1.  Acting:  Break a Leg = Good Luck  Athletics:  Break a Leg = Better than a Sprain??? The Foot, Ankle and Lower Leg

2.  Limbs are part of the appendicular skeleton  Skeleton:  Aid movement  Support and protect organs  Produce red and white blood cells  Store minerals Anatomy & Physiology

3.  Osteo = Bone  Osteocyte: _____________________  Osteoblast: cells that produce more bone  Osteoclasts: cells that absorb/digest bone  The movement of a joint is determined by the shape of the bones in the joint Anatomy & Physiology Osteoblast activity Osteoclast activity

4.  Injury to skeleton/bone = fracture  Most common in ankle and lower leg:  Stress fracture  Simple fracture Injury to bone

5.  Bone remodeling (cells)  Reduction  External fixation:  Cast  Rods  Internal fixation:  Surgery  Wires  Plates  Screws Treatment of bone injury:

6.  1980 – fractured fibula - cast for 6-8 weeks  2014 – fractured fibula - walking boot or brace time dependent upon individual rate of healing  Why?  Muscle Atrophy  Blood Pressure Walking Boot/Brace vs Cast

7.  Skeletal muscle* Tendon  Under voluntary control * Attaches muscle to bone  Aids in movement  Characteristics of muscles  Contractibility – ability to shorten (flexion)  Excitability or irritability – ability to respond to electrical signals called action potentials  Extensibility – ability to be stretched  Elasticity – ability to return to original length after being stretched Muscle (Myo) Physiology

8. Muscle Physiology

10.  Muscles attach to a bone that does not move (origin)  And to a bone that does move (insertion)  Most muscles are arranged in pairs  Example: Bicep Curl  Prime mover  causes the main motion – bicep  Antagonist  opposes the main movement – tricep  Synergist  stabilizes movement Muscle Anatomy Bicep Origin Bicep Insertion

11.  As a result of the structure of muscles and bones, MUSCLES ONLY PULL  Therefore one muscle must pull in one direction – flexion (Bicep)  While another muscle pulls in the opposite direction – extension (Tricep) Muscle Biomechanics

12.  sTrain  Grade 1  stretching or slight tearing  Grade 2  significant stretching and/or  moderate tear  Grade 3  muscle/tendon is torn  Partial tear  Rupture Injury to Muscle

13. Ruptured Achilles Tendon GRAPHIC IMAGE

14.  Pain  Spasm  Weakness  Swelling  Inflammation  Cramping  Loss of function Signs of Muscle Strain

15.  Atrophy  write down an example of how a person could experience muscle atrophy  Hypertrophy  write down an example of how a person could experience muscle hypertrophy Other Muscle Issues

16. Muscle Tone

17.  Made up of collagen fibers (75%)  Fibroblasts – cells that form ligaments  Considered inflexible – they don’t like to be stretched  Ligaments are avascular – they do not have their own blood supply  Little blood flow to middle region of ligament  Blood flow is better at the origin and insertion – where the ligament is attached to bone Anatomy of Ligaments

18.  Ligaments attach bone to bone  Unlike tendons they resist being stretched, thus they are considered joint stabilizers  Stretching can cause injury  Hypermobility – genetics mostly Function of Ligaments

19.  sPrian  Grade 1  overstretching or slight tearing of ligament  Joint is still stable  Grade 2  Partial ligament tear  Grade 3  ligament is torn  Partial tear  Rupture Ligament Injuries

20.  Tendonitis – inflammation that occurs when tendon becomes irritated; overuse; chronic  Bursitis – inflammation of the bursa (fluid-filled sac) resulting from repetitive movement or prolonged or excessive pressure Other Common Chronic Injuries

21.  Contusion – bruise  Myositis ossificans can develop if a bruise/contusion is not managed properly  Calcification forms within the muscle, restricting movement, increasing pain  Surgery Other Common Lower Leg Injuries

22.  Neurons send impulses down the length of the fiber, to the Neuromuscular synapse  Neuromuscular synapse – the point at which the neuron signal crosses to the muscle, causing excitability (contract, relax) Nerves - Neuro

23. Injury to Nerves  Injury to nerves can stop the flow of electrical activity to muscles, causing a loss of sensation and/or function  Nerve injury can result from  Cutting a nerve  A nerve being compressed  A nerve being overstretched  Some nerve injuries can be corrected surgically or with time but severe injuries may result in permanent loss of function (paralysis)

24.  A somewhat common nerve injury in the foot is called Morton’s Neuroma  The nerves that run through the foot to the third and fourth metatarsals become compressed, irritated and damaged  This compression creates enlargement of the nerve, eventually leading to permanent nerve damage.  One of the most common causes is wearing shoes that have a tapered toe box, or high- heeled shoes that cause the toes to be forced into the toe box. Neuroma

26. Ankle anatomy Directions: Label each part of the ankle using the following word key. Some words will not be used depending on the view of the ankle you are looking at. Color-code using the suggestions on the next page. Label each bone either weight-bearing or non-weight-bearing. TibiaDeltoid ligamentSubtalar joint FibulaAnterior talofibular ligamentTalocrural joint TalusAnterior tibiofibular ligament CalcaneusPosterior talofibular ligament Lateral MalleolusPosterior tibiofibular ligament Medial MalleolusCalcaneofibular ligament Achilles tendon LATERAL VIEW OF ANKLE

