Signs & Symptoms Treatment & Rehab Low Leg Lesson 2

Objectives By the end of this lesson: You will recognize signs and symptoms of low leg injuries You will understand the treatments associated with the injury You will create the rehab that goes along with the injury

Terminology Review Tendonitis Strain Rupture Acute Chronic Inflammation of musculo-tendon junction Strain Injury sustained in muscle or muscle tendon Rupture Tearing apart of body tissue Acute Sudden onset of injury Chronic Re-occurring or overuse lingering injury

Achilles Tendon Injuries There are three types of injuries sustained at the Achilles Tendon Acute Achilles Tendon Strain Chronic Achilles Tendonitis Achilles Tendon Rupture Each has it’s own signs, symptoms, treatment and rehab

Achilles Tendon Strain MOI: Occur most often after ankle sprains or sudden excessive Dorsiflexion of the ankle. S/S: Acute pain and tenderness in the Achilles tendon Extreme weakness with plantarflexion TX: Cold compressive wrap—Think RICE! After ice, continue with compressive elastic wrap

Achilles Tendon Strain Rehab Begin gentle stretching exercises soon after pain subsides Strength exercises should begin with toe raises starting with both feet, progress to effected leg. What other low leg strength exercises could be tried? Stair stepping, Jump rope, Skips, Jogging, Running, Sprinting Rehab should always be progressive to functional activity for the athlete

Achilles Tendonitis S/S: Gradual onset of pain and stiffness over a period of time Pain worsens with weight-bearing activity Increased work load + insufficient recovery Uphill running aggravates it Decreased flexibility in Gastroc & Soleus Stiffness in calf in mornings, limited strength with toe raise Heel cord maybe warm to touch & thick compared to other side Pain with passive stretching MOI: Tendon is overloaded because of excessive stress during repetitive dorsiflexed movements.

Achilles Tendonitis TX Rehab Stretch Ice to reduce pain & Inflammation Cross-friction massage to break adhesions Rehab Strengthening exercises Toe Raises Skips Jump Rope Others??

Achilles Tendon Rupture MOI: Result of a sudden pushing off action in foot with knee forced in full extension Most common in “Stop and Go” type athletes Seen frequently in those 30 yrs and older Why?

Achilles Tendon Rupture S/S C/O sudden snap in Achilles “Feels like I’ve been stabbed!” Pain is immediate but rapidly goes away Obvious swelling, pain Unable to do a Toe Raise TX RICE immediately Non-Surgical Route Non-weight bearing 6 weeks cast 2 weeks boot Surgical Route Post Surgical treatment Watch for infections NWB for 6 weeks

Achilles Tendon Rupture Rehab ROM Strength Balance Progress back into sports

Medial Tibial Stress Syndrome MOI: Repetitive Micro-trauma to the muscles on the medial side of low leg S/S: Inability to walk or run normally Pain on medial side & lateral as well May have tight gastroc, old shoes or not used to workouts

MTSS TX Rehab RICE Decrease workout Eliminate pounding What workouts could we do? Bike Elliptical Swim

Anterior Compartment Syndrome MOI Muscles on the anterior side are enclosed in connective tissue When the muscles swell, it compresses that tissue which causes pain

Anterior Compartment Syndrome S/S Pain in low leg that increases with activity Swelling that does not subside after rest Hard, hot and red skin Loss of motion at foot Severe pain TX This is a referral to MD The physician will make an incision to relieve pressure

Anterior Compartment Syndrome Rehab Post surgical ROM exercises Progress to weight bearing Strength Stretching Incorporate cardio Walking Jogging Running Make sure there is not a reoccurrence

Recap Achilles Tendon can have 3 injuries…what are they?? Shin splints are now called___________. If an athlete complains of pain after activity and decreased motion in foot they have _____________________.

Homework!  Create a rehab program for the following athlete Include Runner complains of pain in low calf Injured after coming out of blocks at track meet Unable to walk normally Pain with palpation in Achilles tendon Slight swelling Unable to dorsiflex without pain Include Treatment Rehab from day 1 through day 10.