Musculoskeletal Implications For Special Populations
Musculoskeletal (MSK) conditions are a group of conditions that affect the bones, joints, muscles and spine, and are a common cause of severe long term pain and physical disability.
Special populations are subsets of people with needs that require special consideration and attention in an educational, legal, medical or social setting. Musculoskeletal implications for special populations are the effects of MSK conditions on the health, well-being and functioning of these groups of people.
For example, people with disabilities, older adults, women, or young people may have different needs and challenges related to their MSK health.
Young People Aged 14-16 years
Implications to this age group that MUST be taken into consideration:
Epiphyseal plate – Heavy or strenuous activities can result in ‘overuse’ injuries and fractures to the epiphyseal plates, which can affect growth and future development of the bone.
Excessive training can also cause the following bone injuries:
- Growth plate fractures – injured growing bone cells.
- Avulsion fractures – pull off fracture at the point where tendons/ligaments insert into the bone.
- Osteochondritis – fragment of bone/cartilage breaks off from underlying bone and released into joint.
- Severs Disease – heel pain caused by disturbance to growing area at the back of the heel bone.
- Osgood-Schlatter Disease- pain and swelling just below the knee, usually caused in young teenagers by excessive sport playing
- Avoid excessive training
- Avoid too much high impact activity
- Avoid high intensity strength training
- Ensure a balanced approach to develop all parts of the body
- Ensure exercises are performed in a controlled manner
- Ensure programmes are progressive and that increases in intensity are introduced gradually
Antenatal And Postnatal Women
Implications to this client group that MUST be taken into consideration:
- Increased levels of the hormone relaxin that softens ligaments, leading to an increase in the range of movement all joints for up to 6 months after delivery and could adversely affect joint stability.
- The sacra-iliac joint, lumbar spine, symphysis pubis and pelvic floor muscles are particularly vulnerable.
- Changes to the centre of gravity due to the weight of the baby will be seen.
- Motor skills are affected due to the physiological changes to the body and the difference in weight distribution, which makes transferring weight and changing directions take more time.
- Avoid developmental stretches because of the risk to joint stability
- Impact exercise should be reduced, again because of the risk to joint stability
- Supine exercise should be avoided from 20 weeks into the pregnancy because of hypotensive syndrome (drop in blood pressure caused from laying supine) and pressure on the vena cava from the position of the foetus
- Guidelines state a minimum of 6 weeks before returning to exercise following a normal delivery.
- Guidelines state a minimum of 12 weeks before returning to exercise following a caesarian (c-section)
Older People 50 +
Implications for this client group that MUST be taken into consideration:
- Reduction in bone mineral density owing to the reduced activity of osteoblasts (bone building cells) and increased activity of osteoclasts (bone removing cells).
- Ligaments become more rigid and thicker and tendons become stiffer and shorter due to the result of the collagen content decreasing, mainly noticeable in ankles, knees and hip joints.
- Cartilage growth slows down, resulting in less cushioning at the bone ends. Calcium salts can be deposited into the cartilage making it more brittle and hard. This reduces shock absorption and load spreading capabilities, also increasing the risk of osteoarthritis. This is a degenerative disease of the joints caused by ‘wear and tear’ and a break down in the hyaline cartilage.
- Avoid high impact exercises
- Avoid repetitive stress on the joints
- Avoid exercising for long periods of time
- Mobilise and stretch daily
- Incorporate low intensity low volume
- Avoid exercising if pain is felt
This client group can still engage in many activities and the sessions would need to be adapted to take account of the specific disability and be developed to suit an individual’s requirements. Some of the considerations listed above could have applications to this group.
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