Leg Problems : Outline Gross Anatomy Achilles Problems Compartment Syndromes Shin Splints (MTSS)

LEG PROBLEMS CON’T Stress Fractures Signs, Symptoms and Treatments Prevention programs

GAIT CYCLE  25% stance

Supination Pronation

Pronation: is the impact absorption phase of gait. We either pronate too much, not enough or just right.

As weight is transferred from the outside of the foot to the inside of the foot, the leg internally rotates. As weight shifts from inside to out, external rotation of the leg occurs.

Reminder – Muscles of the leg.

P. Longus P. Brevis P. Tertius Ext. Digitorum Longus Ext. Hallucis Longus Tib. Anterior Tib. Posterior Flex. Digitorum Longus Flex. Hallucis Longus Achilles Tendon

COMPARTMENT SYNDROMES Traumatic and Exertional

Pressure in comp. Volume demands in Compartment. Compromise of capillary profusion. Muscle swells and dumps fluid.

Muscles are attempting in work in a hypoxic environment. Not only is this difficult, it is painful and muscles continue to swell in a hypoxic environment.

Nerves are the first structures to show signs of hypoxia

SENSATION

Compartment Evaluation Test strength x 10 Stretch muscle Palpate for firmness Examine skin.

Left Leg Anterior

Anterior Compartment Area of Sensory Deprivation

Left Leg LATERAL

Sensory deprivation to plantar foot. Pain on palpation middle to lower third of postero- medial tibia. Deep Posterior

Measuring Compartment Pressures

It is not how high the pressure is during running; it is how long it takes to return to normal. 20 Ideal Bad Insertion

GENERAL TREATMENT GUIDELINES Stretching, gradual motion before activity. Icing after activity. Stretching, stretching Modification of activity

SHIN SPLINTS

PERIOSTITIS: an inflammation of the outer covering of the bone. FASCIITIS: and inflammation of the fascial covering of the muscle.

Shin Splints and M.T.S.S…..History of excessive weight bearing (jumping,running, or standing for prolonged periods of time, in combination with improper shoes.

Shin Splints and M.T.S.S. Associated with varus alignment (bowlegs) of the lower extremity and excessive pronation. Improper footwear may be a factor.

GENERAL TREATMENT Icing Stretching Strengthening Motion Control of foot.

SHIN SPLINTS Tibialis Posterior is eccentrically working to slow down the internal rotation of the leg on the foot during pronation of the foot. Muscle thought to pull away from bone.

MEDIAL TIBIAL STRESS SYNDROME Soleus muscle slows down the internal rotation of the tibia on the foot during pronation. Pain in lower medial third.

Postero-medial Tibia

ACHILLES TENDON Gastrocnemius, Soleus, Plantaris Tendon and Paratenon

ACHILLES TENDONITIS

Grade I No discomfort prior to activity. No limitations. Stiffness after activity.

Grade II Discomfort before activity. Pain during activity. Pain and tightness after. Nodules

Grade III Pain and stiffness before activity. Pain limits quality and quantity of activity. Very painful after.

ACHILLES THICKENING

Achilles Tendon Rehab

DEEPPOSTERIOR COMPARTMENT

I CING BEFORE AND AFTER ACTIVITY

Stretching of Achilles. Squeezing lump out of tendon. Curtail injurious activity and substitute other fitness activities. Heel lifts in shoes.

Achilles Paratenonitis Irritation of the paratenon. Caused by overuse. Rubbing of paratenon on the achilles tendon. Pain, crepitation. STOP! Icing, stretching.

ACHILLES RUPTURE Previous multiple minor trauma. Passive stretch plus active contraction TEAR!

EXAMINATION History Palpation Thompson Test Strength Testing

Thompson’s Test

Ruptured Achilles Tendon Tear 1” above heel or at musculotendinous junction. Palpate for gaps. Manually test for strength. Have athlete do single leg toe raise.

ACHILLES RUPTURE

Impact absorbed by shoe, muscles, bones (joints). Too strong of a muscle pull on one sideof the bone

ACTIVITY PAIN s.p. Pain at onset, reduced on warm-up, after pain c.s. Pain escalates as activity continues. s.f. Pain before activity, same during and the same after.

NIGHT PAIN s.p. No night pain. c.s. No night pain. s.f. Deep aching pain that wakes athlete.

REPEATED MUSCLE CONTRACTIONS s.p. No effect. c.s. Cause a slowing and a weakening of contraction (x10) s.f. No effect.

SENSORY CHANGES s.p.No Changes. c.s Potential changes corresponding to compartment. s.f.No Change.

MUSCLE STRETCH s.p.No change. c.s. Stretching a muscle within the affected compart. will increase pain. s.f. No change.