LESSON:5

RISK MITIGATION AND

MANAGEMENT
OBJECTIVES

 To be able to execute proper technique when performing active warm-

up exercises.

 To discriminate among the different kinds of stretching.

 To Explain the RICE procedures in caring for an injury.

Risk of Musculoskeletal Injuries

 When beginning an exercise program, it is best to progressively

overload and be aware of your body's response.

 Rushing into activities for which the body is not prepared puts you at
risk for injury. You are likewise susceptible if you have been exercising
for a long period of time while overusing one area of the body.

 Even though adherence to training principles is an effective strategy for

ensuring safety and effective exercise, the risk of injury is inherent in
any physical activity.
 Acute and chronic injuries can occur during your participation in
sports, recreation, and exercise. Acute injuries (e.g. sprained ankle,
strained back, fractured hand) are those that suddenly occur during
an activity, while chronic injuries (e.g. runner's knee, jumper's knee,
tendonitis, plantar fasciitis, patellofemoral syndrome, iliotibial
syndrome) usually result from overuse.

 There are a number of factors that contribute to exercise-related

injuries: body mechanics (movement and sports skill), level of
muscle strength and conditioning, and the body's overall condition
prior to an intense workout or game.
 Techniques for reducing the risk of injury include self-myofacial release
(SMR), dynamic warm-up, improving movement mechanics through
mobility and stability training (e.g. learning how to stop, change
direction, pivot), and proper conditioning (e.g. developing power and
strength).

 Developing stability and eccentric strength (ability to land properly)

through hopping drills, which involve landing on one leg is also an
important area of conditioning.

 Training for movement, specifically change in direction, entails knowing

the concept of movement and timing the movement. All in all, training
smart (e.g. adherence to training principles, functional training) can
reduce the risk for injury.
Warm-up
 Warm-up is a good take-off point for mitigating your risk for injuries. Warm-up
consists of preliminary activities of low- to moderate-intensity performed before
any workout or strenuous physical activity.

 It is so-called because of its primary purpose of increasing the body's

temperature. But more than just getting 'warmed-up', these preliminary activities
increase the heart rate and promote efficient blood flow to the working muscles.
We already know from the previous lessons how the heart and lungs are
responsible for oxygen uptake and transport, and removal of carbon dioxide as
well as lactic acid from the working muscles.

 This also has the potential of improving performance since it minimizes the
premature formation of lactic acid at the start of the workout. Lactic acid is a by-
product of metabolism as one performs vigorous physical activity. Muscle
fatigue is partially attributed to the accumulation of lactic acid in the working
muscles.
 Warming-up also leads to an increase in the rate and force of muscle
contraction which promotes greater elasticity and extensibility of
connective tissues. As you gradually prepare the body for a higher-
intensity workout, you also increasingly activate the central nervous
system that facilitates your coordination, reaction time, and skill
accuracy.

 Typically, warm-up engages muscles and prepares you for the activity.
It can be reinforced by movement preparation exercises which focus on
incorporating and improving fundamental movement skills and
fundamental sport skills. This consists of exercises that:
(1) develop single leg strength,
(2) develop dynamic flexibility,
(3) increase proprioception, and
(4) activate one muscle while elongating the other.
Warm-up

 Preliminary activities of low- to moderate-intensity

performed before any workout or strenuous
physical activity.
Movement Preparation
 Exercises which supplement the warm-up, are characterized by
activating one muscle group while elongating another, as well as
incorporating fundamental movement and sports skills.

 Movement preparation is so-called because it prepares the body for

movement and enhances the way you move. In particular, it stimulates
the muscles (e.g. activate a muscle group and elongate another) by
gradually preparing them so that they are ready for the shock and
impact of most activities, thus, making you less susceptible to injury.

 This muscle activation even of the small muscles increase joint stability
and proprioception. Movement preparation can, therefore, increase
your confidence to safely participate in your activity, and motivate you
to overcome challenges as well.
Core
 Muscles of the lumbo-pelvic hip complex (lower back, abdominal, and
hip) acting as one integrated functional unit to enable the production
and reduction of force, as well as dynamically stabilize the spine
against abnormal force.

