Managing Common Activity Injuries and Long-Term Disorders

1. Chapter 18 Students With Temporary Disabilities and Other Special Conditions C H A P T E R 18 Students With Temporary Disabilities and Other Special Conditions Christine B. Stopka

2. Common Activity-Related Injuries • Ankle—sprains, fractures • Knee—sprains, strains, and overuse syndromes such as patellofemoral pain syndrome (PFPS) • Shoulder—strains, dislocations, and overuse syndromes such as bursitis, tendinitis, and impingement syndrome

3. Immediate Care for Activity Injuries: RICE • Rest • Ice • Compression • Elevation

4. Types of Exercises • Open chain—not weight bearing (e.g., knee extensions with a weight machine) • Closed chain—weight bearing (e.g., calf raises, half deep knee bend) • Isotonic—with movement (e.g., open or closed chain exercises) • Isometric—without movement (e.g., performing a timed bar hang) • Isokinetic—using a weight machine with a fixed speed but accommodating resistance so that attempts at faster movements result in a greater generation of force, not speed (continued)

5. Types of Exercises (continued) • Concentric—type of isotonic movement in which a contracting muscle shortens as it moves a resistance (e.g., lifting a weight) • Eccentric—type of isotonic movement in which a contracting muscle lengthens as it moves a resistance (e.g., lowering a weight) • Flexibility exercises—static (holding a stretched muscle) and types of PNF exercises (e.g., when a stretched muscle is contracted against resistance and then is stretched again) • Coordination exercises—such as sport-specific skills and drills to prepare for return to participation

6. Selected Exercises • Tilt-board exercises—for ankle and lower-limb flexibility and coordination • Terminal extension exercises—can start from simple isometric contractions of an extended knee (quad sets) and range to isotonic extension movement over the last 5 to 25 degrees of extension, until the knee joint is ready for other exercises • Codman exercises—pendular motions of the shoulder joint to rehabilitate motions in multiple planes (flexion, extension, abduction, adduction, and circumduction)

7. DAPRE TechniqueDaily Adjustable Progressive Resistance Exercise

8. Long-Term Disorders: Fractures • Directional: longitudinal, spiral, transverse, compressed, and so on • Growth plate (physis) fractures: epiphyseal, apophyseal

9. Long-Term Disorders: Specific Knee Conditions Osgood-Schlatter disease (epiphysiolysis*, separation of the tibial tubercle; apophyseal fracture**) • Genu valgum (knock knees) • Genu varum (bow legs) *Lysis means breakdown; thus, an epiphysiolysis refers to a breakdown (dissolution) of the tissue at the growth plate (in this case, the growth plate of the tibial tubercle). **Tubercles and tuberosities are referred to as apophyses. A separation of a tubercle, or tuberosity, from the bone is called an apophyseal fracture.

10. Long-Term Disorders: Common Foot and Ankle Problems • Pes planus (flat feet); pes cavus (abnormally high arches) • Talipes equinus (walking on toes) • Talipes varus (clubbed foot)

11. Long-Term Disorders: Adolescent Hip Diseases • Legg-Calvé-Perthes disease (degeneration, necrosis of the femoral head) • Slipped capital femoral epiphysis (slippage of the femoral head at its growth plate; epiphyseal fracture) • Both conditions heal by removal of pressure on the femoral head and the acetabulum.

12. Key Words for Weight Control • Know about the food pyramid. • Avoid eating anything wrapped in plastic. • Avoid fast food; bag lunch is cheaper and better. • What do you drink?

13. Weight-Control Objectivesfor Students Who Are Obese To reduce the percentage by which an individual is overweight, • improve physical fitness and increase leanness, • increase self-esteem, • improve food habits, and • do no harm.

