Outline

1
Outline

• Musculoskeletal injuries
• Risks
• Classification
• Treatment
• Heat Illnesses
• Evaluation of test quality
• Field tests
• Anaerobic
• Aerobic

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Musculoskeletal Injuries

• Risk increases for all levels of participation
  with increasing
• Activity, intensity and duration
• Incidence and severity can be reduced by
  understanding
• Risks, preventative measures and care
• Risks
• 35-60 of runners report injuries that reduce
  running or require medical attention
• Patellar femoral articulation and foot
• High impact aerobic dance 45 of students 75 of
  instructors
• Lower leg injuries with high frequency (gt 3 times
  per week)

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Injuries

• intrinsic and extrinsic factors interact
• Box 34.4 ACSM
• Poor biomechanics, past physical activity, poor
  baseline fitness, present level of training and
  weight load affect incidence of injury

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Injuries

• Repetitive bouts of micro trauma leading to overt
  tissue injury cause overuse injuries
• Running
• injury increases exponentially with frequency
  and total volume of training
• Beginning jogger - one day rest
• Progress to low impact activity on off days
• Training errors are causal in 60-80 of running
  injuries
• Eg. high progression rates and hill running

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Warm up / Flexibility

• Low flexibility is a risk factor
• Muscle strain and musculoskeletal injury
• Research study - most and least flexible had
  higher risk
• Improper warm up - inc risk for injury
• Warmth - inc elasticity of connective tissue,
  speeds metabolism, inc magnitude and speed of
  contraction
• Muscle stretches more and can resist injury at
  greater force
• Studies are inconclusive on warm up and injury -
  may be more important for performance

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Orthopedic Factors

• Past injury and low physical activity are
  associated with risk
• Excessive weight - acute and overuse injuries -
  hip and knee
• Vigorous activity may predispose to
  osteoarthritis due to mechanical trauma
• Inc risk with competitive but not recreational
  running
• Low back pain risk factors
• Obesity, poor sitting posture, frequent flexion,
  loss of back extension and low activity
• Poor lifting posture and fatigue
• Usually related to acute trauma or overuse

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Recommendations

• Alter predisposing risk factors through education
  and clinical intervention
• Early detection of symptoms and overuse - full
  rehabilitation
• Do not recommend strenuous exercise for those
  with
• Acute joint injury
• Chronic joint inflammation (osteoarthritis)
• Uncontrolled systemic joint disease (rheumatoid
  arthritis)
• For those with joint disease
• Progression needs to be individualized
• Prevent debilitation due to inactivity
• Improve endurance, strength and flexibility and
  exercise tolerance

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Preventing Injuries

• Prescreening
• Well rounded physical training program
• Warm up / cool down
• General and specific
• Flexibility, strength and aerobic conditioning
• Follow principles
• Specificity, overload, progression
• Proper equipment and techniques

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Recognition

• Exercise professionals will often be asked for
  advice regarding injuries or the need for
  referral
• We are not physiotherapists or doctors but an
  awareness can help us assist clients in making
  educated choices when dealing with injury
• Common injury symptoms and causes ACSM Table 57.4
  and 57.5
• Runners knee - patellar femoral pain syndrome
• Shin splints - tibial stress syndrome
  (periostitis)
• Plantar fasciitis
• Achilles tendonitis

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Running Injuries
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Running Injuries

• Plantar fasciitis -inflammation of plantar fascia
  tendon
• tingling, ripping in AM
• stiff/hard midsoles (old shoes)
• poor arch support
• running in court shoes

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Running Injuries

• Runner knee - pain around pattelo-femoral joint
• excess pronation - increases force holding
  patella against femur
• inc. internal rotation - alignment off
• orthotics - motion control in rear foot
• Build endurance of vastus medialis

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Injury Management

• HOPS
• History, Observation, Palpation and Special tests
• Evaluate for
• Immediate first aid and referral to physician
• Advice about training and program modifications
• Physiology of Injured tissue
• Macro trauma - tension, shear or compression
• Micro trauma - overuse, cyclic loading
• Damaged cell unable to process O2, nutrients,
  waste - leads to cell necrosis
• Blood vessel damage - hemorrhage, coagulation and
  decreased blood flow to area
• Primary injury - direct trauma
• Secondary injury - additional swelling and tissue
  damage - more with improper care
• results from reduced O2 supply adjacent to
  primary injury
• further necrosis, swelling - hours after injury

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RICES

• Rest
• range form complete to relative rest
• Allows time to control effects of trauma and
  avoid additional tissue damage
• Ice
• Slows cell metabolism - healthy tissue survives
  diminished blood flow and hypoxia
• Reduce pain and spasm
• Apply for 20-30 minutes every 2 hrs during the
  day for first 24 hrs post injury
• Compression
• Controls edema and prevent fluid accumulation in
  the injured area
• Elevation
• Above level of heart - limits swelling and
  increases venous return - reducing tissue damage
• Stabilization
• Supports injured area allowing musculature to
  relax - reducing pain-spasm cycle

