Dealing with Injury
stop an exercise that causes the joint or muscle unusual pain.
Do not test or stretch the muscle since further damage could
occur. Regardless of the findings the initial treatment remains
the same. Administer first aid. Allow
time for the joint or muscle to heal as you continue to workout
using exercises that do not further aggravate the injury during
its recovery. After sufficient recovery time, start back very
conservatively with a single set or brief bout with very light
resistance. Continue to slowly progress steadily, increasing
the load or volume throughout the following weeks, only if you
can perform the load pain free. Be cautious not to aggravate
the injury by attempting to progress too rapidly. Be aware that
it is possible to not feel pain or discomfort after over doing
it until after the workout or the next day - after it is too
late. See a physician for serious injuries or if the pain persists
or gets worse. A sports medicine physician specializes in exercise
and athletic related injuries. A physical therapist should also
be able to refer you to a physician knowledgeable in exercise
related injuries for proper diagnosis. A specialist can help
you determine possible underlying causes of the injury and make
necessary program modifications to prevent future injuries. See
Adaptation Criteria and
Injury Rehabilitation Phases
- Range of motion (ROM)
- Return to activity
Bomgardner R (2001) Rehabilitation phases and program design
for the injured athlete. Strength and Conditioning Journal, 23(6):
- Inflammation Phase
- First aid and Immobilization
- Manage inflammation
- Lasts days
- Repair Phase
- Rehabilitative exercises
- Fibroplasia (formation of collagen)
- Angiogenesis (formation of new local blood vessels)
- Lasts weeks
- Remodeling Phase
- Conservative reintroduction of activity
- progressive increases of intensity and volume
- Collagen maturation and remodeling initiate
- Lasts months
Evans P (1980). The healing process at cellular level:
a review. Physiotherapy, 66(8): 256-259
Irritability can be rated Low, Medium, or High based on 3
- Pain level (Score of 1-10)
- What it takes to provoke the symptoms
- Latency or time it takes the symptoms to resolve after provocation
Care must be taken when assessing patients of high irritability
because once symptoms are provoked, the remaining assessments
Tovin BJ (2006). Prevention and Treatment of Swimmer's
Shoulder. North American Journal of Sports Physical Therapy,
Strength Imbalance and Injury Relationship
Individuals with strength differences of more than 10% between
the quadriceps of the right and left legs were more likely to
sustain lower limb injuries compared to individuals without such
strength imbalances (Bender et al, 1964).
If these strength differences were due to past injury, one
could speculate that previous injury at least partly attributed
to increased the risk of injury, not necessarily the strength
imbalance itself, since past injury is most predictive of future
injury (see studies below) and past injury typically results
in weakness (and decreased range of motion) in the injured limb.
Ankle Sprain Predictors
BMI and past ankle sprains were much more predictive of future
injury in high school athletes than were balance, height, ligamentous
laxity, ankle tape/bracing usage, and hip strength balance. High
school football players were 16 times more likely to sustain
an ankle sprain if the athlete was overweight or obese and had
a history of ankle sprain. Incidentally, the use of preventive
taping or bracing did not reduce the incidence of injury.
Mirabella MR, Tyler TF & McHugh MP (2004) Risk Factors
for Ankle Sprains in High School Football Players. Journal of
Athletic Training. Supplement 39(2), 38.
Tyler TF, McHugh MP & Tetro (2004) Risk Factors for
Ankle Sprains in High School Athletes. Journal of Athletic Training.
Supplement 39(2), 37.
Past Distal Injuries Delay Proximal Muscular Activation in
Both Affected and Unaffected Limbs
Bullock-Saxton (1994) found a delay in Gluteus
Maximus activity in individuals
with a previous injury to the ankle. Changes appeared to occur
in both the previously injured and uninjured sides of the body.
Bullock-Saxton JE, Janda V, Bullock MI (1994). The Influence
of Ankle Sprain Injury on Muscle Activation During Hip-extension.
Int J Sports Med. 15(6): 330-334.
Exercise & Arthritis
Exercise can decrease pain and improve functional capacity,
ROM, and muscular strength
Felson DT, Lawrence RC, Hochberg MC, McAlindon T, Dieppe
PA, Minor MA, Osteoarthritis: New insights. Part 2. Treatment
approaches. Ann Intern Med. 133:726-737, 2000.
Casper JM, Berg K. Effects of exercise on osteoarthritis:
A review. J Strength Cond Res. 12:120-125, 1998.
The human foot has 26 bones, approximately 20 muscles, 33
joints, and over 100 ligaments holding it all together.
Connective Tissue Sheaths
Weight training may strengthen the sheaths of connective tissue
within and around the muscle by increasing their collagen content.
