1. Lesson 6 Unit 1 Specific Injuries (cont 3)
Conducting Subjective/Objective Assessments
Specific Injuries (cont 3)

2. Aims of the Session
This session will allow candidates to have an understanding of the specific injuries and the identification of them.

3. Learning Outcomes
By the end of the lesson the candidate will be able to
Identify 4 specific injury pathology, including signs & symptoms
Describe the common probable causative factors
Explain the assessment findings of the conditions
Explain the treatment needs

4. Lesson structure
We will be looking at the following specific conditions
Osgood-Schlatters Disease,
Medial Tibial Stress Syndrome,
Plantar Fasciitis,
Carpal Tunnel Syndrome.

5. Osgood-Schlatter Disease
Introduction
Osgood-Schlatter disease is a common cause of knee pain in growing adolescents. It is an inflammation of the area just below the knee where the tendon from the kneecap (patellar tendon) attaches to the shinbone (tibia).
Osgood-Schlatter disease most often occurs during growth spurts, when bones, muscles, tendons, and other structures are changing rapidly. Because physical activity puts additional stress on bones and muscles, children who participate in athletics — especially running and jumping sports - are at an increased risk for this condition. However, less active adolescents may also experience this problem.
In most cases of Osgood-Schlatter disease, simple measures like rest, over-the-counter medication, and stretching and strengthening exercises will relieve pain and allow a return to daily activities.

6. Osgood-Schlatter Disease
Introduction
The bones of children and adolescents possess a special area where the bone is growing called the growth plate.
Growth plates are areas of cartilage located near the ends of bones. When a child is fully grown, the growth plates harden into solid bone.
Some growth plates serve as attachment sites for tendons, the strong tissues that connect muscles to bones. A bony bump called the tibial tubercle covers the growth plate at the end of the tibia. The group of muscles in the front of the thigh (called the quadriceps) attaches to the tibial tubercle.
When a child is active, the quadriceps muscles pull on the patellar tendon which in turn, pulls on the tibial tubercle. In some children, this repetitive traction on the tubercle leads to inflammation of the growth plate. The prominence, or bump, of the tibial tubercle may become very pronounced

7. Osgood-Schlatter Disease
Introduction

8. Osgood-Schlatter Disease
Pathology
Growth acceleration or excessive exercise can pull the patella tendon away from the periosteum at the
tibial attachment.
This leads to inflammation of the bone tissue and the production of additional bone as the area attempts to increase its strength and repair damage.
This condition affects around 15% of active clients in the age group of 12 to 16 years.

9. Osgood-Schlatter Disease
Pathology
Healing is often spontaneous and problems seldom occur once the leg is fully developed unless changes to the bone affect the mechanics of the patella when under load.
However, some individuals will continue to experience
recurrent inflammatory responses throughout their life, particularly if they make changes to their activity
levels, rapidly increasing the stress to the tendon attachment.

10. Osgood-Schlatter Disease
Signs & Symptoms
Pain at the tibial attachment of the patella tendon,
Heat and inflammation.

11. Osgood-Schlatter Disease
Possible Causative Factors
Growth spurt,
Excessive exercise,
Tight muscles,
Poor diet.

12. Osgood-Schlatter Disease
Assessment Findings
Enlarged tibial tuberosity,
Pain at the tibial attachment of the patella tendon,
Heat and inflammation.

13. Osgood-Schlatter Disease
Treatment
Treatment for Osgood-Schlatter disease focuses on reducing pain and swelling,
Limiting exercise activity until your child can enjoy activity without discomfort or significant pain afterwards,
In some cases, rest from activity is required for several months, followed by a strength conditioning program,
Stretching exercises,
Non-steroidal anti-inflammatory medication.

14. Medial Tibial Stress Syndrome
Introduction
Shin Splints is a common term for shin pain during running. It can be a misleading term and most sports medicine professionals try to avoid using it. This is because shin pain and 'Shin Splints' can be due to several different conditions. One of the most common shin conditions that is frequently labelled 'Shin Splints' is Medial Tibial Stress Syndrome.

