1. Signs & Symptoms Treatment & Rehab
Low Leg Lesson 2

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

3. 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

4. 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

5. 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

6. 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

7. 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.

8. 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??

9. 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?

10. 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

11. Achilles Tendon Rupture
Rehab
ROM
Strength
Balance
Progress back into sports

12. 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

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

14. 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

15. 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

16. 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

17. 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 _____________________.

18. 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.