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Injury Prevention Basics for Trainers and Fitness Professionals

Injury Prevention Basics for Personal Trainers NESTA Certification

As a Fitness Professional or trainer, it is vital to have a clear understanding and working knowledge of basic injury prevention and healing, especially when working with athletic clients, clients with prior injuries, or clients who are more prone to injuries because of age or chronic conditions.

Read on for basic injury prevention concepts, as well as an explanation of how to approach and initially treat common injuries and training ailments.


Fractures are breaks or cracks in a bone of the body.

Closed Fracture – has little or no movement of the bone, it does not come through the skin.

Open / Compound Fracture – a displacement of the bone that breaks through the skin. These are more serious due to the possibility of infection, and loss of blood.

Avulsion Fracture – occurs when an injured ligament or tendon pulls a piece of the bone with it.

Stress Fracture occurs with repeated overloading or overuse, which fails to allow the bone sufficient recovery time between periods of use.  Onset is gradual, with dull aches progressing to sharp pinpoint pain during activity. As the stress fracture worsens, pain can occur both during and after activity, ultimately resulting in constant pain. 

Persons at risk for stress fractures include overweight individuals, those lacking calcium in their diet, and those who train too quickly, essentially “doing too much too fast”, and persons with structural conditions of the foot.  Stress fractures do not have accompanying swelling and often won’t show on an initial x-ray. The healing of the fracture will become apparent on a follow-up x-ray after a rest period of 10-14 days.

If a stress fracture is suspected, it is recommended to stop the action so the bony callus can form and begin to heal the bone — usually, 2 to 6 weeks, depending on the location of the fracture.  After which, a gradual return to activity helps reduce the likelihood the stress fracture will return. During recovery, cross-training that avoids placing stresses on the injury site is recommended to maintain fitness levels.

Dislocation vs. Subluxation

Dislocation occurs when a bone is forced out of joint and stays out.  Putting the bone back into place (either manually or surgically) is known as reducing a dislocation.

Subluxation occurs when a bone is partially forced out of joint but returns back into place on its own.  Because a bone deformity is not always obvious in a dislocation (muscle or swelling may be hiding the dislocated bone), palpation and comparison to the opposite side of the body may be necessary.

During dislocation or subluxation, the ligaments and tendons surrounding the joint can suffer damage as well, reducing the stability of the joint.  As a result, a first-time dislocation can develop into a chronic recurring dislocation or subluxation.

An untrained person should not try to reduce the first-time dislocation because the surrounding muscle often becomes tight and guarded to protect the injured joint; reducing it incorrectly may cause a fracture or sever an artery.  Return to activity is dependent on the extent of the soft tissue damage, as soft tissue can often take longer to heal than a bone fracture.

Ligament Sprains vs. Muscle Strains

Both sprains and strains are graded by severity on a scale of 1 to 3, with Grade 3 presenting the most severe symptoms.

A sprain refers to a stretch or tear of a ligament (connective tissues that attach a bone to another bone. Ligaments are non-elastic, so once torn, a ligament will not support the joint as well.

Grade 1: Stretching of the ligament with mild symptoms; little or no joint instability, pain, swelling, stiffness, and disability.

Grade 2: Partial tearing of the ligament fibers with moderate instability.

Grade 3: Total tear or rupture of the ligament with major instability.  

A Strain refers to a stretch or tear of a muscle or tendon

Grade 1: Some muscle fibers have been stretched or torn with mild pain on AROM, but full ROM still possible.

Grade 2: A number of muscle fibers have been stretched or torn with severe pain on AROM, and decreased ROM. A divot might be palpable and some swelling and discoloration may occur.

Grade 3: A complete rupture of the muscle can occur in the belly (middle), the musculotendinous junction, or at the tendon attachment to the bone. Initially, pain is severe but may diminish due to nerve separation. Very little ROM, or no ROM.  Discoloration is moderate to severe and may travel downward as a result of gravity.


A contusion, also known as a bruise, is typically caused by blunt impact in which the capillaries are damaged allowing blood to seep into the surrounding tissue. Bruises can be associated with more serious injuries, including fractures and internal bleeding.

Contusions are graded by severity — first, second, or third degree.


  • pain upon movement and painful to the touch
  • ecchymosis (discoloration)
  • edema (swelling)
  • decreased ROM
  • decreased function
  • muscle weakness and/or spasm
  • hematoma (blood-filled sac)
  • may be able to palpate a “knot” like structure, or divot.
  • possible nerve symptoms, if a nerve has been hit


  • a blow to the body that compresses tissue. Ranging in severity from superficial to deep, and can penetrate the bone, resulting in a bone bruise.