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Healing

• Inflammation, Repair, Remodeling
• Time to fully recover depends on injury and
  treatment during each phase
• Inflammation - redness, local heat, swelling,
  pain and loss of function
• Sliverthorn table 24.2, Berne and Levy fig 45.19
• Protection and prepare for repair
• Lasts up to 2-3 days
• Chronic inflammation may occur when cause of
  injury in not eliminated - delaying
  rehabilitation process
• - Treatment goal - prevent damage of healthy
  tissue, create good environment for new tissue
  growth
• - RICE, ultrasound, electrical stimulation
• - maintain health of rest of body through
  modified training

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Healing

• Repair - within initial hours - depending on
  resolution of inflammation (2-3 days)
• Proliferation and regeneration of collagen fiber
  leads to scar formation - not as structurally
  sound
• May last up to two months
• Treatment goal - prevent excessive atrophy and
  joint deterioration
• gradually introduce low load stresses to increase
  collagen synthesis and prevent loss of joint
  motion - ultrasound, electrical stimulation and
  ice
• Maintain fitness of uninjured areas through
  modified activity
• Proprioception and neuromuscular control -
  stability, vision and speed
• Remodeling - realignment of collagen according
  to tensile forces
• Scar tissue becomes stronger, regeneration of
  collagen slows
• With increased loading the collagen fibers begin
  to hypertrophy and align themselves along the
  lines of stress
• Ligament repair can take up to a year
• Duration of remodeling extended with excessive
  strain or re-injury
• Treatment Goal - optimize tissue function through
  progressive loading
• Move from general to sport specific, functional
  exercises

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Follow up treatment

• Cold effective in reducing chronic swelling
• Heat - should not be applied until after acute
  inflammation phase
• After first 24-48 hours
• May flush injured area by increasing
  circulation
• May reduce pain, increasing mobility
• Contrast baths - anecdotal support
• Exercise is most important follow-up treatment
• Treatment should be directed by physician or
  physiotherapist

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Evaluation of Test Quality

• You must decide if a test is
• Valid?
• Reliable?
• Objective?
• Safe?
• Comparable to Norms?
• Appropriate?
• Economically your best choice?

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Validity

• How well does a test measure what it is intended
  to measure - most important aspect of test design
• There are several types of validity
• Logical Validity
• degree to which a test measures an underlying
  attribute based on existing knowledge
• Old CSTF sit-up test - legs held, hands behind
  neck, rate of 60 / min
• Inappropriately tests psoas muscles at high
  contraction rate
• Partial curl ups now put focus on endurance of
  abdominal muscles
• Construct validity - degree to which a test
  measures an attribute or trait that cannot be
  directly measured
• Athletic ability, anxiety, percent body fat
• Content validity
• Is the test battery measuring all the component
  abilities for performance
• List ability components for sport, and ensure
  they are all represented
• Eg soccer - speed, agility, coordination, kicking
  power

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Validity (cont.)

• Criterion-Referenced Validity - includes
  concurrent and predictive
• Concurrent Validity
• Used when a test is proposed as a substitute for
  another valid test
• Degree of correlation with a original test should
  be reported
• over .8 correlation coefficient is acceptable.
• eg. Coopers Test and VO2 Max (.897) (see next
  slide)
• SEE - standard error of estimation - should also
  be small
• However, Cooper used adults who were well trained
  and motivated
• ? Applicability to other groups ?
• Predictive validity - amount by which test score
  corresponds to future behavior or performance
• Does prior fitness actually reduce injury in
  demanding jobs?
• Do fitness scores relate to sport performance
  measures? (goals, rebounds, assists)

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Reliability

• Definition 1 - Consistency or repeatability of a
  test
• a test must be reliable to be valid
• test can be reliable but invalid
• Eg. 60 sec sit up test
• Definition 2 - ability of the test to detect
  reliable differences between subjects
• Pass/Fail tells us very little if everyone gets
  the same result
• Important when comparing to norms
• Ensure test is being administered as it was
  designed
• Single test, test retest, individual test score
  vs group of subjects (BMI)
• Factors influencing reliability
• Type of test, level and range of ability, Length
• Consistency of client preparation

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Objectivity

• Accuracy in scoring a test
• Quantitative vs qualitative
• Long jump vs gymnastics
• Intrajudge objectivity - errors often masked,
• Can be ok for test re test situations after
  months of training
• Interjudge objectivity - degree to which
  different testers agree
• Standardization of training and certification
  important
• Sources of error
• Skill of administrator (eg. skin folds)
• Calibration of equipment
• Personality of subject (motivation)

