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ACE-CPT · Chapter 15

Considerations for Clients with Musculoskeletal Issues

How to recognize acute and chronic injuries, respond and refer within scope, manage pain, and design safe exercise programs for every major joint and region.

30Theory Quiz
35Case Studies
65Total Q's

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📖 Theory Guide →
Healing · Acute Injuries · Overuse · Pain · Shoulder · Spine · Hip · Knee · Ankle

Chapter 15 Theory Quiz

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Chapter 15 Case Studies

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Three Stages of Healing (Table 15-1)

PhaseTimePhysiologyActivity
Inflammation3–4 daysRedness, swelling, pain, local heatNon-weight bearing, active ROM; RICE
Repair3 days–6 weeksInitial scar formationWeight bearing as tolerated; gentle pain-free movement
Remodeling4 weeks–2 yearsIncreased scar-tissue strengthProgressive, pain-free exercise
RICERest/restricted activity · Ice (indirect, ≤20 min, first 24–48 h) · Compression (firm not tight) · Elevation (above heart). Exercise is contraindicated when pain/swelling is present at the injury site.

Strain & Sprain Grading

GradeStrainSprain
IMild; strength normalMicroscopic tear; RICE
IIModerate; weakness, ↓ROM, limpPartial tear; RICE + MD eval
IIIComplete tear; pop, deformationRupture; air splint, prompt referral

Perceived Pain Scale

0–10 scale0 = no pain · 10 = worst pain ever experienced.
Threshold = 3At a pain level of 3, modify or stop the exercise. Assess before AND throughout the session. Pushing through pain can make an acute injury chronic.

Post-Rehab Training by Injury (Table 15-3)

InjuryCardio optionsAvoid
Lower extremityWater exercise, upper-body ergometer, recumbent/stationary bikeWeight-bearing until cleared; any painful movement
Upper extremityWalking, recumbent/stationary bike, ellipticalRunning; exercises needing both hands; painful movement
Back / spinalWater exercise, walking, recumbent/stationary bikeWeighted spinal rotation; floor exercises; reps >8–10; painful movement

Region-Specific Facts

RegionKey facts
ShoulderLargest ROM, least bony stability; impingement of supraspinatus/subacromial bursa; press in scapular plane (30° anterior); stabilizers = lower trap, rhomboids, serratus anterior; avoid overhead early
Elbow/wristLateral epicondylitis = tennis elbow (extensors); medial = golfer's elbow (flexors); ages 30–55; carpal tunnel compresses median nerve
Low backAges 30–50; up to 80% of adults; 30% of acute → chronic; exaggerated lordosis; do daily endurance exercises (cat-cow, curl-up, bird dog, side bridge)
HipBall-and-socket, deep acetabulum; piriformis compresses sciatic nerve; sciatic splits piriformis in ~22%; ~6% of LBP is piriformis; ~2.5M U.S. hip replacements (2010)
KneeHinge, up to 130° flexion; only popliteus crosses; ITB friction ages 15–50; PFPS/genu valgum/chondromalacia; avoid open-chain knee extension
Ankle/legMTSS = periostitis (posterior shin); ankle sprains ~2M/yr; lateral/inversion ~75%, 70% recur; Achilles rupture = grade III strain (clients >45)

Scope & Action

Scope of practiceMovement screening YES; evaluation/assessment/diagnosis of injury NO. Refer to a healthcare provider for pain.
Acute vs chronicAcute = single identifiable onset; chronic = onset over months/years (LBP >6 months).
Don't move an injured client…unless they are in danger. Ice and call EMS as needed; document the injury.

Key Terms

Avascular cartilageCan't heal without blood supply → often surgery; outer ⅓ of menisci is vascular.
Second-impact syndromeLife-threatening result of a second concussion before healing — remove immediately, written clearance.
−itis"Inflammation of" — tendinitis, bursitis, fasciitis, periostitis.
Nucleus pulposusGelatinous disc core that leaks through a torn annulus fibrosus to compress nerves.