Exercise Injury

This following information is not to be used for self-diagnosis. It's primary intent here is for identification purposes in order to provide first-aid care or to help understand a medical professional's diagnosis. A medical professional always should be consulted in all cases of injury or suspected injury. Symptoms may appear to indicate one type of injury but may in fact be an indication of a more serious injury.

It is important to understand where first-aid and symptomatic relief end and medical diagnosis and treatment begin. The later can get you prosecuted for practicing medicine without benefit of a license. Wrongful first-aid through negligence can get you involved in a civil suit. They're both bad.

For example, if a client tells you of a specific pain that they're having and you say that they probably have such and such, you've just made a diagnosis. Now, if you further extend yourself by telling them that they should do this exercise or take ibuprofen for 3 days, you have prescribed a treatment (rehabilitative or drug), which should be done by a medical professional. The solution is very simple, tell them not to do the offending exercise and see their doctor if pain persists. Protect yourself legally and your client's physical well-being.

First-aid treatment is designed to provide pain relief and limit further injury immediatley after an acute injury in order to limit further injury, swelling, bleeding, etc. until a medical professional can attend to the injury. Don't confuse the two scenarios. First-aid treatment should be encouraged not forced. If a person refuses first-aid and you insist on providing it anyway, you're probably exposing yourself legally again. First-aid should be limited to Rest, Ice, Compression, and Elevation or RICE and advice to see their doctor.


Acute Injury

Chronic Injury

Overuse Injuries

Chondromalacia and Patellofemoral Syndrome

Plantar Fasciitis and Neuromas

Tendonitis, Arthritis, Bursitis

Shin Splints and Compartment Syndromes

Breathing Reactions

Environmental Concerns

Heat Related Injuries

Heat Index

Heat Cramps

Heat Exhaustion and Heat Stroke

Emergency Response

Temperature and Humidity

Hypothermia and Frostbite

Hyperventilation


Acute Injury

If you pull a muscle or have a specific pain after exercising, the immediate first-aid treatment is RICE (rest, ice, compression, elevation). Ice every 2 hours for about 10-15 minutes, over a 48 hour period. If injury doesn't respond to RICE in a couple of days, you should see a medical professional.

Chronic Injury

Chronic injuries fall into the "other" category of diagnosis and treatment. See a doctor.

Overuse Injuries

Overuse injuries encompass a broad range of exercise-related injuries. These type injuries are caused by overtraining over a long period of time gradually weakening or irritating an area of the body until exercise becomes difficult or impossible, or other symptoms appear.

Most overuse injuries can be avoided by utilizing proper form and technique, appropriate rest, proper equipment and clothing (especially footwear), and a conservative increase of exercise frequency, intensity, or duration.

Chondromalacia and Patellofemoral Syndrome

Patellofemoral Syndrome (Runner's Knee) is generalized knee pain. Generally caused by improper running form over a period of time and may or may not be due to a pathological condition of chondromalacia.

Chondromalacia is the wearing away of the cartilage on the back surface of the kneecap, manifested as a "clicking" or "grating" sound, and knee pain under the patella (kneecap).

Plantar Fasciitis and Neuromas

Plantar fasciitis is literally an inflammation of the plantar fascia, a web of tough, fibrous connective tissue on the bottom of the foot.

Neuromas are irritated nerve endings, but can cause pain in the foot (or other places, depending on the nerve in question).

Either condition cold be caused by poor technique or simple overuse but should be examined by a physician to determine the cause. In the problem is orthopedic in nature, orthotic shoe inserts may be prescribed by a medical professional to alleviate future problems.

Tendonitis, Arthritis, Bursitis

Tendonitis (inflamation of a tendon) and Bursitis (inflamation of the fluid filled cushioning sacs between tendons and bones) are common overuse injuries. Rehabilitation requires rest and the attention of a physician.

Osteoarthritis is caused by worn joint cartilage thereby exposing the joint surfaces swelling and edema (fluid buildup). Rheumatoid arthritis is an auto immune disorder in which the body's immune system attacks joint tissues.