 Developing its strength, neuromuscular control, power, and endurance

will contribute to more efficient movement throughout the entire kinetic
chain (improved biomechanics), minimize compensation factors, poor
posture during movement, and the extra strain and stress on the
muscles and their connective tissues.
Stretching and Flexibility
 Static stretching is performed slowly in a sitting or standing position. It
increases flexibility and relaxes the muscles. But this does not prepare
the muscles and connective tissues for dynamic movements that occur
while working out or playing your sport. Stretching can, therefore, be
performed in the cool-down period.

 It is important to particularly stretch problematic regions of the body or

areas that are limited in their range of motion to enhance their flexibility.
A word of caution though on static flexibility: more is not necessarily
better because as joint mobility increases, joint stability decreases.
Extremes of flexibility (inflexibility and hypermobility) are associated
with higher risks for injury. What is important therefore, is to achieve
normal levels of flexibility as this aids in daily functioning and PA
performance.
Stretching exercises are usually classified into:

1. Passive (use of external force, usually another person),

2. Static (slow increase in muscle length and holding the stretched position
for a short time),

3. Ballistic (fast, bouncing movements aided by momentum; generally

avoided due to greater risk of injury from the high force that is generated),
and

4. Proprioceptive neuromuscular facilitation or PNF (series of 'contract-

relax' involving isometric contraction and static stretch that is assisted).
 Static and PNF stretching are recommended at least three times a
week, preferably daily and post-workout or exercise.

 Static stretching allows muscles to slowly elongate, maintains

muscle relaxation, and lessens myotatic reflex or the action of
muscle spindles to contract when it senses a change in the length of
the muscle.

 This reflex action is sensitive to ballistic (e.g. fast and jerky) stretch.
Cool-down
 Cool-down gradually returns the body to resting state and promotes
effective recovery (e.g. removal of lactic acid). Activities are of low-to-
moderate intensity but gradually diminishes so as to bring breathing,
heart rate, and metabolism back to baseline levels.

 This controlled 'slow-down' is important for the heart so as to avoid

cardiac abnormalities (e.g. negative and abrupt changes in heart
rhythm). In addition, it prevents the sudden pooling of blood in the lower
extremities and ensures adequate circulation to the skeletal muscles,
heart, and the brain. This reduces the tendency toward dizziness and
fainting from a sudden drop in blood pressure.
 Finally, cool-down aids in preventing or relieving spasms or
cramps in fatigued muscles through static stretching. Since
your muscles are warm from the workout, they are more
pliable and it is best to perform static stretching at this time.

 Stretching as part of the cool-down can help improve

extensibility of the muscles and connective tissues and the
range of motion around the joint.
Management of Injuries
How do you find out if an injury exists? You can look at and feel the area for one or
more of the following signs:

1. Deformity (abnormal shape compared to an uninjured part on the other side of the
body),

2. Open wounds (break in the skin and bleeding),

3. Tenderness or pain (sensitive to touch and usually the individual can point to the
site), and

4. Swelling (area is larger than usual because of fluid from inflammation and/or
bleeding).
 The mnemonic DOTS can help you remember these signs.

 When an acute injury to the muscle, bone or joint occurs, the standard
treatment is rest, ice, compression, and elevation, or RICE of the
affected body part.

1. REST
 Avoid moving the injured part as well as stopping your activity
altogether to keep from aggravating it.
2. ICE.
 Immediately apply ice or a cold pack, or submerge in cold water the
injured area for 15 to 30 minutes every two or three hours, or three to
five times a day for the first 24 to 48 hours.
 The cold constricts the blood vessels and reduces swelling and
inflammation. time it takes for healing to occur is associated with the
amount of swelling.
 The skin reacts to ice application in four stages: cold, burning, aching,
and numbness. Avoid applying heat to the injured area as this will
increase blood circulation and further the swelling and pain. After the
first 24 to 48 hours, heat can be used if the injury shows no further
swelling or inflammation to promote healing.
3. COMPRESSION
 Apply an elastic bandage or wrap in an upward,
overlapping spiral on the injured area, specially the foot,
ankle, knee, thigh, hand, or elbow.