14. Powerhouse Produce Heaviest hitters from the fruit bin • Oranges • Strawberries • Kiwi • Cantaloupe • Peaches and nectarines • Grapes (continued)

15. Powerhouse Produce(continued) Best bets from the veggie section • Broccoli • Spinach • Peppers (especially red) • Sweet potatoes • Onions • Tomatoes

16. The New Pyramid: Leaner Food Choices and Daily Physical Activity

17. Adverse Health Effects or Consequences of Obesity • High blood pressure and hypertension • High bad cholesterol and low good cholesterol levels (high LDL and low HDL) • Coronary heart disease and stroke • Atherosclerosis, peripheral vascular disease, and intermittent claudication • Congestive heart failure • Type 2 (non-insulin-dependent) diabetes • Diabetic retinopathy, angiopathy, nephropathy, and neuropathy • Insulin resistance (decrease in insulin sensitivity), glucose intolerance • Gallstones, gout (continued)

18. Adverse Health Effects or Consequences of Obesity (continued) • Osteoarthritis • Obstructive sleep apnea and respiratory problems • Some types of cancer (such as endometrial, breast, prostate, and colon) • Complications of pregnancy • Poor female reproductive health (such as menstrual irregularities, infertility, and irregular ovulation) • Bladder control problems (such as stress incontinence) • Psychological disorders (such as depression, eating disorders, distorted body image, and low self-esteem)

19. Dietary Considerations to Promote Weight Loss • Restrict calories to 10 kcal per 1 lb (.5 kg) of body weight (e.g., 1,600 kcal per day for a 160 lb [73 kg] person). • Reduce the amount of saturated fat (daily intake should not exceed 30% of total calories, and saturated fat, including trans-fatty acids, should not exceed 10% of total caloric intake). • Increase dietary fiber and complex carbohydrate (starch). • Reduce simple carbohydrate (sugar). • Use lean meats and trim excess fat. (continued)

20. Dietary Considerations to Promote Weight Loss (continued) • Reduce or eliminate cooking oil and fat in the preparation of foods (e.g., substitute canola or olive oil; minimize saturated fat and avoid trans fat as much as possible). • Avoid fried foods; broil or bake instead. • Reduce sugar and fat in all recipes. • Seek out fat-free and cholesterol-free alternatives. • Feature fruits and vegetables at snack time. • Avoid fast-food restaurants.

21. Physical Activity Guidelines for Weight Loss • Expending at least 1,000 kcal per week engaged in physical activities is a goal for everyone. • For youths aged 10 to 17, a frequency of 4 to 7 days a week is recommended with 30 to 60 minutes of activity time per day. The intensity should be 55% to 75% of maximal heart rate (about 115-145 beats per minute, or 5-7 METs, at a rate of perceived exertion [RPE] of 12-13). • For students with disabilities, the frequency and total duration are similar, yet each exercise bout might need to be more intermittent (with more breaks). The intensity might need to be reduced, depending on the amount of actively engaged lean body mass and the initial fitness level.

22. Desirable Training Programs for Youths Who Are Overweight or Obese • The activity should emphasize the use of large-muscle groups in low-impact, aerobic activities. • Intensity should be deemphasized; duration should be stressed. • The activities should be daily, or nearly daily, in frequency, thus raising the total daily energy expenditure. • There should be a gradual increase in frequency, volume, and intensity. (continued)

23. Desirable Training Programs for Youths Who Are Overweight or Obese (continued) • Participation time (daily duration) can be accumulated throughout the day, thus encouraging intermittent activities, especially for younger children and those beginning an exercise program; encourage participation in active household chores. • The activities should be pain free. • The activities should be well liked. • Encouraging the participation of others (such as partners, small groups, and especially family) is very helpful for program maintenance, motivation, and enjoyment.

24. Suggestions to Enhance and Maintain Participation in Physical Activities • Select activities that are developmentally appropriate. • Ensure that students have the necessary skills to participate successfully and safely. • Select well-liked activities and do them in pleasant surroundings. • Emphasize that accumulated physical activity is beneficial. • Give guidance regarding the amount of activity, intensity, and duration. • Start easy and progress gradually; avoid doing too much, too fast, too soon. (continued)

25. Suggestions to Enhance and Maintain Participation in Physical Activities (continued) • Teach skills for lifetime activities and those that invite the involvement of others. • Provide individualized guidance, reinforcement, and personal attention. • Empower participants by encouraging self-assessment and self-monitoring. • Provide feedback regarding physiological and other skill and functional improvements. • Develop knowledge, understanding, and values regarding health-related fitness. • Develop and implement an award system and other incentives for participation.