These connective tissues sheaths provide the framework that supports
muscle overload and are the main component in the tensile strength
and passive viscoclastic properties of muscle.
- endomysium surrounds individual fibers
- perimysium encloses groups of muscle fibers
- epimysium surrounds the entire muscle
Fewer than 200 cases of total or near-total pectoralis ruptures
have been reported in the literature (Aarimaa 2004).
The first incidence of those 200 cases was described by Patissier
in 1866 documenting a French boy who tore his pectoral tendon
while he was lifting an heavy piece of beef from a hook. Later
in 1861 Letenneur reported a similar case. (Merolla 2012)
Aarimaa VJ, Rantanen J, Heikkila, Helttula L, Orava S (2004).
Rupture of the pectoralis major muscle. Am. J. Sports Med. 32:12561262.
Merolla G, Paladini P, Campi F, Porcellini G (2012). Pectoralis
major tendon rupture. Surgical procedures review. Muscles Ligaments
Tendons J. 2012 2(2):96-103.
Tensile strength and elasticity of bones decrease about 2%
per decade from age 20 to 90 years (Hayes, 1986).
Bone is only one fifth the weight of steel but can withstand
two times the compression force as granite, or four times the
compression force as concrete.
Weight bearing activities such as walking can prevent bone
mineral loss. Weight resistive exercises can prevent bone mineral
loss if the antigravity musculature is activated.
In animal studies, the first 40 repetitions of an exercise
stimulate greater than 95% of bone formation. Additional repetitions
do not significantly increase bone formation (Riewald 2004).
Astronauts have about the same rate of bone loss as those
on bed rest: about one percent per month.
Riewald S (2004). Bone of Contention: What Exercises Increase
Bone Strength? Strength and Conditioning Journal. 26(1): 46-47.
can thicken the hyaline cartilage on the articular surfaces of
the bone (Ingelmark & Elsholm 1948).
Joint cartilage depends on synovial fluid for its nutrition
since it has no vascularization. Synovial fluid is forced into
the cartilage surfaces when the joint is loaded, as in physical
activity. Joint cartilage functions in an elastic manner during
short term loading. The cartilage becomes temporarily deformed
when long term loading forces water out of the cartilage. It
returns to its original shape after cessation of loading when
water is again drawn into the cartilage. The alternate compression
and decompression along with the pumping of synovial fluid due
to physical activity is partly responsible for nutrition to the
Tendon and Ligament
Resistance training can increase the size and strength of
tendons and ligaments (Fahey et al. 1975). This may be due to
an increase of collagen within the connective tissue sheaths
The elastic limit of a tendon or ligament can be enhanced
by exercise and training and can be reduced by aging and inactivity.
The elastic limits of ligament are estimated to be 12-50%, and
the elastic limits of tendon is 9-30% (Weakest at MTJ).
Research using animal models demonstrate that junction strength
of ligaments increases with endurance-type physical activity
and decreases with immobilization. Furthermore, damaged ligaments
regain strength faster if physical activity is performed afterwards.
Junction strength failure of a bone-ligament preparation occurs
at the attachment site of the ligament. The Junction strength
failure is similar in a bone-tendon-muscle-tendon-bone preparation,
although separation may also occur at the muscletendinous junction
or in the muscle itself.
Tendons exhibit viscoelastic properties and are adaptive to
conditions of increased loading and disuse. Strains within the
tendons near their insertion site do not appear to be uniform.
The traditional concept of tensile failure may not be the essential
factor in the pathomechanics of insertional tendinopathy. Particular
joint positions are more likely to stress the area of the tendon
usually affected by tendinopathy. Incorporating different joint
position during exercise may allow for more controlled stresses
on these affected areas of the tendon which may allow for better
maintenance of the mechanical strength of that tendon region
in effort to prevent injury. Such exercises could stress a healing
area of the tendon in a controlled manner thereby stimulating
healing once an injury has occurred. (Maganaris 2004)
Fahey TD, Akka L, Rolph R (1975). Body composition and
Vo2max of exceptional weight-trained athletes. J Appl Physiol.
Laurent GJ, Sparrow MP, Bates PC, Millward DJ (1978). Turnover
of muscle protein in the fowl. Collagen content and turnover
in cardiac and skeletal muscles of the adult fowl and the changes
during stretch-induced growth. Biochem J. 176(2):419-27.
Maganaris CN, Narici MV, Almekinders LC, Maffulli N (2004).
Biomechanics and pathophysiology of overuse tendon injuries:
ideas on insertional tendinopathy. Sports Med. 34(14):1005-17.
Also see Ligament