1. LOWER EXTREMITY INJURIES
Objective 3: Recognize common injuries to the lower extremity…

2. Knee Anatomy - Bones Bones Femur Patella Tibia Fibula
Tibial Tuberosity
Medial Malleolus
Fibula
Lateral Malleolus

4. Knee Anatomy - Joints Joints - Tibiofemoral – Patellofemoral
allows knee flexion/extension
Patellofemoral

5. Knee Anatomy – Muscles Muscle Location Function Quadriceps Femoris
Rectus Femoris
Vastus Medialis
Vastus Lateralis
Vastus Intermedius
Anterior Thigh
(Vastus Intermedius lies deep to Rectus Femoris)
Extends the knee
Hamstrings
Semimembranosus
Semitendinosus
Biceps Femoris
Posterior Thigh
Flexes the knee

6. Quadriceps

7. Knee Anatomy – Soft Tissues
Major Tendons
Patellar Tendon – attaches the quadriceps muscles to the tibia

8. Hamstrings

11. Knee Anatomy – Soft Tissues
Menisci of the knee
Lateral Meniscus – Joint cartilage that deepens the knee joint.
Medial Meniscus – Joint cartilage that deepens the knee joint . Has a deep attachment to the MCL.
Outer 1/3 has a blood supply, rest is avascular.

12. Knee Anatomy – Soft Tissues
Ligaments of Knee
Medial Collateral (MCL)
Resists valgus forces
Lateral Collateral (LCL)
Resists varus forces
Anterior Cruciate (ACL)
Resists anterior translation of the tibia
Posterior Cruciate (PCL)
Resists posterior translation of the tibia

13. Femur Femur PCL ACL MCL LCL Fibula Fibula Tibia Tibia Lateral Meniscus
Medial Meniscus
LCL
MCL
LCL
Tibial Tuberosity
Fibula
Fibula
Tibia
Tibia

15. Knee Injuries

16. Prevention Strategies
Common Injuries
Thigh Contusion
Mechanism of Injury
Signs and Symptoms
Treatment
Prevention Strategies
Severe impact to the thigh musculature
Pain, loss of function, swelling, decreased ROM
Ice, compression with knee flexed. MUST be managed appropriately to avoid complications.
Protective equipment

17. Thigh Contusion cont…

18. Prevention Strategies
Common Injuries
Muscle Strains – Quadricep/Hamstring
Mechanism of Injury
Signs and Symptoms
Treatment
Prevention Strategies
Sudden stretch or sudden contraction
Pain, spasm, loss of function, swelling, possible deformity.
RICE, flexibility and strengthening exercises.
Proper warm-up, stretching and strengthening.

19. Grades of Strains and Sprains
Grade 1: Fibers are stretched, but not torn
Grade 2: Fibers are mildly torn to partially torn
Grade 3: Fibers are completely torn

20. Muscle Strains cont…

21. What Injury?

22. What Injury ?

23. Prevention Strategies
Common Injuries
MCL Sprain
Mechanism of Injury
Signs and Symptoms
Treatment
Prevention Strategies
Valgus force or tibial external rotation
Pain medial knee, mild swelling, joint stiffness, possible joint instability.
RICE, ROM and strengthening exercises, restrict activity until asymptomatic.
Lower extremity strengthening and conditioning.

25. What Injury?

26. Prevention Strategies
Common Injuries
LCL Sprain
Mechanism of Injury
Signs and Symptoms
Treatment
Prevention Strategies
Varus force or tibial internal rotation.
Pain lateral knee, mild swelling, possible joint laxity.
RICE, ROM and strengthening exercises, restrict activity until asymptomatic.
Lower extremity strengthening and conditioning.

