Achilles Tendinitis Overuse injuryCare: Increase flexibility Gradual progression Orthotics/heel lift Foot mechanics

Shin Splints Posterior or Anterior Cause – Repetitive stress – Rapid increase in training – Weak tibialis anterior S/S – Pain/ache – Gradual increase

Care – PIER – Achilles, Tib Post/Tib Ant stretching – Taping – Gradual return

The Knee

The Knee Joint – Anterior Patella Medial (Tibial) collateral ligament Patellar ligament Tibial tuberosity Tibia Quadriceps tendon Fibula

The Knee Joint Anterior (deep) Femur Lateral (Fibular) collateral ligament removed Medial (Tibial) collateral ligament removed Lateral Meniscus Tibial Tuberosity Fibula Lateral CondyleMedial Condyle Medial Meniscus Tibia Posterior cruciate ligament Anterior cruciate ligament

The Knee Joint – Posterior Femur Adductor magnus tendon Medial head of gastrocnemius tendon Semimembranosus tendon Medial (Tibial) collateral ligament Lateral (Fibular) collateral ligament Fibular head Lateral head of gastrocnemius tendon Oblique popliteal ligament Fibula Tibia

The Knee Joint – Posterior (deep) Anterior cruciate ligament Popliteal tendon Lateral meniscus Lateral (Fibular) collateral ligament Medial (Tibial) collateral ligament Medial meniscus Posterior cruciate Femur Fibula Tibia Posterior meniscofemoral ligament

MCL Sprain Most common acute knee injury Mechanism: – Valgus force – Weak VMO’s, weak proprioception

S/S – Loss of stability (test) – Swelling (wipe test) – Pain on palpation Care: – PIERS – Brace/tape up to a year – Surgery infrequent LCL Sprains

ACL Sprain Weak hamstrings, hip ER, squatting with a knee valgus motion Many mechanisms S/S – Pop, “dislocated”, anterior drawer test, swelling

ACL Sprain Care PIER Crutches Brace for 1 year-career Surgery** Proprioception training PCL Sprains

Meniscus Tears Alone or paired with ACL/MCL tears Rotational force while weight bearing (meniscus is squeezed between tibia and femur) S/S – Locking at 10 degrees of flexion – Clicking – Pain Treatment: – Surgery

Chronic Knee Injuries Patella Femoral Syndrome – Uneven tracking of patella – Weak hip LR, tight ITB, weak VMO’s – Crepitus, pain, pain on stairs/squatting – PIER, fix cause, taping to correct tracking

ITB Syndrome (Runner’s Knee) – Tight ITB, pronated foot – Point tenderness, pain during flexion – PIERS, ITB treatment, correct imbalances, reduce distances

Patellar Tendinitis “Jumper’s Knee” Frequent jumping, repeated stress Pain between patella and insertion Treatment: – PIER – Strap – stretch (quads) and strengthen

22 Common Strains Quadriceps Adductors Hip flexors Hamstrings Rotator cuffs

23 Hamstring Strains Most frequently strained muscles Mechanism: – Rapid contraction in a lengthened position – E.g. sprinting and running Due to strength imbalance – Hamstring strength < quadriceps strength Emphasize hamstrings and quadriceps equally

Using the handout and “Blue” Textbook: For each of the following, describe the: – Mechanism – S/S – Treatment Lateral Epicondylitis (p183) SC Joint Sprain AC Joint Sprain Glenohumeral joint dislocation

Chiropractor vs Physiotherapist Compare chiropractors and physiotherapists (page 193 and page 194)

Physiotherapy Modalities