may be torn. Or when your foot is forced upward towards your shin. -Pain outside of the lower leg, may hear a pop or snap and there will be swelling around the ankle. -RICE, elastic bandage, stirrup splint (aircast or gelcast) , rehabilitation exercises.

Calf Strain Symptoms? Treatment?

-muscle fibers are stretched or torn. -will cause immediate pain to the back of your leg, may hear a pop or a snap, it will be hard to rise up on toes. -RICE, elastic bandage, possible crutches, tape muscles, rehabilitation exercises.

Rhomboid Muscle Strain or Spasm

-muscle fibers or tendons are stretched or torn. -involuntary contraction of muscle -Usually caused by overuse (overhead sports like tennis or reaching upward) It can also occur from rowing, carrying a heavy backpack over one shoulder, or poor posture (too much computer use) -pain in upper back between shoulder blades and spine. May feel like a knot or tightness in the muscle. May feel pain when you move your shoulders or breath. -RICE (lay down on ice), anti-inflammatory, massage: Do with tennis ball on floor and gently roll over muscles. also rehab exercises. Prevention :stretching Stretches include : Pectoralis stretch (in doorway) Thoracic extension, door frame stretch (lean back with one arm), scapular squeeze, mid trap exercise (on stomach, elbows straight, thumbs up squeeze shoulder blades together and release.) thoracic stretch (and side) and rowing exercise

Prepatellar (knee) Bursitis

-same as Pes Anserine but prepateller bursitis sac is on the front of the knee.

Osteitis Pubis

A stress fracture to the pubic symphysis caused by repeated overload of the adductor muscles or repetitive stress activities.

Fractured Clavicle

Connects sternum to scapula (shoulder blade) -Caused by direct blow -Pain and swelling at area of break, difficulty moving arm or shoulder EX: straight arm press down (just the bar, wand flexion exercise), wand extension exercise, Rotations with bar/wand, shoulder flexion and abduction see pages 111-112 for more

Hip Pointer How? Treatment?

Deep bruise on the top portion of your pelvis called the iliac crest. Caused by direct blow to the hip. Need xrays Heal with RICE

Tennis elbow (lateral epicondylitis)

Inflammation of the wrist extensor tendons ( about 5 ) on the lateral epicondyle of the elbow (humorous) -is caused by overuse or misuse of the muscles of the forearm that straighten and extend the wrist and hand. activities include racket sports, tennism typing, knitting, carpentry, baseball swings -symptoms include point tender, Pain when straightening the wrist/hand, lifting heaving objects, making a fist, handshake, gripping, brushing teeth. -Prevention includes proper WU and form, wrist extension stretch (on a table), wrist ROM stretches, passive wrist stretch, wrist flexion stretch (on table backs of hands down), forearm pronation and supination, Circumduction (egoscue) : table top back, fold in half, hold wait with one arm, subtle arm circles.

Meralgia Paresthetica Possible Reasons? Symptoms?

Irritation of one of the nerves that goes to your upper and outer thigh. This nerve starts in your low back , As the nerve leaves the lower abdomen on its way to the thigh it can become trapped. Cause is a mystery, sometimes may be from a lower back injury/slipped disk. OR: being overweight, diabetes, or wearing tight pants and belts. Symptoms include burning, tingling, numbness, or pain in the upper and outer thigh area. The skin may be sensitive. X-ray, CT scan, or MRI may be done on your lower back/abdomen. Wear looser clothing, Lose weight if needed, Cortisone injection to the nerve, (if severe then surgery) or possible treatment of the disk.

Piriformis Syndrome

Irritation of the sciatic nerve as it passes through or next to the piriformis muscle. Piriformis is located deep in the toosh, and allows you to rotate outwards. If this muscle is tight and spasms then the sciatic nerve can become irritated and inflamed. Could be related to downhill running. Sciatic nerve can also be irritated by a back injury like a slipped disk, may need scans. RICE and rehab exercises Quadruped pointer, partial curl, resisted hip abduction.

Posterior Cruciate Ligament How does it occur? Symptoms? Treatment?

Major ligament in the knee, connects thigh bone (femur) to the shin bone (tibia) this ligament helps keep the knee stable. Sprains are grade 1, 2, 3 based on severity. -can come from a direct blow to a bent knee, fall to the ground, or in a car accident when your knee hits the dashboard (they're not common) -fluid may swell in your knee and things will feel loose. If it is an old injury you may feel that your knee gives away during activities. (needs an MRI and possibly reconstructive surgery depending on severity) -RICE, elastic bandage, crutches, and knee rehabilitation exercises.

Scoliosis Symptoms ? Diagnosis? Treatment/Prevention?

Spine curves from side to side instead of straight down. Develops gradually. Sometimes vertabrae may have developed badly or not at all, legs may be different lengths, or could be caused by diseases. -Symptoms are easy to go unnoticed, but you may notice that you have uneven shoulders, hips or waist. Have a hump on one side of your back, have one or both shoulder blades sticking out, lean slightly to one side or have back pain. -Your doctor will base treatment on your age, how likely it is that you will grow, the degree and pattern of your curve. also the type of scoliosis. -Observations every 4-6 weeks, may need brace or surgery if curve is over 40 degrees -Use good posture, do exercises that keep your back strong and flexible, avoid carrying backpacks that are too heavy, and take frequent stretch breaks.