Shin Splints and Compartment Syndromes

Shin Splints are a common name for pain felt in the anterior portion of the lower leg and can be caused by a muscle imbalance. Shin Splints require rest, ice, compression and elevation (RICE) and strengthening exercises to prevent future occurrences.

Pain can also be caused by a more serious condition known as a compartment syndrome where one of the compartments between the muscles becomes inflamed and swollen which stresses the blood vessels and nerves in the area. This situation requires immediate medical attention.

Breathing Reactions

Exercise reactions, range from red blotchiness on the neck, face, or arms (uticaria), to exercise-induced Asthma or Bronchospasm, or even Anaphylaxis and Hyperventilation. Exercise-induced Anaphylaxis is an severe allergic reaction requiring immediate medical attention. A Physician may prescribe carrying a bee-sting kit as treatment.

Exercise-induced Asthma may be triggered by exercising in cold, dusty, or excessively humid environments, and can range in severity from mild coughing to severe discomfort. Individuals who suspect that they have exercise-induced asthma are encouraged to seek medical attention.

General recommendations for persons with exercise-induced Asthma include an extended warm-up, avoidance of cold, dusty, or extremely humid environments for exercise. A physician may recommend an inhaler.

Hyperventilation is the process of repeated quick and shallow breaths utilizing the top of the chest. This sharply reduces the level of carbon dioxide in the blood which causes the arteries in the body to constrict thereby reducing the flow of blood throughout the body. This includes the carotid artery to the brain. Lack of blood flow, and subsequently oxygen, trigger the sympathetic nervous system causing anxiety, irritability and confusion.

Hyperventilation can be caused by anxiety, extensive physical injuries or even heart or lung disease. It is important to keep the victim calm. Have everyone step back and give them some "breathing room". A crowd can increase the anxiety level for the victim.

Procedure:

  • Cover the nose and mouth with a small paper bag
  • Breath slowly and re-breathe bagged air about 10 times
  • Then breathe normally for a few minutes, about one breath every 5 seconds
  • Repeat above if symptoms persist.

Environmental Concerns

In hot weather wear light clothing that breathes well, and allows for the evaporation of sweat.

"Sauna suits", "tummy wraps", and other products designed to encourage quick weight loss through sweat are particularly dangerous. The body can reach dangerous (or even fatal) core temperatures in very short periods of time. Any weight lost is simply water and will be regained as soon as water is ingested again.

Exercise at a reduced intensity during high humidity. The body is cooled by blood circulation and the evaporation of sweat. In a high humidity, evaporation becomes less effective at cooling, and the risk of heat-related injury is greater.

Adequate hydration is also key to safe exercise in the heat, as the body will produce large quantities of sweat. Ingest 1-2 cups of water before exercise and 4 oz every 10 to 15 minutes during exercise.

Thirst lags behind the body's need for fluid. By the time thirst is felt dehydration has occurred. Minor dehydration can affect performance, and severe dehydration can be life-threatening.

Contrary to popular belief, water consumed during exercise will not contribute to cramping, so "swish and spit" should be avoided in favor of consuming small amounts of water steadily during the exercise session. Dehydration can actually contribute to cramping.

In cold weather, dress in layers that will wick sweat away from the body. Remove outer layers as the body warms and replace during the cool-down to avoid an excessive chill.

Heat Related Injuries

High risk individuals are those who work or exercise outdoors, elderly people, young children, those with medical conditions that cause poor blood circulation, and those who take medications to get rid of water (diuretics).

Heat Index

The likelihood of Heat Disorder with prolonged exposure or strenuous activity is demonstrated in the following chart:




Source: NOAA's National Weather Service

Activities performed in the Caution zone result in premature fatigue and, therefore, the inability to effectively pursue cardiovascular and weight training goals. Activities that are performed in the remaining zones can result in muscle cramps and the more severe Heat Stroke and Heat Exhaustion.

Heat Cramps

Heat Cramps are the least severe and first sign of an impending heat problem and is manifested by painful muscle spasms usually in the legs and abdomen.

Have the victim rest in a cool place. Give them cool water or a commercial sports drink. Lightly stretch and gently massage the area. The victim should NOT take salt tablets or salt water. The can make the situation worse.

