• Musculoskeletal injuries
– Risks
– Classification
– Treatment
• Heat Illnesses
• Evaluation of test quality
• Field tests
– Anaerobic
– Aerobic
1

• 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 (> 3 times per week)
2

– Poor biomechanics, past physical activity, poor baseline fitness, present level of training and weight load affect incidence of injury
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4

• 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
5

• 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
6

• 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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• 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
8

• 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
9

• 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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12

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• Plantar fasciitis
-inflammation of plantar fascia tendon
– tingling, ripping in AM
– stiff/hard midsoles (old shoes)
– poor arch support
– running in court shoes
14

• 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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• 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 O
2 necrosis
, nutrients, waste - leads to cell
• 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 O
2 supply adjacent to primary injury
– further necrosis, swelling - hours after injury
17

• 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
18 cycle

• 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
19

• 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
20

• 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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• 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…
26

• 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 VO
2
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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• 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
29

• 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)
30

• 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
31

• 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)
32

• 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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• 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
34

• 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.
35

• 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
36

• 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
37

• 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 %
38

• 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 VO
2 max estimates
– administrator calls out times and records completed laps - to nearest quarter or tenth
– good correlation to VO
2 max test results
39

40

• 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 O
2 kg -1 min -1
41

• 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
42

• 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
43