Summary Clients with Orthopaedic,
Injury and Rehabilitation Concerns
– minor PT
Book: Chapter 21
SAMENVATTING BOEK:
In short
People frequently rely on the expertise of a personal trainer to design individualized
safe, and effective programs to support a full recovery and facilitate a return to activity.
To successfully manage the needs of this clientele population, a personal trainer must
understand the various types of orthopaedic injury, time line for tissue healing, general
psychophysiological factors that contribute to injury recovery and considerations
related to how injury may affect movement and functions. Failure to recognize the
framework of the healing process will unnecessarily slow the healing time line and
ultimately interfere with the full restoration of client function.
Note: This chapter is NOT intended to provide detailed rehabilitations protocols for
specific injuries, NOR it is designed to take the place of medical advice given by
qualified health care professionals. The intent is to provide the personal trainer with a
general framework to guide the delivery of personal training services to meet the unique
needs of clients with orthopaedic injuries or impairments.
Injury Classification
Musculoskeletal injuries are characterized and classified based on a variety of factors
including onset and type of tissue damaged. Mechanism-based terms used to classify
injury onset:
Macro trauma > refers to an injury with a sudden and obvious episode (incident)
of tissue overload and subsequent damage
Micro trauma > results from the accumulation of tissue damage across time;
therefore micro trauma is often referred to as an ‘overuse injury’.
o But it is important to note that unlike overuse, the term micro trauma
does not imply (include) that the injury is due to repeated physical
activity.
o Micro trauma injuries will recover only from REST!
Example micro trauma: Training errors = faulty biomechanics or technique during
performance, decreased flexibility, insufficient (not enough) motor control or skeletal
malalignment.
The type of injury is determined by the tissue involved.
Types of injury:
Strain (spanning)
Sprain (verstuiking)
Fracture (gescheurd)
,Tissues which could
be involved:
Muscle
Tendons
Joint
Bone
See Table 21.1
for example of
musculoskeletal injuries
Impact of Injury on Function
Injury often results in several physical impairments including limitations to range of
motion (ROM), strength, balance and coordinated functional movement patterns.
Range of motion can be especially affected since injury creates changes in all tissues.
After trauma, injury by-products (exudate = afscheiding) and collagen crosslinks (scar
tissue = littekenweefsel) are deposited (gedeponeerd). Ground substance decreases,
resulting in fibrosis, which limits the flexibility of connective tissue. Limitations in ROM
can be even further complicated should a period of immobilization follow the onset of
injury of if circulation is impaired due to age or a medical condition.
The progression of ROM or stretching exercises can depend on the type of tissue,
severity of injury, stage of healing, and the person’s motivation. If there is a period of
reduced activity or immobilization following the injury, than collagen cross linkage
formation can be more significant and may require repeated lengthy stretches to regain
as well as maintain ROM, even after full motion has been achieved.
The magnitude of the effect of injury on the expression of strength will depend on the
extent of the injury, the area of type of tissue injured, the amount of time the person
has been immobilized or disable by the injury or some combination of these. There can
be damage to the muscle itself, or pain and swelling can contribute to the inhibitions of
, a muscle of group of muscles. Following injury, the rate of muscle loss is greater than
the rate of gain; thus strength seems to be one of the most sought after parameters
following injury. Injury-related deficits in neuromuscular control and proprioception are
due to microscopic nerve damage in soft tissue, called deafferentations
(waarnemingen/prikkels) and disruption in the sensory feedback pathways used for
joint stabilization and neuromuscular coordination.
The pshychological reactions and adaptations can depend on the extent of the injury
and rehabilitation. Short term injuries and rehabilitations can be a mild inconvenience
for the person, who may exhibit responses of impatience and even optimism to return
to activity; Longer term injuries and rehabilitations can create reactions of anger,
frustrations, fear and even isolations to name a few.
Tissue Healing Following Injury
It is generally agreed that all tissues follow a pattern of healing that includes three
phases:
Inflammation: The body’s initial reaction to injury and is necessary in order for
normal healing to occur. During the inflammation phase, several events
contribute to both tissue healing and an initial decrease in function. These
substances increase blood flow and capillary permeability, causing edema (the
escape of fluid into the surrounding tissues), which inhibits contractile tissue
functions and significantly limits to injured client’s activity level.
Proliferation: Repair Phase > Begins three, five of seven days following injury.
There is no definitive ending of the inflammations phase or definitive beginning
of the repair phase: rather it is a transition flow. The repair phase of healing
allows for the replacement of tissues that are nog viable following injury or
surgery. In this phase, new capillaries and connective tissue form in the area
and collagen fibers are randomly laid down to serve as the frame work on which
the repair takes place. This random alignment does not allow optimal strength of
the new tissue and therefore limits its ability to transmit and accept force.
Remodelling: The weakened tissue produced during repair is strengthened
during the remodelling phase of healing. In this phase, production of collagen
fibers has decreased significantly, allowing the newly formed tissue the
opportunity to improve its structure, strength and function. With increased
loading, the collagen fibers of the newly formed scar tissue begin to hypertrophy
and align strength of the newly formed tissue and allowing for the injured
client’s return to function.
