Lower Limb Injuries Flashcards by Kathryn Fisher

What percentage of all sporting injuries are lateral ankle sprains?

10-15%

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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

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What is the mechanism of injury for a lateral ankle sprain?

Inversion and plantar flexion of the foot

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How is a lateral ankle sprain diagnosed?

X-ray, MRI, Anterior Draw Test
Signs and symptoms
Pain on inversion

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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

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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

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What are stress fractures?

Hairline or microscopic breaks in a bone due to repetitive stress rather than trauma

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What are common sites of stress fracture?

Tibia
2nd and 3rd metatarsals
Fibula
Femoral neck
Tarsals
Vertebra

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What are the risk factors for stress fractures?

Inadequate shock absorption
Sudden increase in training
Post-menopausal women
Amenorrhea
Nutritional factors
Compromised biomechanics

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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

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How long does it take for a stress fracture to heal?

6-8 weeks

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What is achilles tendon bursitis?

Repeated trauma/friction causes inflammation of the bursa

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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

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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

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What are the potential parts of inflamed bursa?

Tendocalcaneal - irritated by shoes, especially heal counter

Retrocalcaneal - irritated by calcaneus and/or the tendon

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What is plantar fasciitis?

Inflammation caused by overloading of the plantar fascia

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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