Abdominal Muscle Strain How does it happen? Symptoms? Treatment/Exercises?

Strain = stretch or tear in the muscle or tendon. -Occurs from vigorous activity, such as lifting, coughing or sneezing these muscles could become strained -You will mainly have pain all over the abdominal area. Fascia may torn all the way through causing a hernia. (where some of the contents of the belly will be protruding through the tear.) -RICE, anti-inflammatory, and possible surgery if there is a hernia. EX: pelvic tilt, dead bug, partial curl, diagnol curl, lower abdominal exercise (legs up)

Spondylolisthesis and Spondylolysis How does it happen? Symptoms? Treatment?

Stress fractures in the lower lumbar vertebrae, Spondylolysis is a smaller fracture and spondylolisthesis is a larger more serious fracture, these could also be called par defects because the break occurs in the ring around the vertebrae (Par) -Occurs from repetitive extension of the back because it causes weakness in the rings of the lumbar vertebrae. Less commonly happens from injury to the back. Very common in dancers, gymnasts, and football players. -Symptoms include low back pain or spasms. You may have no pain at all and only be bothered from time to time. Usually does not damage nerves. -May need x-rays or a CT scan. -For lower intensity you'll be advised to ice it, take anti inflammatory and continue daily life as long as there is no pain. May need to modify daily movements. Rehab movements will include: Pelvic tilt, Deadbug, gluteal stretch, Quadruped pointer, partial curl, and double knee to the chest.

Hamstring Strain

Stretch or torn muscle or tendon (in hamstring muscle group) Occurs from forceful muscle contractions during activities like running and jumping with weak or cold muscles. sudden starts and stops, muscle imbalance. ( quads over hamstrings, hamstrings should have 60-70% of the strength. ) Burning and popping feeling (muscle fibers tearing) , bruising, sharp pain walking. Treat with RICE , bandage, and possible crutches. Rehab with standing calf stretch, hamstring standing stretching, hamstring on the wall, rested hamstring curl, chair lift and lunges.

Pelvic Avulsion Fractures

When a tendon pulls away a part of the bone. May occur from sudden forceful contraction. Most often happens where the satorius muscle attaches to the top portion of the pelvis. Or where the rectus femoris attaches to the front of the pelvis, also the hamstring group that attaches to the part of your pelvis called the ischial tuberosity. Pain at site of injury and soreness. most importantly rest. RICE and anti inflammatorys.

`Herniated Disk

a herniated disk is a disk that has bulged out from its proper place on your back. The sift rubbery center of the disc squeezes out through a weak point in the harder layer. (Normally these disks act as shock absorbs between vertebrae) - Can result from a fall or accident, repeated straining of your back, sudden strenuous action (lifting to heavy of a weight or twisting violently) -Symptoms include back pain, numbness or tingling in one or both legs (sciatica) and changes in bladder or bowel movements. (symptoms of herniated disk in neck develop gradually) -For treatment the doctor may prescribe 1-2 days of bed rest ( laying flat on your back) and also further sleep with pillow arrangements, pain relievers, muscles relaxants, RICE, back massage, physical therapy or steroid injections. May need surgery if symptoms don't go away over time. PREVENTION: good posture, proper lifting, sleeping positions. HERNIAS CAN ALSO OCCUR ELSEWHERE PAGES 115-117

Snapping Hip Syndrome

a snapping sensation either heard or felt during motion of the hip

Hip Flexor Strain How does it occur? Symptoms? Treatment?

a strain is a TEAR in the muscle or tendon. The tendon may become inflamed (tendonitis) Hip flexor muscles allow you to bend at the waist and lift your knee. Occurs from overuse in the muscles that help you flex your knee, or do high kicks. Common in soccer players. Pain in upper groin area, where the thigh meets the pelvis. Treat with RICE, anti-inflammatory, and rehab exercises. (hip flexor stretch, quad stretch, resisted hip flexion)

test question! does this refer to your elbow or your shoulder joint? A: SHOULDER Occurs: from overuse, swimming, acute injury, and weak or injured rotator cuff Symptoms: pain on arm/shoulder movement (especially shoulder flexion) point tender, hurts to throw. Prevention: proper warm up : wings, ski-poles, elbows to pockets, not worthys, and touchdowns (mikes warm up) Review other bicep exercises from book!

bicep tendon strain

Tailbone Injuries

break or bruise to the coccyx vertebrae Occurs from direct fall Tailbone will be very tender and there will be pain when walking and especially sitting. Will need donut cushion, and RICE

