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Chapter 8
Muskuloskeletal Health
Staci, 21, currently overweight and inactive, mother has
osteoporosis. Staci’s doctor suggests jogging but Staci
worries about this as she has experienced various
aches/pains from jogging….
Questions
What is the relationship b/w PA and muskuloskeletal health?
What is the difference between a strain and a sprain?
What are the functions of tendons, ligaments, and cartilage?
What are the differences b/w Osteo + Rheumatoid arthritis?
What are the steps to treat a soft tissue injury?
Assumptions
* Typical ADLs provide adequate stimulus to maintain
healthy joint cartilage through compression of joint
surfaces and contraction of surrounding muscles.
* Both bring synovial fluid to the joint surface. The fluid
provides lubrication and nourishment
* Inflammation is the initial response to a soft tissue injury.
* Overuse injuries are the fastest growing medical problem
in the workplace today.
I.
Effects of PA on bones
* Similar to its effect on muscles (hypertrophy vs
atrophy); PA provides stresses bones needs to grow
normally and remain strong (density).
* When immobilized (cast), bone size and strength are
reduced…more easily injured
* But…PA also holds several RF that incr the likelihood
of inj to muscle/bones.
A. RF for musculoskeletal (MS) injuries
1. Aging:
Beyond 30, size and quality of collagen fibers
(the protein of connective tissue fiber) begin to
dec….thus tendons, ligaments etc…more
susceptible to injury and more immobile.
* Older folks are also less active and less likely
to take joints through their full ROM
* Older people tend to experience loss of
flexibility equally throughout body
2. Structural faults in MS system:
Misalignment of bones in a joint or
overstretched ligaments result in abnormal force
exerted on surrounding joint tissue.
* Ex. torn ACL (meniscus)
3. Excessive body weight:
Abnormally high compressive forces in joints
over time (obese: walking/jogging)
* adjust type/intensity….?
* Overzealous beginners
4. Previous MS injuries:
Folks who’ve had previous injuries tend to
sustain additional inj more often…?
* Overtraining
* If any of the RF apply; pay attn to type/ intensity
of ex carefully (high/low impact)
* Which of the risk factors are alterable?
II. Structure + function of healthy joints
* in general a joint structure connects 2 or more bones;
A. Types of joints
1. Diarthrodial: partly or completely immovable
* Fibrous joint: bone is connected to bone by
fibrous tissue (ex. top of skull).
* Cartilaginous joint: bone is connected to bone
by fibrocartilage (ex. intervertrebral discs);
shock absorbers
2. Synovial joints: freely movable
have a fibrous joint capsule lined w/synovial
membrane and joint articular cartilage
* pg 196 lower part of femur to upper part of tibia
* ligaments stabalize the joint, a ligamentous sleeve
creates a capsule within which articular cartilage
and a synovial membrane function.
B. Types of cartilage
1. Articular cartilage: lines the ends of bones that
form an articulation (knee); synovia: is the
lubricating fluid that minimizes the friction b/w
bony surfaces and provides nourishment.
2. Fibrocartilage: in some, but not all joints; various
functions; ex discs located in the spine are a type
of FC; shock absorber
C. Ligaments
hold bones together at a joint
* help stabilize/support a joint; when you sprain
ligaments you need to provide artificial support
* contribute to joints ROM. Ex ACL resists
sideward displacement and rotation.
III. Joint Diseases
The most common condition directly affecting joints is
arthritis (“arthro” = joint “itis”= inflamation )
* Like cancer, there are multiple forms of arthritis.
A. Osteoarthritis (OA): a degenerative joint disease
* most common type of Arthritis
* Gradual deterioration of articular cartilage; often
affects more than one joint but can be localized
* Typically affects middle/older aged folks
* Risk factors that contribute incl age, obesity,
previous inj to joint, faulty joint alignment…?
