W6 SS Ankle and lower limb Flashcards
Exertional Compartment Syndrome
Increase in pressure in a lower limb compartment leading to pain
Key points ECS
- Sudden onset of muscle hypertrophy
- Overuse injury during exertion
- Exercise-induced muscle and nerve condition
- Common muscles effected are tibias anterior and posterior
Common causes of ECS
- Sudden increase of training intensity, frequency, involving jumping and running on a hard surface
- Longer stride length and over-striding
- Age, males and females under 30 years old are more at risk of developing the condition
- Overtraining
- Type of exercising e.g. repetition
Signs and symptoms
- Increasing pain when active
- Aching, burning or cramping
- Weakness to the muscle on active and resisted movements
- Sensation of numbness
- Local swelling
- Affected muscle may feel tight
- No pain at rest
Treatment of ECS
Apply appropriate soft tissue mobilisation techniques to the affected muscle, CTM and STR to increase fascial mobility
Post care advice ECS
- Stretch and mobilise affected muscle
- Foam roll the muscle
- Apply heat to the area before long training session and ice post
- Analyse surfaces and training loading
- Avoid compression garments
Medial tibial stress syndrome
Referred to as shin splints, inflammation of muscle attachments along the periosteum around the tibia
Common causes of MTSS
- Over pronation of supination
- Change of training surfaces techniques or footwear
- Intensive training on hard surfaces
- Impact to the medial boarder
- Poor biomechanics
- Fatigue in posterior lower leg muscles causing an over load on the tibia
Signs and symptoms of MTSS
- Tenderness and lumps on palpation
- Diffuse pain along the boarder on activity but no pain at rest
- Pain decreases as the athlete warms up
- Pain increases after exercise or is worst in the morning
Treatment of MTSS
- Address trigger points in calf complex
- METs to the calf complex to increase doors flexion
- Taping techniques
Post care advice MTSS
- Strengthening exercises
- Proper warm up before exercise
- Rest and ice
- Maintain cardiovascular fitness
Tendinopathy
General term for tendon damage involving overuse, mircotears and collagen degeneration, resulting in pain and weakness
Common causes
- Degeneration of the tendon is caused through overload of the tissue
- Muscle weakness relative to the load being placed on it
- Changes in training load
- Training errors
- Recent lower limb injuries
- Reduced Dorsi flexion
- Over pronation
- Age
Signs and symptoms
- Gradual swelling/thickening to the achilles tendon, most seen in the lower 5cms
- Stiffness first thing in the morning and often after activity
- Tenderness on palpation of the tendon
- Increasing pain when loading the tendon
- Pain gradually becomes more frequent
- Tightness in the calf complex
Treatment tendinopathy
- Soft tissue work does not have a role within tendinopathy but it can restore balance to the kinetic chain if movement patterns have been altered
- Apply ischemic pressure for STR and MET to help reduce tension
- Avoid massaging directly over the tendon
Post care advice tendinopathy
- Strengthening the muscles to offload the tendon
- Heavy and slow resistance
Ligament sprains
Over stretching to either the lateral or medial ligaments of the ankle
Common causes
- Inversion sprain one of the most common injuries damaging the ATFL and CFL
- Eversion sprain damage to deltoid ligaments
- Medial ligament sprain occurs during eversion
- Uneven surfaces
Signs and symptoms ligament sprain
- Pain get when weight bearing
- Swelling and tenderness
- Bruising and skin discolouration
- Instability in ankle joint
- Passive inversion and eversion
- Joint laxity
Treatment for ligament sprain
- Immediate management, effleurage above the area
- Gentle frictions during proliferation
- Taping and strapping
Post care advice ligament sprain
- Early mobility
- Weight bearing as soon as possible
Plantar fasciopathy
Degeneration of the plantar fascia on the base of the foot, stretching from plantar surface of the calcareous to metatarsal heads
Common causes plantar fasciopathy
- Achillies tendon injuries
- Reduced dorsi flexion and great toe extension
- Poor hallux and everted strength
- Repeated actions
- Poor ligament sprain rehab
- Reduces hamstring length
Signs and symptoms plantar fasciopathy
- Morning pain and stiffness
- Pain is local
- Tenderness on palpation
Treatment plantar fasciopathy
- Neuromuscular techniques to the calf comples
- Ischemic pressure for trigger points to increase dorsi flexion
- Taping can elevate pain and offload the fascia
Post care advice plantar fasciopathy
- Apply ice during acute phase
- Avoid pounding activities
- Isometric toe flexion
- Strength work to increase arch
- Gripping floor with toes to develop proprioception
Objective assessment of the lower limb
A - asymmetry, balance from left to right and posterior ton anterior
R - range of movement, identifying restrictions of function, pain or weakness
T - tenderness on palpation
S - Special tests, isolate structures and test for contradictions
Observation and asymmetry
Anterior:
- Muscle bulk of anterior compartment
- Arch of feet high and low
- Centre of gravity
Lateral:
- Muscle bulk of the lateral compartment
- Centre of gravity eating forwards and backwards
Posterior:
- Muscle bulk of posterior compartment
- Thickness of achillies
Ankle and lower limb palpation checklist
- Gastrocnemius
- Soleus
- Tibialis anterior
- Flexor hallucis longus
- Peroneals
- Tibialis posterior
- Medial tibial boarder
- Talocrual joint line
- Lateral and medial ankle ligaments
- Achillies tendon
- Dorsal and plantar surface of the fooy
Special and functional tests
Special tests:
- Thompson squeeze
- Knee to wall
Functional tests:
- Standing on tip toes
- Balance on one foot
- Squat
- Lunge
- Labials post strength test