27. Ankle anatomy Directions: Label each part of the ankle using the following word key. Some words will not be used depending on the view of the ankle you are looking at. Color-code using the suggestions on the next page. Label each bone either weight-bearing or non-weight-bearing. TibiaDeltoid ligamentSubtalar joint FibulaAnterior talofibular ligamentTalocrural joint TalusAnterior tibiofibular ligament CalcaneusPosterior talofibular ligament Lateral MalleolusPosterior tibiofibular ligament Medial MalleolusCalcaneofibular ligament Achilles tendon ANTERIOR VIEW OF ANKLE

28. Common Foot & Ankle Injuries Plantar Fasciitis

29. Common Foot & Ankle Injuries Shin SplintsMedial Tibial Stress Syndrome NEXT SLIDE IS GRAPHIC!

30.  Achilles Tendonitis“Shredded” tendon

31. Compartment Syndrome

32. NEXT SLIDE IS GRAPHIC!

33. Compartment Syndrome

34. Taping and Bracing: Which is the Better Option?

35. The purpose of a tape job is usually one of two things.  One possible reason to tape an ankle is to prevent an ankle injury. Taping Since most injuries occur due to an inversion (turning in of the ankle) and plantarflexion, most ankle tape jobs are applied so that they limit the inversion motion.

36.  Preventative tape jobs are useful in situations of ankle weakness or when the likelihood of suffering an ankle injury is high due to the practice or game conditions.  If the ankle is weak the athlete must also _____________________ the injured area  Examples:  Gas pedalWindshield wipers  ABC’sToe taps  Toe raisesBand exercises  Stretches Preventative Taping Gas pedal = Gastroc (jy)

37.  After an ankle sprain, the ligaments, muscles and tendons are weak and injured.  In order to resume practice and play safely and swiftly, ankle tape jobs are often applied to protect the injury. Protective Taping

38.  Again, since most injuries are due to an inversion and plantarflexion mechanism, these tape jobs often center around preventing ____________ & ________. Protective Taping  Mechanism of injury must be determined by an athletic trainer or doctor prior to return to play so that the tape job can be modified to protect against the exact mechanism of injury

39.  Taping may weaken the body’s natural protective mechanisms  Ligaments  Muscles  Tendons  Joint capsule  proprioception Disadvantages of taping Many believe that regular use of a tape job will cause the secondary supports to become weaker and less effective, so that if the tape job fails or the athlete plays without it, injury is more likely. Taping tries to mimic what the ligaments are supposed to do. But what else should the athlete be doing?

40.  One of the main problems with ankle tape jobs is that learning to tape is difficult. In other words, one must complete many tape jobs to become efficient. Another potential problem is that there is a great deal of variability between tape jobs applied by different people.  A veteran trainer once commented that there are as many different ways to tape the ankle as there are people taping. Disadvantages of taping

41.  An alternative to ankle taping is ankle bracing. Most sports medicine professionals prefer one over the other with some advocating taping and others bracing. In reality, there are probably uses for both. Bracing

42.  Consistency – same feel every time  Adjustable – unlike tape, if it’s too tight or too loose the user can easily make adjustments  Self-reliance – unlike taping, you do not need anyone to put a brace on for you. You can use a brace even when a trainer is not available  Custom-made option – you can buy a brace that has been made just for you. This option usually requires a doctors visit and a prescription for the type of brace you need Advantages of Bracing

43.  Smelly-factor  bacteria  skin irritation  discomfort  gross!  Over-the-counter option  everyone can walk into a drug store and buy a brace, but that doesn’t mean that they know which brace is right for them and their injury.  Easy access to a brace is good if you know how to shop for one, but can be a very bad thing if you get the wrong brace and end up doing more harm than good Disadvantages

44.  Weakens the support structures in the ankle, just like tape does. The injured area gets dependent on the brace; patient MUST be doing rehab to ensure the injured area gets stronger! Con’s of Bracing, cont.

45. Inflammation is a good thing for a short period of time. RICE helps flush out waste products (dead cells) and bring in healthy oxygenated cells to help repair the Damage. Injury Management

46. Wrapping an ankle Distal to proximal Snug but not too tight Do NOT sleep with a wrap on Felt or Foam horseshoe cut-out Can also ice while wrapped

47.  Progression is critical!  Non-weight bearing ROM  Weight-bearing ROM & strengthening  Proprioception  Functional  Don’t skip steps in the process Rehabilitation Exercise

48.  Non Weight-bearingWeight-bearing  ABC’sHeel raises  Gas pedalHeel to Toe walking  Seated toe tapsBand exercises  Windshield wipers Progressive Rehabilitation

49.  ProprioceptionFunctional  Balance exercisesAgility  Eyes closed exercisesSport-specific movements  Rocker board Rehabilitation Exercise

50. Which of these are… Non-weight-bearing? Weight-bearing? Proprioception

51. These exercises are shown using a Bosu Board but you could also use a rocker or wobble board These exercises would be classified as…

52.  " The 20 benefits of ankle taping > ManageYourLifeNow.com." Manage Your Life Better with ManageYourLifeNow.com. N.p., 13 Jan. 2009. Web. 11 Apr. 2010..  "People who exercise on work days are happier, suffer less stress and are more productive." Mail Online. N.p., 16 Dec. 2008. Web. 11 Apr. 2010..  "The FITT Principle of Training." Phil Davies' Sports Fitness Advisor - Get Fit for Sport & Life. Sports Fitness Advisor, n.d. Web. 11 Apr. 2010..  Bolton, Raphael. "Exercising Properly With Aerobic And Anaerobic Exercises." Article Alley. N.p., 1 Apr. 2010. Web. 11 Apr. 2010..  Bronson, Mary. Glencoe Health. Woodland Hills; TIME,2009.335.print