* role of genetics is unclear
OA and Physical Activity
* PA may play a dual role
1. Repetitive mov’t in a job/sport can lead to OA;
* wearing away of articular cartialge
2. Healthy/balanced PA can be a part of T(x);
* help restore/lessen the rate of deterioration of
cartilage
B. Rheumatoid Arthritis:
A SYSTEMIC disease; affects multiple systems,
including joints; under a doctors care
* an Autoimmune disease: body’s natural immune
system attacks its own healthy joint tissue, results in
inflammation/damage to cartilage and bone
* onset typically middle age (W), unknown cause
* genetics plays a role; a genetic MARKER HLA-DR4;
predisposed to it
* T(x) relieve (not cure) symptoms (inflammation) and
preserve normal joint f(x)
RA and Physical Activity
* PA can be beneficial but program needs to be
developed and supervised by qualified medical
personnel (PT or OT).
IV. Soft Tissue Injuries
* Playing basketball I _____ my ankle and _____ some
ligaments.
* Initially while bench-pressing I slightly ______ my
pectoral. Trying to “tough it out” I kept training and
eventually _____ my pec.
A. Ligament injury:
Joint becomes unstable
1. Sprain: L is overstretched + some of its fibers are
damaged. Becomes inflamed and swelling occurs.
* joint was forced to move beyond ROM
* can result in a joint becoming unstable
* Grades: I (minimal); II (significant tearing); III
(complete tear)
B. Muscle Injuries
1. Strain: overstretching or contracting a muscle very
strongly when stretched.
2. Torn: more serious injury to muscle
3. Contusion: a deep muscle bruise (Charlie horse)
C. Tendon Injuries: attach muscle to bone
* exceptionally strong; not often torn
* typically occur as a result of repetitive mov’t (overuse)
sometimes pain is only exp during that specific mov’t;
1. Tendinitis: become inflamed from rubbing against
surrounding bone/tendon
Patellar tendintis: “jumpers knee” tendon attaching
quad to tibia becomes inflamed.
Tennis elbow: multiple tendons connecting muscles
that extend from wrist/fingers to above elbow.
Shin splints: tendon connecting tibialis posterior
muscle to tibia
D. Bursa
A fluid filled sac whose f(x) is to decrease friction b/w
tendons or b/w tendon/bone; not bone to muscle (T).
* pg 202 Bursitis vs Tendonitis
* bursitis: bursa sac itself becomes inflamed
* often result of overuse
D. Overuse/Cumulative Trauma Injuries
* vs sprains, strains, tears contusions (often result of
specific incident)
* tendonitis, bursitis occur gradually
* Can an overuse injury occur in the bones?
V. Treatment of Soft Tissue Injuries
Various ST have similar response to injury
* Initial response is inflammation: first step tissue takes
to healing itself (24-48 hrs)
* Goal of RICE is to minimize effects of inflammation;
particularly secondary.
1. Rest: stop doing what you’re doing; at least 72 hours
2. Ice: reduce the swelling, pain, heat; 10-15 min at a
time; 1 hr intervals. Why not heat?
3. Compression: elastic wrap reduces amount of space
available for swelling. Approx 72 hours
4. Elevation: doesn’t allow blood to pool; as much as
possible in first 72 hrs
A. Physical Activity and rehabbing ST Injuries
* specific exercises can facilitate healing by
increasing circulation to area, preventing stiffness
loss of ROM, minimize muscle weakness.
* Increased circulation and the release of synovial
fluid provides more oxygen and nutrients
* you should not return to usual PA w/ swelling or
w/out full pain-free ROM
* When you do return..ease into it; if pain or
swelling occur during/after; stop
VI. Bone injuries
* bones are capable of resisting most stress
* inj associated w/ ST are more frequent
Fractures: broken bones, acute trauma
Stress Fracture: overtraining; repetitive force on bone;
* when first develops painful only during ex, after a
while pain is worse after ex. They don’t show up on xrays until healing process has already started.
* W/rest bone heals itself 4-6 wks.
* Start back slowly (atrophy of bone and muscle.)
VII. Osteoporosis: bone that is porous
Loss of bone mineral density accelerates beyond
expected loss w/ age.
