Safe and Sound

Musculoskeletal Injuries
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Overuse Syndromes

Whenever a muscle is overused that is, exercised past its state of conditioning there is actual destruction of the muscle tissue and generation of lactic acid. Given a reasonable rest period, the products of metabolism are carried away in the circulation and the muscle tissue regenerates to a healthy, sometimes even stronger, condition. However, if the exercise has been vigorous and unrelenting, the participant may suffer from a variety of aches and pains that are generally categorized as overuse syndromes.

Muscle Fatigue

Simple fatigue, with depletion of energy stores within the muscle, is manifested as weakness, pain on exertion, soreness to the touch, and cramping. In many cases, this is compounded by dehydration, deficiencies of electrolytes (usually sodium and/or potassium), lack of sufficient caloric intake, or a specific injury. The sufferer has been informed by his body that it is time to rest. Sufficient time should be allowed to remove waste products, restore energy sources, correct dehydration, and regenerate muscle tissue. The victim should avoid vigorous physical activity for 12 to 24 hours, and should eat and drink amply. Pharmaceutical muscle relaxants are of little value, and pain medication is generally not necessary. Massage of the involved muscle groups is relaxing, although it probably does not hasten recovery.

Shin Splints

Shin splints is the term used to describe a painful disorder generated by excessive walking, running, or hiking. The sufferer has irritated the thin membrane that connects his two lower leg bones along the longitudinal axes where the membrane attaches to the bones. With every footstep, there is further irritation of the membrane, so that it can become impossible to walk rapidly. The victim should attempt to curtail running or vigorous walking activity, and may benefit from the administration of aspirin or a nonsteroidal anti-inflammatory drug (such as ibuprofen or naproxen). A shoe that is well cushioned (particularly its ball and heel) is very important for prevention and recovery. More complex orthotics may be required.

Plantar Fasciitis

Plantar fasciitis is inflammation of the fascia (tough connective sheath tissue) that encloses the muscles and tendons that traverse the bottom of the foot. It is a syndrome of overuse, caused by excessive walking or running, particularly associated with repetitive impact upon the bottom of a foot that is improperly cushioned or without appropriate arch support. Symptoms include pain in the bottom of the foot (ball, arch, and/or heel), worsened by weight bearing. It occurs commonly in athletes and long-distance hikers, particularly if they wear poorly fitting shoes or boots.

Treatment consists of rest, elevation of the foot with cold (ice packs) applied to the tender areas at the end of the hiking day, wearing orthotics, and administration of an oral nonsteroidal anti-inflammatory drug, such as ibuprofen. Worn at night, a splint that holds the foot in neutral position thus keeping the planter fascia slightly stretched may help.

If the victim must continue to walk on the painful foot, it can be taped to provide arch support; this can do much to reduce pain. It is accomplished as follows: Apply a thin layer of benzoin or spray tape adhesive onto the bottom of the foot. Fix an anchor strip of 3/4" ( 1.9 cm) adhesive tape in a U shape around the heel from just under the malleoli (prominences of the ankle) up to just behind the level of the"knuckles" of the toes (figure 152A). Next, lay fairly tight cross-strips of '/2" (1.3 cm) tape across the bottom of the foot, with their ends torn to lay on the anchor strip (figure 152B). This creates a "sling" of tape under the foot for support. Finally, apply another U-shaped piece of tape around the heel that crosses under the center of the arch and locks down the crosspieces.

Torn Muscle

A torn muscle ("pulled" muscle) is recognized as sudden pain in a muscle group associated with a particular vigorous exertion, such as sprinting or lifting a heavy object. Depending on the severity of the injury, there may be associated bruising, swelling, loss of mobility, and/or weakness. For instance, a small tear in the deltoid muscle of the shoulder may cause minor discomfort upon lifting the arm over the head, while a complete separation of the quadriceps group in the anterior thigh will cause inability to straighten the leg at the knee, extreme local pain, blue discoloration of the knee, and a defect in the shape of the muscles above the knee that is easily felt and seen.

In general, a minor muscle injury can be distinguished from a bone injury by evaluating active and passive range of motion. Active range of motion is the range of normal activity the victim can manage without rescuer assistance; this will be painful with both muscle and bone injuries. Passive motion is movement of a body part performed only with the aid of the rescuer; no effort is provided by the victim, who should attempt to relax the muscle completely. If there is no pain on passive (assisted) motion, but there is pain present on active motion, then the injury is most likely muscular, because an injured bone will hurt no matter how it is moved. If there is pain on passive motion, with or without pain on active motion, suspect a bone injury.

Minor muscle injuries should be treated in the first 24 hours with immobilization, the application of cold (insulated ice packs or chemical cold packs, for example; do not apply ice directly to the skin) for 30 to 45 minutes every 2 to 3 hours, and elevation. After 48 to 72 hours, the application of heat (warm water or a heating pad, not ointments) and gentle movement should be started. If a significant injury is suspected (for example, complete tear of the biceps muscle or quadriceps muscle group), the injury should be immobilized as for a fracture and the victim transported to a physician.