15. Medial Tibial Stress Syndrome
Introduction
Medial Tibial Stress Syndrome has been classified into two distinct types,
Type One This is characterised by a stress reaction on the inside border of the shin bone.
Type Two This is characterised by irritation of the outer surface (periosteum) of the inside of the shin bone at the point where the Soleus and Tibialis Posterior muscles attach.
 Medial Tibial Stress Syndrome has been reported to occur frequently in military recruits, distance runners, dancers, football (soccer) players and gymnasts. Medial Tibial Stress Syndrome has been classified into two distinct types, which affect specific tissues on the inside of the shin: Type One This is characterised by a stress reaction on the inside border of the shin bone. A stress reaction is a preceding stage to a stress fracture.
Type Two This is characterised by irritation of the outer surface (periosteum) of the inside of the shin bone at the point where the Soleus and Tibialis Posterior muscles attach. Regardless of the type, Medial Tibial Stress Syndrome is largely caused by over-use, with those who run regularly on hard or uneven surfaces being particularly affected. However, there are a number of factors, such as altered foot, knee and hip posture, which can make a person susceptible to the syndrome.

16. Medial Tibial Stress Syndrome
Pathology
MTSS describes inflammation of the periosteum, usually experienced on the posterior and medial surfaces of the tibia,
The function of the tibialis anterior muscle is to dorsiflex the foot.

17. Medial Tibial Stress Syndrome
Pathology
Since the weight of the foot is minimal it requires (relatively) little strength to perform this action and is therefore, quite a small muscle,
However, the foot can only be raised if the powerful plantar flexors relax,
Should they fail to do so, tibialis anterior does not only need to overcome the weight of the foot but also the ‘intrinsic’ resistance of these antagonistic muscles.

18. Medial Tibial Stress Syndrome
Pathology
This extra effort imparts a severe overload on the tibialis anterior, which results in pain and discomfort, especially when walking / running uphill, since the ROM required increases,
Impact, a change of stress (shoes, surfaces, intensity) or over pronation of the foot can lead to inflammation
of the tibial periosteum.

19. Medial Tibial Stress Syndrome
Pathology
The resultant scar tissue can stick or ‘splint’ the affected muscles (gastrocnemius/soleus) to the bone which makes it increasingly difficult for them to lengthen (to allow tibialis anterior to function).

20. Medial Tibial Stress Syndrome
Signs & Symptoms
Pain on the anterior tibia or posterior tibial border.

21. Medial Tibial Stress Syndrome
Probable Causative Factors
Muscle imbalance,
Poor posture – pronation,
Overuse,
Too much too soon – change in training stressors (footwear, surface, intensity).

22. Medial Tibial Stress Syndrome
Assessment Findings
History consistent with possible causes,
Onset of persistent discomfort during activity which increases on walking / running uphill,
Limited dorsiflexion (caused by tight calf muscles),
Pain on palpation along medial tibial border,
Pain on full contraction or stretch,
Pronation of the foot.

23. Medial Tibial Stress Syndrome
Treatment
Change in training regime,
Taking anti-inflammatory drugs to decrease swelling
Ice and rest,
Change of foot wear,
Physical therapy exercises which include stretching to increase flexibility and decrease tightness around the shin.

24. Plantar Fasciitis Introduction
Plantar fasciitis is thickening of the plantar fascia, a band of tissue running underneath the sole of the foot. The thickening can be due to recent damage or injury, or can be because of an accumulation of smaller injuries over the years. Plantar fasciitis can be painful.

25. Plantar Fasciitis Introduction
A number of factors can contribute to plantar fasciitis. While men can get plantar fasciitis, it is more common in women. You're also more likely to have this condition as you age or if you:
Are overweight. Take up a new form of exercise or suddenly increase the intensity of your exercise. Are on your feet for several hours each day. Have other medical conditions such as rheumatoid arthritis.
Tend to wear high-heeled shoes, and then switch abruptly to flat shoes.
Wear shoes that are worn out with weak arch supports and thin soles. Have flat feet or an unusually high arch. Have legs of uneven lengths or an abnormal walk or foot position. Have tight achilles tendons, or ‘ heel cords’

26. Plantar Fasciitis Introduction

27. Plantar Fasciitis Pathology
The function of the plantar fascia is to aid the tarsals in supporting the foot,
This function is most necessary when standing, jumping or running on the toes, since in these situations, the arches cannot ‘lock’ together,
Overstretching of the fascia will lead to damage and inflammation,
Since the periosteum can be affected, left untreated or poorly managed this condition may result in a calcaneal spur.