* No symptoms; doesn’t show on x-rays until 30% loss
has occurred
* 80% of sufferers are W; lots of fractures;
A. RF for Osteoporosis (205-206 a slew)
Some incl gender, age (>45), race (Caucasian) early
menopause, smoking, family h(x), inadequate
calcium, ex less than 2-3 x’s a week
* Estrogen slows the resorption of bone.
* Lowered estrogen (can result from menopause,
low body fat, smoking)
* Ca sustains various physiological f(x)s (muscular
contractions); when too low body takes it from
bones (preM W need 1000 milli; postM w 1500)
* Strength training and cardiovascular ex can lessen
rate of bone loss.
B. Preventing Osteoporosis
The big 3 are estrogen replacement therapy, increased
calcium intake, and exercise.
C. PA and Osteoporosis:
PA increases bone mass as bones are “mechanically
loaded” (compressed or pushed upon) by either weight
bearing positions (standing not swimming) or muscle
contractions (weight training)
* higher impact PA w/out injury is better; for elderly this
may be walking; for younger this may be jogging
Compression: the natural force exerted on the bones
during movement (walking vs swimming)
* folks must ex at least 6 mos before changes in bone
density can be detected; benefits are site specific
* Include weight training to improve strength and
balance and reduce the risk of falls and fractures.
Contractions: muscles contract and pull a tendon
which in turn pulls a bone.
V. Low Back Pain
8 in 10 folks experience this at some point; nearly 60%
of folks miss some work.
A. Structure and Function of the back
The spine provides structural support, protects the spinal
cord, supports much of the body’s weight, serves as
attachment site for many muscles, tendons, and
ligaments, and allows movement of neck and back.
* The spinal column is made up of 33 vertebrae stacked
on top of each other and curved to bring body weight
in line with the axis of the body (cervical, thoracic,
lumbar, sacral, coccygeal)
* Intervertebral discs, made of gel and water-filled
nucleus surrounded by a series of fibrocartilage rings,
separate vertebrae from each other and absorb shock.
During light activities (walking) discs secrete fluid to
lubricate between vertebrae.
Natural Spinal Curvature assist in shock abs + posture
Kyphotic: curving outward; thoracic and sacral regions
Lordotic: curving inward; cervical and lumbar regions
B. Causes of back pain
LBP may be caused by injury, but more often it is the
result of weak muscles, poor posture, or poor body
mechanics while lifting/carrying things.
* Most causes are unknown; longer pain persists more
likely cause will be identified
* LBP generally affects the lumbar region because it
bears the majority of body weight. In general if LBP
heals on its own and fairly quickly probably ST injury
* A back injury can cause a disk to bulge out b/w
vertebrae against a nerve root, which can cause pain,
numbness, loss of muscle function, or muscle spasms.
Disc problems do not resolve quickly.
* Degenerative changes can incl spinal narrowing which
can cause spinal cord to become compressed..tingling
in legs=spinal stenosis
C. Preventing LBP:
1. Understand rf related to your occupation!
Physically demanding:
* Infrequent heavy lifting or submaximal repetitive
lifting most common
* proper technique; straddle object; bend your knees
and lower body toward object; keep back straight;
grasp object; bring it close to you; raise with legs.
Sedentary jobs (student)
* correct sitting posture (212); maintain normal
lordotic curve ;
* slouching or slumping puts great strain on back
muscles; cause neck to lean forward
2. Strengthen and build endurance of lower back and
abd muscles
3. Lose weight, use a firm mattress, and reduce stress
D. Treating LBP
* Most folks who have an episode of LBP (Soft Tissue)
don’t need to seek medical tx
* Typically symptoms go away w/in a week; ice may
help relieve discomfort early
* brief bed rest followed by light PA is typical T(x); pay
attn to pain-free range.
* If you experience numbness, tingling, severe pain in
leg(s), numbness/tingling in groin/rectal region,
difficulty w/ bladder/bowel mov’t seek medical t(x)