The best way to prevent a pulled muscle is to stretch and warm up adequately. This allows the local blood flow to increase and minimizes the risk for small tears that can cause spasm, which in turn leads to decreased flexibility.

Sprains and Strains

Sprains and strains are injuries to ligaments (which attach one bone to another) and tendons (which attach muscle to bone) that are incurred by twisting, direct blunt trauma, or overexertion. Symptoms include pain, swelling and/or deformity, decreased range of motion secondary to pain, and bruising. The treatment is the same as for a suspected fracture. The injured part should be elevated, immobilized, and treated with cold applications for the first 24 to 48 hours ("RICE": rest, ice, compression, and elevation). After 72 hours, heat may be applied. It is important to prevent reinjury (ankles are notorious) by proper wrapping or the application of a splint. Because the injured joint is immediately weakened, it should not be relied upon for great exertion.

The most common sprain is of an ankle. If the injury is minor (no chance of a fracture) and/or if the victim needs to put weight on the ankle in order to seek help, the ankle may be wrapped snugly with an elastic wrap in a figure-of-eight method or taped in a crisscross weave. During the wrapping or taping, have the victim point his toes and ankle upward by passmg a slender rope or strap around the ball of the foot and pulling toward the body. This allows the ankle to be strapped with the foot perpendicular to the leg and the ankle ligaments in the shortened position in which they best heal. A splint can be fashioned from a SAM Splint to provide additional support. If the sprain is severe, splint the ankle as for a fracture. An Aircast Air-Stirrup ankle brace is excellent for in-shoe support.

The Achilles tendon, which runs from the heel into the lower calf, may become irritated or inflamed due to recurrent impact or repetitive stretching, particularly if the heel is not well padded. An inflamed Achilles tendon that is painful should be protected against further irritation by limiting vigorous exercise and using a heel cup or extra padding underneath the heel in order to reduce stretch forces upon the tendon.


Arthritis is irritation and inflammation of a joint that can be caused by overuse, infection, or various diseases (such as gout, caused by deposition of uric acid crystals). Symptoms include pain in the joint with motion, swelling (fluid collection), redness, and warmth. If there is an infection within the joint, the condition can rapidly become serious. Generally, people with such infections have high fever, shaking chills, weakness, a recent infection elsewhere in the body, or recent direct injury (often penetrating through the skin) to the joint. Differentiating between an arthritic and an infected joint is often impossible until a physician inserts a needle to see if bacterium-laden fluid or pus is present within the joint, and to obtain fluid for a culture. If infection is a possibility, the victim should be started on dicloxacillin, erythromycin, or cephalexin immediately.

If there is little chance of infection and you know the joint problem is due to overuse, have the victim take aspirin or a nonsteroidal antiinflammatory drug, such as ibuprofen or naproxen. Rest the affected joint, keep it elevated if it is swollen, and adjust goals for the trip accordingly.


Bursitis is irritation and inflammation of the lubricating sac (bursa) that allows muscles to move freely around a joint. Common areas of irritation include the sac in front of the kneecap (irritated by prolonged kneeling), behind the elbow (irritated by a fall), in the shoulder (irritated by arm swinging), and on the outside of the hip (irritated by walking, hiking, or falling). Evaluation and treatment are the same as for arthritis.


Thrombophlebitis is inflammation in a vein associated with the development of a blood clot. This occurs in conditions of injury to the veins (cuts, bruises), or after periods of prolonged rest in a single position (sitting on a plane, cramped in a cave); it may also be associated with other risk factors (pregnancy, tobacco use, cancer, varicose veins). A blood clot irritates the lining of the vein and causes local redness, swelling, warmth, and pain. If the clot enlarges, an entire limb length can become affected. If the clot is in a deep vein, it may break off and travel to the lungs, where it causes a serious condition known as pulmonary embolism.

It is easy to confuse the presentation of thrombophlebitis with that of an infection. If you suspect the former, have the victim elevate the limb and apply hot packs or soaks for 60 minutes every 3 hours. Seek immediate medical attention. If you are more than 24 hours from help and not absolutely certain whether you are treating infection or inflammation, administer an antibiotic (dicloxacillin, erythromycin, or cephalexin).

Back Pain

The most common back injury is muscle strain. Symptoms include muscle pain and spasm adjacent to the vertebrae. If these occur in the lumbar (lower-back) region, treatment consists of maximum rest while lying supine on a firm supporting surface. The knees may be drawn up on a pillow or rolled blanket. All possible lifting and forward bending should be discontinued. The victim should take aspirin or a nonsteroidal antiinflammatory drug to control inflammation, and additional pain medicine as necessary. Gentle massage and alternating applications of ice packs and heat are often soothing.

If one of the cushioning intervertebral (between the vertebrae) disks has been injured, additional symptoms may be noted, which include numbness and/or tingling of parts of the leg (indicating impingement of the disk upon a nerve root arising from the spinal cord), shooting pains through the buttocks and posterior leg (indicating irritation of the sciatic nerve [sciatica]), leg weakness, foot drop, constipation, or difficulty with urination. The acute treatment is the same as for muscular back strain.

Published: 29 Apr 2002 | Last Updated: 15 Sep 2010
Details mentioned in this article were accurate at the time of publication


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