Lower Limb Injuries Flashcards
What percentage of all sporting injuries are lateral ankle sprains?
10-15%
Why is a lateral ankle sprain more prevalent than medial ankle sprains?
Weaker ligaments
Fibula acts as a mechanical barrier
Most people land in an inverted foot position
What is the mechanism of injury for a lateral ankle sprain?
Inversion and plantar flexion of the foot
How is a lateral ankle sprain diagnosed?
X-ray, MRI, Anterior Draw Test
Signs and symptoms
Pain on inversion
What is the treatment for a lateral ankle sprain?
RICE during inflammatory phase Early onset mobilisation Light passive stretching Proprioception (wobble board) Strengthening surrounding tissues Massage (deep friction) Sport-specific rehab
What massage techniques can be used for lateral ankle sprain?
Lymphatic drainage techniques to reduce oedema
Treating all compensatory tensions in surrounding soft tissues
Deep transverse frictions over damaged ligaments
What are stress fractures?
Hairline or microscopic breaks in a bone due to repetitive stress rather than trauma
What are common sites of stress fracture?
Tibia 2nd and 3rd metatarsals Fibula Femoral neck Tarsals Vertebra
What are the risk factors for stress fractures?
Inadequate shock absorption Sudden increase in training Post-menopausal women Amenorrhea Nutritional factors Compromised biomechanics
What are the signs and symptoms of stress fractures?
Pain and swelling at locality
Pain at rest
Stress reaction may proceed
Diagnosis via bone scan
How long does it take for a stress fracture to heal?
6-8 weeks
What is achilles tendon bursitis?
Repeated trauma/friction causes inflammation of the bursa
What are the symptoms of achilles tendon bursitis?
Pain at back of heals, especially when running uphill due to compression
Pain on wearing shoes
Swelling
Spongy feel to the area
What is the treatment for achilles tendon bursitis?
Heel raise
Ice
Shoe change if acute
Bursa/bone resection if chronic and the deep bursa
No massage over inflamed bursa but can use techniques into proximal tissues such as gastrocnemius and soleus
What are the potential parts of inflamed bursa?
Tendocalcaneal - irritated by shoes, especially heal counter
Retrocalcaneal - irritated by calcaneus and/or the tendon
What is plantar fasciitis?
Inflammation caused by overloading of the plantar fascia
What are the causes of plantar fasciitis?
Over-pronation/flat feet Reduced range into dorsiflexion Sudden increase in activity Excessive weight, obesity/pregnancy Improperly fitting footwear
What are the symptoms of plantar fasciitis?
Stiffness and pain first thing in the morning
Pain upon direct pressure over sight of dysfunction
Pain up stairs, on tip-toes or standing for long periods
Pain sometimes lessons as exercise continues
Associated tightness of achilles and gastrocnemius
What is the treatment for plantar fasciitis?
Address the underlying reason for the issue: Biomechanics Increase in activity Weight gain Poor footwear Excessive tension in plantar flexors
What massage techniques can be used for plantar fasciitis?
Reduce tension into gastrocnemius and soleus with effleurage, petrissage, myofascial release, STR, NMT, and MET stretching
Friction to plantar fascia
Longitudinal sports massage techniques on plantar fascia with palms, thumbs, and knuckles
What is achilles tendinopathy?
Chronic damage to the achilles tendon due to excessive loading
What are the causes of achilles tendinopathy?
Overuse Sudden increase in training Unaccustomed activities Overpronation Excessive tension in plantar flexors
What are the symptoms of achilles tendinopathy?
Pain upon palpation Pain on tendon during exercise Possible creaking/crepitus upon movement Pain and stiffness in the morning Pain walking up stairs
What can be done to treat achilles tendinopathy?
Identify cause and take action
Orthotics
What massage techniques can be used to treat achilles tendinopathy?
Soft tissue techniques into gastric and soleus including effleurage, petrissage, STR, myofascial release, and MET stretching
Specific soft tissue mobilisations
Deep friction
Massage to gastrocnemius and soleus
What is the eccentric strengthening protocol for achilles tendinopathy?
Exercises where gastrocnemius and soleus are contracting whilst lengthening
What are ‘shin splints’?
General term for pain in the shin area
Stress fracture, compartment syndrome, medial tibial stress syndrome (MTSS), periostitis of medial tibia due to attachment of soleus and it contracting eccentrically
What are the causes of shin splints?
Overpronation
Sudden increase in training
Running in spikes and forefoot strikers and hard surfaces
Sports with repeated landing and take off
Insufficient warm up
Tight soleus muscles
What are the symptoms of shin splints?
Tenderness over medial tibia
Swelling, lumps, and bumps over the bone
Pain on plantar flexion
What is the treatment for shin splints?
RICE when acute
Correct overpronation
Behavioural/training change
What massage techniques are used for shin splints?
Soft tissue techniques into gastric and soleus including effleurage, petrissage, STR, myofascial release and MET stretching
Friction to medial tibial border
‘Stripping’ up medial tibial border
STR for tibia anterior, gastrocs, soleus, and peroneals
What is compartment syndrome?
When the muscle becomes too big for the fascia that surrounds it
Acute compartment syndrome is a medical emergency
Chronic compartment syndrome can be treated with hands-on techniques
What are the symptoms of compartment syndrome?
Sharp pain in muscle Weakness, pallor, sensory loss, lack of pulse Swelling and tenderness Pain during exercise which goes at rest Difficulty in plantar/dorsi flexion
What is the treatment for chronic compartment syndrome?
Correct biomechanical dysfunction
What massage techniques can be used for chronic compartment syndrome?
Longitudinal and cross-fibre massage on muscle
Myofascial release techniques
Soft tissue release for tibias anterior
Neuro muscular techniques on local tissues
What is the treatment for acute compartment syndrome?
Diuretics
Anti-inflammatories
Fasciotomy
What is a calf muscle strain?
A grade 1-3 tear of the soleus or gastrocnemius
Most commonly injured at the musculotendinous junction
What are the causes of calf muscle strain?
Inadequate warm up Extensive scar tisse Hypertonic muscle group Overstrain/overstretch Unaccustomed activity
What are the symptoms of calf muscle strain?
Sudden sharp pain
Difficulty in contracting or standing on tip-toes
Pain, swelling, or bruising in the calf muscle
What is the treatment for calf muscle strain?
RICE when acute
Heel raise
What sport massage techniques can be used for calf muscle strain?
Effleurage, petrissage, deep frictions, myofascial release techniques, STR, and neuromuscular techniques on gastrocnemius and soleus
What are possible lower extremity stretches for calf muscle strain?
Peroneals
Gastrocs
Soleus
Tibialis anterior