 The even, slightly tight pressure limits the ability of the skin
and other tissues to expand and reduces internal bleeding.
Pale skin, numbness, and tingling could mean that the
bandage has been wrapped too tightly
4. ELEVATION
 Elevating the injured area decreases the blood flow and
minimizes swelling.
 An injury is fully healed when there is no longer pain,
swelling, and limping (favoring the uninjured side of the
body) or instability.
 It is important to seek rehabilitation from the injury by
recovering full range of motion and flexibility, achieving
muscle strength and endurance that is proportionate to the
unaffected extremity, resumption of pre injury endurance
levels, and exhibiting good balance and coordination.
 If surgery has been performed on the injury area, it would
be important to get clearance from the physician before
returning to physical activity.
 Symptoms and care of common injuries are listed in Table
5.1.
When there are obvious deformities (possibly a fracture or dislocation), splint the
injured area in order to stabilize against movement. Do a quick check of circulation,
sensation, and movement (CSM) for injuries to the extremities to guard against
limb loss —the tissues of arms and legs cannot survive for more than three hours
without blood circulation:

a. Circulation: For an arm injury, feel for the radial pulse; for a leg injury, feel for
the posterior tibial pulse located between the Achilles tendon and inside ankle bone
(see Figure 5.1). Tie absence of a pulse indicates the need for immediate surgical
care.

b. Sensation: Lightly touch or squeeze the finger or toes to determine the

presence of sensation. Loss of sensation indicates possible nerve damage.

c. Movement: Check for nerve damage by wiggling the fingers or toes, only if they
are not injured.
Passive Stretching

 A form of stretching exercise that employ external force

upon a limb, usually by another person, to further a
stretched position.
Static Stretching

 Exercises that require holding the final stretched position, which is

usually challenging and could be uncomfortable but should not be
painful, for a period of time.
Ballistic Stretching

 Use of the body's momentum (e.g. bouncing) and is usually

uncontrolled, erratic, and jerky.
Dynamic Stretching

 Distinct from ballistic stretching in that it is controlled,

smooth and deliberate.

 More movement oriented and, therefore, helpful for

improving functional movements used in daily life and
sports.
Proprioneuromuscular Facilitation (PNF)

 Originally developed as a form of rehabilitation. It involves

stretching a muscle group passively, then sustaining this
contracted position as a partner applies sufficient force for
5-6 seconds to inhibit movement, followed by a relaxed and
controlled stretch past its normal range of movement for
about 20-30 seconds.

 Recover for 30 seconds before repeating the process two

to four times.
DOTS

 A mnemonic for deformity, open wounds, tenderness, and

swelling, which are indications that an injury exists.
RICE

 A mnemonic for rest, ice, compression, and elevation. It is

the standard treatment for an acute injury to the muscle,
bone, or joint.
CSM

 A mnemonic for circulation, sensation, and movement.

 A quick check of these is done for injuries to extremities, to
guard against loss of limb.
Contusion

 Injury that does not break the skin but results in some
discoloration.
Sprain

 Trauma (micro- or macro-) to a joint with damage to or

tearing of connective tissues (tendons, ligaments).
Strain

 Trauma to the muscle or tendon caused by overextension

or overstretching.
Dislocation

 Also called subluxation. Separation of a joint, wherein the

bone ends move out of the joint capsule.
Fracture

 A break in the continuity of a bone.

Muscle Soreness

 Microscopic damage to muscle fibers involved in the

exercise.
 It is experienced during exercise (acute) and/or 12-24 hours
after exercise (delayed).
Activity 5.1

 The are two sample routines of active warm-up exercises which

promote movement preparation. Perform these routines prior to your
workout proper. These mobility and stability exercises essentially
activate the ankle, knee, hip complex, the core, and lumbar and
thoracic spine. Besides mobility and stability, theses exercises require
balance and coordination too. It is recommended that one performs
dynamic stretching after the warm-up before your workout proper, and
static stretching during cool-down. Do ten repetition of each exercise.