Heat Exhaustion and Heat Stroke

Heat Exhaustion is more severe and is symptomized a cool, moist, pale or flushed skin, headache, nausea, dizziness, weakness, and exhaustion.

Heat Stroke is the most severe heat emergency. The body systems are overwhelmed by heat and begin to stop functioning. Heat Stroke is a serious medical emergency that is manifested by red, hot, dry skin, loss of consciousness, a rapid, weak pulse, and rapid, shallow breathing.

Move the victim out of the heat. Loosen any tight clothing and apply cool, wet cloths. If the victim is conscious, give cool water to drink. Do NOT allow he victim to drink too quickly. Give about one glass (4 ounces) of water every 15 minutes. Let the victim rest in a comfortable position and watch carefully for changes in their condition. The victim should not resume normal activities the same day.

Emergency Response

Call 911 (or emergency services) if the victim refuses water, vomits, or losses consciousness. If the victim vomits, stop giving fluids and position the victim on their left side. Watch for signals of breathing problems. If you have ice packs or cold packs, place them on each of the victim's wrists, ankles, groin, armpit, and neck (a.k.a. pulse points). Do NOT apply rubbing (isopropyl alcohol).

Temperature and Humidity

Heat cramps, or heat exhaustion possible.

  • 93 F (34 C), 20% humidity
  • 87 F (31 C), 50% humidity
  • 82 F (28 C), 100% humidity
Heat cramps or heat exhaustion likely.
  • 105 F (41 C), 20% humidity
  • 92 F (34 C), 60% humidity
  • 87 F (31 C), 100% humidity
Heat Stroke imminent.
  • 120 F (49 C), 20% humidity
  • 108 F (43 C), 40% humidity
  • 91 F (33 C), 100% humidity
Reference, 1993 American Red Cross Standard First Aid Manual

Hypothermia and Frostbite

Frostbite is the freezing of tissue. The skin becomes yellowish, and will be cold to the touch. Provide first aid by warming the affected area using warm water. Do NOT rub the area, as this can cause further tissue damage. A medical professional is required to access the extent of the damage.

Hypothermia is a life-threatening condition wherein the core body temperature has become dangerously low. Many of the same symptoms as heat exhaustion, including dizziness, nausea, loss of appetite, vision problems, etc., may be present. In the case of hypothermia it is important to call 911 immediately, and use any means present to warm the victim, such as removing wet clothing or putting them in a sleeping bag with an unaffected person who can provide body warmth until help arrives.

Hyperventilation

Symptoms: short rapid breathing, (as if running), can be brought on by a number of factors, they include:

  • Anxiety (the most common cause)
  • Severe stomach pains.
  • Heart or lung disease.
  • Extensive physical injuries.
  • The symptoms usually last 15 to 30 minutes, and can seem like hours to anyone having them.
  • Though very frightening for the patient and indeed for the onlooker, hyperventilation is not usually dangerous.
  • Breathing into a paper bag increases the amount of carbon dioxide in the blood and relieves the symptoms.
Follow these steps for self-help:
  • Loosely cover your nose and mouth with a small paper bag.
  • Breathe slowly into the bag and rebreathe the air in the bag about 10 times.
  • Set the bag aside and breathe normally for a couple of minutes.
  • Repeat steps 2 and 3 until the symptoms lessen or go away.
  • Try to breathe slowly. Focus on taking one breath every 5 seconds.
To treat someone who is hyperventilating.

  • Avoid becoming caught up in the panic (remain calm )
  • Make direct eye contact, and speak clearly and slowly.
  • Identify yourself if you're not known to the person.
  • Give short clear instructions.
  • Make calming gestures.
  • Allow the casualty some space ( don't crowd them in )
  • Minimize embarrassment and avoid an audience.
  • Get them to sit down, if they aren't already.
  • Sit with them at eye level
  • Encourage them to breathe normally. ( talk them through the breathing cycle )
  • Inhale, take in long slow deep breath. ( breathe with them )
  • Hold breath for +1 seconds.
  • Exhale slowly, ( pucker your lips like you're going to kiss )
  • Tell them to relax in a clam voice, just before they reach the end of exhalation.
  • Start a new breathing cycle while telling them how well they are doing.
  • Continue encouraging them to breathe normally.