Upper back Pain

called thoracic back. -back pain occurs when ligaments or muscles attaching to the vertebrae are injured. Can be caused by overuse, car accident, throwing, bending, twisting, and sitting at a desk for prolonged times or sneezing. -Symptoms include: pain in the upper back, muscle spasms, pain when you take a breath, pain when your back is touched or you move, pain when you move your shoulders or move your neck forward. -early stages should be treated with RICE, after ice for 2-3 days you may start using heat to loosen up stiff muscles. Anti-inflammatory, massage. -Prevention includes proper warm ups and stretching. Proper heavy lifting and taking breaks between desk work to stretch. -Rehab exercises: see above and pg 140-141 OTHER CAUSES: -muscular strain in the traps or erector spinae - ligament sprain - ruptured disk or stenosis ; naturally narrow space in the thoracic canal

Femur Fracture Types? Cause? Symptoms? Treatment?

femur = thigh bone. There are a few different kinds of femur fractures: Simple - There is only one fracture line and the bone is broken in two places. Comminuted - There is more then one fracture line and there are more then 2 bone fragments at fracture site Closed - The skin around the fracture is not broken Open - The skin around the fracture is broken Pathological - The bone has been weakened or destroyed by disease and broken easily Stress - hairline fracture, occurs from overuse. -Usually fractures are caused by a lot of force like a high speed collision. -Symptoms include severe pain, swelling and bruising, inability to walk, visible deformity at site of break and the feeling of your bone moving inside your thigh. (could also possibly loose a lot of blood and go into shock) -Most fractures will need to be fixed with surgery that includes steel screws, plates and rods. May also need cast and crutches depending on age and severity. Will need physical therapy and rehabilitation until leg is fully back to strength.

gluteal strain Symptoms? Treatment? Stretches?

gluteal muscle fibers are stretched or torn, happens to hurdlers and dancers from running and jumping. - Pain moving your leg backwards and in your butt - RICE, Anti-inflammatory, and rehab exercises. - Stretches include: Single Knee to the Chest, Gluteal Stretch, Gluteal sets, Prone hip extension (w/ bent leg), Resisted hip extension, resisted hip abduction, Lunge

iliotibial band syndrome How does it occur? Symptom? Treatment/Rehab?

inflammation and pain on the outer side of the knee. The band is a layer of connective tissue and begins at a muscle near the outer side of your hip and down the outer side of your thigh, crosses the outer side of the knee, and attaches the the outer/upper shin. Occurs when it is repeatedly rubbed over the femur near the knee. Can be due to tightness in the IT band itself or the hip pelvis and leg. Also can occur from having to different sized legs, running on sloped surfaces, and running in shoes with a lot of wear on the heel. Will feel pain on the outer side of the knee. Treat with RICE, ice massage, anti-inflammatory, and rehab exercises. Recovery time depends on age, health and etc. Severe may take as long as 6 weeks to recover. EX: IT band stretch standing/leaning, calf stretch, knee stablization and clam exercise.

Rotator Cuff Injury

muscles : suprapinatus, infraspinatus, teres minor, subscapularis function: stabilize head of humorous in glenoid fossa what is it : strain/tear in the RC tendons, impingement of supraspinatus occurs: from direct fall to the arm, lifting heavy objects, repetitive over hand movements and manual labor symptoms: pain on point, decreased ROM, especially in overhand movements

Low Back Pain

pain and stiffness in the lower back. -Usually caused when a ligament or muscle holding vertebrae in place is strained. Making the spinal cord lose its stability = pain. Can occur from improper lifting, bad posture, being overweight, violent sneezing or other abrupt movements. Can result from infection, immune system problem, degenerative disease or arthritic disorder. -Symptoms include pain in the back and legs and stiffness and limited motion. Pain may be continuous or occur in certain positions, may occur in one spot or spread. * Low back strain does not produce pain past the knee or calf, this may be a sign of a herniated disk or pinched nerve. * Could also be caused by unconditioned abs/diaphragm (intra-abdominal support means giving support to both sides of the spine) -Treat with RICE, hot water bottle, resting on a firm mattress, aspirin, massage, wearing belt or corset for support, talk to therapist (if related to emotional pain) program for physical therapy. Sleep with pillows, practice good posture. *When pain subsides exercise moderate everyday with a warm up and cool down Check pages 130-131 for exercises. *could also be caused by untrained abs/diaphragm (in need of intra-abdominal support) this is important because of the pressure that keeps the core together.

Sacroiliac Pain How does it happen? Symptoms? Treatment?

part of lower back made up by the sacrum and the top part of the iliac crest on your pelvis. Ligaments hold these bones in place. -Occurs from possible activities that involve twisting, bending or heavy lifting. Also a direct fall or blow, imbalance of muscles around the areas or length of legs, or the ligaments around the sacroiliac joint is loose. -Symptoms can include pain in the low back, trouble bending or twisting the low back, pain after sitting for a long time, stiffness in the low back, hip or leg, and a feeling of being out of alignment. -Treat with RICE, anti inflammatory, exercises, massage, physical therapy, insert for shoes, a sacroiliac belt for support,or cortisone shot for swelling.

Quadriceps Contusion

thigh bruise; most common of all thigh injuries