Lecture #17b (Leg and Thigh Rehab)

Question 1

What are some common injuries involved with the leg and thigh?

Answer 1

Quad/hamstring strain, calf strain, compartment syndrome, quad contusions, myositis ossificans, ITB friction syndrome, and plicae syndrome

Question 2

How would you go about treating a quad/hamstring strain?

Answer 2

• Control pain and swelling (ice, NSAIDS, masage, e-stim, myofascial techniques)
• ROM (heel slides, bike)
• Flexibility (eventually do PNF when tolerable)
• Cardio (treadmill, elliptical, pool, bike)
• Strengthening (SLRs, ham curls, knee extensions, steps, lunges, leg press, squats, SLDLs, balance, and proprioception)
• Progress to ecccentric loading, full ROM (such as leg cycle exercise–resisted running, downhill running, and gear shifts–sprint progression)

Question 3

What are the keys when rehabbing a quad/hamstring contusion? (x3)

Answer 3

• warm up before exercising and stretching
• re-establish full flexibility
• watch and control myofascitis (indicated by pain and abnormal soreness away from the injury)

Question 4

How would you go about rehabbing a calf strain?

Answer 4

• Control pain and swelling (ice, NSAIDS, masage, e-stim, myofascial techniques)
• ROM (ankle pumps, bike)
• Flexibility (eventually do light PNF when tolerable–**perform with the leg bent and straight)
• Cardio (elliptical, pool, bike)
• Strengthening (weight shifts, ankle theraband, ham curls with dorsiflexion, and heel raises)
• balance and proprioception
• Progress to shuttle jumps, agility ladder, plyos, sprint progression, resisted running, and pushing drills

Question 5

True or false:

Compartment syndrome rehab may take an extended period of time. Why or why not?

Answer 5

True…this is a slow progression because you have to be watching for sighs of swelling/pressure/spasms/pain, but also there’s a slow progression to return ROM (which may never be full if fasciotomy was performed) and slow gradual strengtheing (because atrophy may be present)

Question 6

What are the two keys to rehabbing a quad contusion? (other than the fact that its very similar to a quad strain)

Answer 6

1) Use agents to avoid myositis ossificans and/or aid in the breakdown of unwanted tissue
2) Re-establish full flexibility

Question 7

Does ITB friction syndrome occur more frequently at the hip or knee?

Answer 7

The knee

Question 8

How do you physiologically treat ITB friction syndrome?

Answer 8

Must get plastic changes of the ITB to gain length to reduce stress on the tissue

Question 9

True or false:

The ITB is closer to a tendon than a ligament. Therefore, it has GTOs.

Answer 9

False…its more like a ligament, so it does not have GTOs so stretching it does not feel the same

Question 10

What knee postural condition predisposes someone to ITB at the hip? What about at the knee?

Answer 10

Genu valgum= the hip

Genu varum= the knee

Question 11

How should you treat ITB friction syndrome?

Answer 11

• Control pain and swelling (ice, NSAIDS, masage, e-stim)
• Use US and heat to gain tissue elasticity
• Stretch aggressively to gain ITB length
• Decrease, modify, or stop activity initially
• Slowly return back to activity (watch for symptoms and avoid doing too much one day and too little the next)
• Try joint mobs if improvement is too slow

Question 12

If there is no improvement with an ITB syndrome patient, then what other condition may possibly be considered?

Answer 12

Lateral meniscal tear

Question 13

What is the key to treating plicae syndrome?

Answer 13

Stretching the plicae to gain length and plastic changes to help reduce stress