28. Plantar Fasciitis Signs & Symptoms
Pain on the plantar fascia (normally close to the calcaneal attachment) especially on first steps in the morning.

29. Plantar Fasciitis Probable Causative Factors
Heavy or repetitive landings,
Posture - over pronation of the foot,
Inadequately supportive footwear for impact activities,
Problem is exacerbated by tight plantar flexors since they exert opposing tension.

30. Plantar Fasciitis Assessment Findings
Initial discomfort or aching on weight-bearing which lessens after time,
Point of tenderness on calcaneal attachment,
Increasing pain on active or passive dorsiflexion,
Pronated foot,
Tight plantar flexors.

31. Plantar Fasciitis Treatment
Physical Therapy - may be helpful, providing massage and stretching,
Rest where possible,
Ice massage,
Manual friction.

32. Carpal Tunnel Syndrome
Introduction
Carpal tunnel syndrome (CTS) is a relatively common condition that causes a tingling sensation, numbness and sometimes pain in the hand and fingers.
Usually, these sensations develop gradually and start off being worse during the night. They tend to affect the thumb, index finger and middle finger.
Other symptoms of carpal tunnel syndrome include:
pins and needles (paraesthesia)
thumb weakness
a dull ache in the hand or arm

33. Carpal Tunnel Syndrome
Introduction
Carpal tunnel syndrome is caused by compression of one of the nerves that controls sensation and movement in the hands (median nerve).
The carpal tunnel is a narrow passage in your wrist made up of small bones and a tough band of tissue that acts as a pulley for the tendons that bend the fingers. It isn't known why the median nerve becomes compressed in most cases, although certain things are thought to increase the risk of CTS developing, such as:
a family history of CTS pregnancy – up to about 50% of pregnant women develop CTS injuries to the wrist
other health conditions, such as diabetes and rheumatoid arthritis strenuous, repetitive work with the hand

34. Carpal Tunnel Syndrome
Pathology
The carpal bones form an arch which is supported by the flexor retinaculum;
This provides a tunnel through which the flexor tendons and nerves which innervate the hand and fingers pass,
Carpel tunnel syndrome is caused when the flexor tendons get inflamed (RSI) or a collapse in the carpal bones causes a compression of the median nerve.

35. Carpal Tunnel Syndrome
Pathology
Repetitive strain injury’ (RSI), also called work-related upper limb disorder (WRULD), is a general term
used to describe the pain caused to muscles, nerves and tendons by repetitive movement and overuse,
The condition mostly affects parts of the upper body, such as the forearm, elbow, wrist, hands, neck and shoulders.

36. Carpal Tunnel Syndrome
Signs & Symptoms
Radiating pain into the first 3 fingers and the radial half of the fourth.

37. Carpal Tunnel Syndrome
Probable Causative Factors
Trauma,
Overuse of flexor tendons,
Fluid retention during pregnancy.

38. Carpal Tunnel Syndrome
Assessment Findings
Radiating pain along the nerve line,
Prolonged wrist flexion will enhance symptoms,
If treatments do not relieve the compression or if the client has very diminished sensation in the fingers
or hands for prolonged periods of time then referral to the GP will be needed so that further investigations
can be made.

39. Carpal Tunnel Syndrome
Treatment
Decrease swelling,
Massage, but if symptoms get worse, stop immediately,
Trigger point therapy,
Met’s & STR.

40. Learning Outcomes
By the end of the lesson the candidate will be able to
Identify 4 specific injury pathology, including signs & symptoms
Describe the common probable causative factors
Explain the assessment findings of the conditions
Explain the treatment needs