28. Prevention Strategies
Common Injuries
ACL Sprain
Mechanism of Injury
Signs and Symptoms
Treatment
Prevention Strategies
Noncontact:
- decellereation
- foot planted
- rotation
- valgus stress
Contact:
hyperextension w/foot planted
Hears or feels a “pop”, rapid swelling, joint instability.
RICE, restore ROM and strength, surgery required to reconstruct the ligament.
Lower extremity strengthening and conditioning.

30. ACL injury occuring https://www.youtube.com/watch?v=1lFbCtDtWsM

31. ACL Strain cont…

32. Inside the Knee: ACL

35.
Animated ACL reconstruction
Actual ACL reconstruction

36. Surgical Reconstruction of the ACL

37. Prevention Strategies
Common Injuries
PCL Sprain
Mechanism of Injury
Signs and Symptoms
Treatment
Prevention Strategies
-Falling on bent knee
- direct force to front of knee
- rotational forces
Hears or feels a “pop”, minimal swelling, posterior tibial sag.
RICE, restore ROM and strength. Surgery is controversial.
Lower extremity strengthening and conditioning.

40. Prevention Strategies
Common Injuries
Meniscus Tear
Mechanism of Injury
Signs and Symptoms
Treatment
Prevention Strategies
Weight bearing with rotational force.
Swelling, joint line pain, loss of motion, locking or giving way.
RICE
Avascular area:
Surgically trimmed and smoothed.
Vascular area:
Surgically repaired.
Lower extremity strengthening and conditioning.

44. Prevention Strategies
Common Injuries
Patellar Subluxation/Dislocation
Mechanism of Injury
Signs and Symptoms
Treatment
Prevention Strategies
Combination of foot planted, deceleration, and change of direction.
Obvious deformity, pain, swelling, limited ROM.
RICE and immobilization initially, then ROM and strengthening exercises. McConnell taping or bracing.
Lower extremity strengthening and conditioning.

47. How do your Patellas move?

48. Prevention Strategies
Patellar Tendinitis – “Jumper’s Knee”
Common Injuries
Mechanism of Injury
Signs and Symptoms
Treatment
Prevention Strategies
Repetitive deceleration
Vague pain and tenderness of patellar tendon that worsens with running/jumping activities.
Rest, ice, NSAID medications, patellar strap, friction massage, and lower extremity strengthening.
Progressive increase in frequency/intensity of training. Lower extremity strengthening and conditioning.

49. Patellar tendon Strap with pre-wrap!

50. Prevention Strategies
Common Injuries
Patellofemoral Syndrome
Mechanism of Injury
Signs and Symptoms
Treatment
Prevention Strategies
-Tight hamstring and calf muscles
-Increased Q-angle
-Weak quadriceps muscles
-Poor foot mechanics
Tenderness of one or more patellar edge, dull ache, crepitus, pain with compression, positive Apprehension test.
NSAIDs, quadricep strengthening, sleeve with buttress and/or McConnell taping, orthotic foot insert.
Lower extremity strengthening and conditioning.

52. Lower Leg and Ankle

53. Anatomy
Bones
Tarsals
Calcaneus
Talus
Metatarsals
Phalanges

54. Terms to Help You Tibio = Tibia Fibular = Fibula Talo = Talus
Calcaneo = Calcaneus
Phalangeal = Phalanges
Anterior =
Posterior =
Lateral =
Medial =
Superior =
Inferior =
Sub =
Break down the words on the upcoming slides! Don’t panic!!!

55. Foot and Ankle Articulations
Tibiotalar (ankle joint)
Allows plantar and dorsiflexion
Subtalar
Joint between talus and calcaneus
Allows inversion and eversion
Midfoot – where tarsals meet metatarsals
Metatarsal Phalengeal (MP)
Allows toe flexion and extension
Interphalengeal (PIP & DIP)
Allows flexion and extension of toe segments

56. Ligaments of the Ankle Anterior Inferior Tibiofibular Ligament
Resists forced dorsiflexion and rotation of talus
Posterior Inferior Tibiofibular Ligament
Deltoid Ligament
Resists eversion