  • P.R.I.C.E.
  • a second or third-degree contusion may need:
    • an x-ray or MRI to rule out a bone fracture or soft tissue damage
    • a sling or crutches
    • rehabilitation to restore ROM and strength
    • protect with a pad to reduce the chance of re-injury
    • progress back to activity gradually

Myositis Ossificans (muscle ossification)

Is defined as calcium deposits in the muscle. If a muscle contusion or strain is not treated properly or is allowed to recur, the body will initially employ scar tissue in an attempt to heal the area; but with repeated re-injury, the body deposits calcium in the area. The key is to prevent repeated hits to the same area. A donut pad or gel pad can be used to protect the injured area. The calcium deposits may be detected by x-ray and can only be removed with surgical intervention.

Muscle Soreness

The pain that occurs during and immediately after an injury is known as Acute Onset Muscle Soreness (AOMS).  The second type of muscle soreness is known as Delayed Onset Muscle Soreness (DOMS).

It is caused by performing an unaccustomed activity, especially eccentric muscle contractions. This type of pain and stiffness occurs approximately 4 -12 hours after performing the activity, and peaks about 24 – 48 hours later. DOMS is the result of small muscle tears or stress at the muscle-tendon junction.

The symptoms gradually decrease over a 3 to 4 day period. Ice should be applied during the first 48 hours, and gentle stretching is also helpful in reducing soreness.


The suffix “-itis” refers to inflammation; common examples include appendicitis, tonsillitis, and tendinitis.  Inflammation is an acute reaction that must occur to initiate the healing process. Inflammation is not a pathological condition in itself, but rather the body’s reaction to tissue damage. The inflammatory cells remove debris and draw healing cells to the injury site. However, if irritation continues, the process becomes detrimental and the inflammation becomes a chronic debilitating condition.  Symptoms include pain, swelling, skin warmth, and redness.

Inflammation Treatment Protocol (ITP)

The following is a general treatment protocol for most inflammatory conditions.  The ITP can reduce the extent of inflammation and its unwanted effects.

Not all aspects of the ITP are needed or recommended for every situation.

  • correct the cause
  • cryotherapy (usually after activity)
  • heat therapy (usually prior to activity)
  • anti-inflammatory medications (OTC or prescription strength)
  • iontophoresis
  • electrical muscle stimulation
  • ultrasound
  • massage techniques to improve blood flow
  • stretching and ROM exercises
  • muscle strengthening, including proprioceptive and kinesthetic exercises
  • support with athletic tape
  • cortisone injections
  • rest
  • gradual return to activity
  • surgery


Swelling (edema) is different than inflammation. Swelling is the build-up of excess fluid, proteins, and cell debris in the injured tissue. One of the primary goals after an injury is to reduce the amount of edema in the injured area. Swelling causes pain, decreased range of motion, decreased proprioception, loss of function, atrophy, and eventually adhesions (scar tissue).


Tendinitis is inflammation of a tendon often caused by overuse, as repeated muscle contractors cause the tendon to persistently slide over the bone.  Signs of tendinitis include site pain (which often subsides when the tendon is warmed-up but returns when cooled down), decreased function and motion, and crepitus  – a grating or cracking sound caused by the inflamed tendon struggling to move through its covering.

Treatment of Tendinitis includes:

  • correct the cause
  • cryotherapy (usually after activity)
  • heat therapy (usually prior to activity)
  • anti-inflammatory medications (OTC or prescription strength)
  • iontophoresis
  • electrical muscle stimulation
  • ultrasound
  • massage techniques to improve blood flow
  • stretching and ROM exercises
  • muscle strengthening, including proprioceptive and kinesthetic exercises
  • support with athletic tape
  • cortisone injections
  • rest
  • gradual return to activity
  • surgery

Other Tendon Injuries

Tendinosis – a chronic degeneration of the tendon caused by repeated microtears. This is not an inflammatory condition, and may not respond well to an anti-inflammatory protocol (ITP).

Tendinopathy – refers collectively to tendinitis and tendinosis

Tenosynovitis – is inflammation of the synovial sheath covering the tendon

Calcific Tendinitis – is the build-up of calcium deposits in the tendon.  It may occur if the symptoms of tendinopathy are ignored.

Bursitis – A fluid-filled membrane sac that serves as a buffer between tendon and bone, skin and bone, or between two muscles is known as the bursa.  These bursae act as lubricators to decrease friction. Bursitis can occur with overuse of the bursae, or with acute trauma or chronic compression of the bursae.  Bursitis presents itself with site swelling, decreased range of motion. Common sites are the shoulder (subacromial), elbow (olecranon) and patella (infrapatellar).  Bursitis is best treated by following the inflammation treatment protocol (ITP) described earlier in this chapter.

Osteoarthritis – Osteoarthritis is the wearing away or degeneration of the cartilage surrounding a bone. Significant degeneration will eventually expose the bone and result in bone-on-bone contact and resultant pain. Osteoarthritis is most common in weight-bearing joints but can occur in the upper body as well.  The condition presents with joint stiffness, especially in the morning or when the body is cold and can be accompanied by crepitus and/or mild joint swelling. Because there is no cure, pain and damage control is the main goal. Typical treatment methods include medication, heat and/or cold treatments, and stretching or water exercises to maintain flexibility and mobility.