Chronic Lower Extremity

Question 1

most types of chronic lower body injuries are what kind?

Answer 1

non-traumatic, usually due to training load errors, insufficient recovery, biomechanical factors (intrinsic, equipment, or environment); often assoc with poor E absorption, usually on landing

Question 2

bone stress injury spectrum

Answer 2

1. past healthy adaptation, inflammation of the periosteum (double CT layer with high blood flow and innervation) causes pain when tendons attaching to it pull on it
2. higher stress cause microfracture which can progress into bigger or complete cortical fractures

Question 3

medial tibial stress syndrome

Answer 3

1. when FDL and soleus tendons attaching to medial side of tibia pull on the periosteum too much, causing imbalance in bone remodelling due to unevenly distributed stress leading to weakness
2. decrease PF active ROM and strength, and decrease DF ROM, pain during active and strength inversion, weak inversion since soleus and FDL are also inverters thus hard to pronate to absorb impact; no change in toe flexion since it is weak motion
3. palpate along deep post med border of tibia for pain, single conc spot of pain indicate fracture; single leg heel raise (how high, how many, comp bilat) and single leg hop (how high, how many, comp bilat); measure MLA angle between centre of med mall, tubercle of navicular, and MTP (normal 130 -150 deg)
4. gait training to shorten stride, run soft, and land on mid and fore foot to utilize plantar fascia to absorb pressure; use orthotics

Question 4

bone insufficiency and fracture risk

Answer 4

1. bone mineral density due to nutritional deficiencies of Ca2+ and vit D, low E availability or REDS
2. high in adolescents with immature bone undergoing early sport specialization (<13 y/o) since sport shapes bone struc, prone to injuries
3. postmenopausal decrease in estrogen decreases bone formation

Question 5

tendon pathology spectrum

Answer 5

1. past healthy adaptation. actute overload of tendon results in reactive tendinopathy, is reversible, swelling and fluid retention (high proteoglycans) without inflammation since tendons don’t have a lot of inflammatory molecules, moisture thickens tendon
2. progress into chronic tendon dysrepair, high collagen synthesis but not remodelling so lots of weak collagen, has potential for reverisibility
3. eventually tendon degen (tendinosis) through tenocyte death, decreased structural integrity decrease stiffness and peak strength leading to rupture; pathology increase innervation and BF leading to high pain sensitivity and inflammation

Question 6

Achilles tendon vulnerability

Answer 6

1. twisted 90 deg from origin to insertion
2. hypo vascular zone makes it hard to heal with slow metabolism
3. bears tensile load up to 12.5 times body weight

Question 7

Achilles tendinopathy

Answer 7

1. overuse injury, heel lifts can decrease load
2. pain during plantar flexion strength and active and during passive and active dorsiflexion
3. palpate for gap in Achilles tendon, single leg heel raise (how high, how many, comp bilat) and single leg hop (how high, how many, comp bilat); Thompson test for Achilles rupture (prone pos with feet hanging off edge of bed, squeeze calf, in normal Achilles the foot will plantarflex slightly, ruptured Achilles will not move, comp bilat)