57. Ligaments of the Ankle Anterior Talofibular Ligament
Resists plantarflexion and inversion
Posterior Talofibular Ligament
Calcaneofibular Ligament

58. Soft Tissues Tendons
Achilles Tendon – attaches the calf muscles to the calcaneus

60. Soft Tissues Muscles Muscle Location Function Gastrocnemius
Posterior Lower Leg (superficial to soleus)
Plantarflexion; assists in knee flexion
Soleus
Posterior Lower Leg (deep to the Gastroc)
Plantarflexion
Tibialis Anterior
Anterior Lower Leg
Dorsiflexion of ankle
Tibialis Posterior
Posteromedial Lower Leg
Inversion of foot/ankle
Peroneus Longus
Lateral Lower Leg to top of foot
Eversion of foot/ankle
Peroneus Brevis
Lateral Lower Leg to 5th Metatarsal

61. Gastrocnemius and Soleus
Plantarflexion (Gastroc. assists with knee flexion)

63. How to Stretch the Gastrocnemius and Soleus

64. Tibialis Anterior - dorsiflexion of the ankle
Feet flat on the floor Heels stay on floor Lift your toes as high and as fast as you can for 30 seconds

65. Tibialis Posterior (Inversion of ankle and foot)
Palpate a neighbor’s Tibialis Posterior
“Dig” behind the medial tibia from the knee to the ankle (be careful, it will be tender on most people

66. Peroneus Longus and Peroneus Brevis
Eversion of the ankle and foot
Evert your ankle and foot while palpating the lateral lower leg

69. Prevention Strategies
Common Injuries
Medial Tibial Stress Syndrome – “Shin Splints”
Mechanism of Injury
Signs and Symptoms
Treatment
Prevention Strategies
Repetitive running activities.
Diffuse pain in distal medial tibia, increasing with activity.
Correct faulty foot mechanics with footwear, or orthotic foot insert, calf stretching
Appropriate footwear for activity, lower leg flexibility and strengthening, orthotic foot inserts.

71. Prevention Strategies
Common Injuries
Ankle Sprains – Lateral/Medial
Mechanism of Injury
Signs and Symptoms
Treatment
Prevention Strategies
Inversion: forced inversion and plantar flexion “rolling”
Eversion: forced eversion of ankle – high risk for fracture.
Syndesmosis (high): forced inversion with rotation of the talus.
Pain, swelling, decreased ROM, possible joint laxity.
RICE, symptomatic modalities, taping and/or bracing.
Appropriate footwear for activity, lower leg strengthening, proprioceptive training, taping and/or bracing of joint.

76. Prevention Strategies
Common Injuries
Plantar Fasciitis
Mechanism of Injury
Signs and Symptoms
Treatment
Prevention Strategies
Tight calf muscles, poor arch support, possible leg length discrepancy, over striding while running.
Medial heel pain, particularly in the morning; pain with forced dorsiflexion of the toes.
Calf stretching, plantar fascial stretching, heel cup, orthotic foot inserts.
Calf flexibility, correction of faulty foot mechanics.

78. Roll your foot out!

79. Prevention Strategies
Common Injuries
“Turf Toe”
Mechanism of Injury
Signs and Symptoms
Treatment
Prevention Strategies
Hyperextension sprain of the great toe. MP joint. Can be related to either trauma or overuse.
Pain at MP joint of great toe, increasing with extension of the joint.
Steel toe insoles or taping, symptomatic modalities.
Appropriate footwear, correction of faulty foot mechanics.

81. Activity Review on Butcher Paper
outline the following body structures by tracing a group member
Anterior lower extremity (femur down to ankle)
Posterior lower extremity (femur down to calcaneus)
Lateral lower leg
Lateral ankle
After drawing the outline, fill in all the structures for each of the body parts
Go through your review sheet to do this
Include bones, muscles, tendons, and ligaments

82. Handouts