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Referenced Tests

• Norm-referenced test
• the test score is compared to a norm so the
  person can be compared against others in the same
  age and gender category
• Criterion-referenced test
• the test score is compared to a standard. This
  target could be set appropriately for the age and
  gender
• Eg police and fire fighter standard tests
• validating a criterion (pass/fail) is a difficult
  task, while using a normative database and just
  reporting a percentile ranking is easier.
• most criterions are based on normative data
  originally, could also be based on assessment of
  requirements for successful performance

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Field-Tests LaboratoryAerobic and Anaerobic Tests

• Advantages and Disadvantages
• allow examiners to test numerous participants at
  once without the need for sophisticated and
  expensive equipment.
• Validity of Field-Tests
• Field-tests are not as accurate as the original
  test they are designed to emulate
• Field-tests are usually used as motivational
  tools rather than in scientific studies, so the
  lower level of accuracy is often quite acceptable
• Care must be taken however to use the field test
  on the population group it was designed for (may
  have concurrent validity for a certain age
  population but not for another)

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Field Test

• Reliability
• If the field-test does not have a skill component
  they will usually be very reliable
• e.g. Cooper test requires pacing skill
• Simple tests of maximal strength, like the grip
  strength, have very high reliability
• Objectivity
• Field-tests usually have excellent objectivity
  (e.g. timed runs, laps completed in set amount of
  time)
• Normative Databases
• Field-tests often have large databases, in part
  because so many people can be tested easily
• Care should be taken to use the appropriate
  database for the clients whom you have tested

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Safety of Field Tests

• Most aerobic tests are sub maximal and less
  likely to put excessive strain on subject
• 20m aerobic shuttle is maximal
• Screening during test often difficult
• ECG, BP
• Rely on prescreening tests
• Anaerobic tests require maximal effort - select
  clients carefully
• High risk of muscle strain in sprint tests if not
  fully warmed-up or inexperienced with sprinting

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Field Tests

• Virtually all field-tests are very inexpensive to
  run
• test numerous subjects at the same time, reducing
  personnel costs
• minimal equipment is required
• There are numerous field-tests available so
  finding an appropriate test for your client(s)
  should not be a problem.

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Lab Organization

• Warm Up (done in the 10 min prior to test
  participation)
• 2 laps of 400m track
• Stretching (optional)
• 2 X 50 m sprints at 50-75 max (optional)
• Purpose
• to have you complete, administer and/or observe
  some common filed tests
• Decide after outline which you will participate
  in as a subject
• one aerobic
• one anaerobic if you are used to sprinting

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Anaerobic

• Lactic acid and Alactic Systems
• Usually reserved for specific sports groups
• does not contribute to cardiovascular/respiratory
  fitness
• can be associated with muscle strain
• 600 m and 100 m shuttle tests
• norms are for elite athletes
• useful on test/retest basis only
• require good warm up/stretching
• T-Test
• Test of agility (approximately 10-15 seconds)
• Two trials

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Anaerobic cont.

• 600m Run
• Lactic acid System
• 2 trials (one in 343)
• 4 runners max. use inside lane
• warm up essential
• 100m shuttle
• alactic/lactic acid systems
• sprint 5 times between 20m lines
• practice trial at 75
• 50 yard sprint
• alactic system
• practice trial at 75

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Aerobic System

• Coopers Test
• Target subjects - large groups, assumed to be
  healthy, experience running as pacing is
  important
• Normative data for Swim and Bike Coopers tests
  are also available
• warm up important
• 12 minutes around 400 m track
• pacing is important (experience)
• up to 30 runners, keep to inside lane
• use table p. 12 for miles and VO2 max estimates
• administrator calls out times and records
  completed laps - to nearest quarter or tenth
• good correlation to VO2 max test results

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Aerobic cont.

• 20 m Aerobic shuttle
• Target subjects
• Healthy subjects of any age
• warm up in protocol
• avoids pacing problem
• pace increases progressively from brisk walk
• If subject fails to keep pace
• by two steps on two consecutive laps
• the last number called out is their stage level
• MET estimated by stage and age
• MET is Metabolic Equivalent
• 1 MET 3.5 ml O2 kg-1 min-1

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Aerobic cont.

• Rockport Fitness Walking Test
• Target group
• sedentary, older individuals, those not
  accustomed to running
• walk at fast, comfortable pace
• record time for four laps
• timer can use lap function for more than one
  subject
• record 10 second heart rate at finish using stop
  watch
• Compare results to age and gender specific graphs
  in lab book

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Aerobic Tests (cont)

• 1.5 mile run
• Target subjects
• Large groups
• Prior experience running this test distance as
  pacing is important
• Timed test - 6 laps of 400 m track
• Moderate warm up and stretch
• One administrator can time up to four subjects,
  keeping track of completed laps
• Compare time to age and gender specific fitness
  scale