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Leg Problems : Outline Gross Anatomy Achilles Problems Compartment Syndromes Shin Splints (MTSS)
LEG PROBLEMS CON’T Stress Fractures Signs, Symptoms and Treatments Prevention programs
GAIT CYCLE 25% stance
Pronation: is the impact absorption phase of gait. We either pronate too much, not enough or just right.
As weight is transferred from the outside of the foot to the inside of the foot, the leg internally rotates. As weight shifts from inside to out, external rotation of the leg occurs.
Reminder – Muscles of the leg.
P. Longus P. Brevis P. Tertius Ext. Digitorum Longus Ext. Hallucis Longus Tib. Anterior Tib. Posterior Flex. Digitorum Longus Flex. Hallucis Longus Achilles Tendon
COMPARTMENT SYNDROMES Traumatic and Exertional
Pressure in comp. Volume demands in Compartment. Compromise of capillary profusion. Muscle swells and dumps fluid.
Muscles are attempting in work in a hypoxic environment. Not only is this difficult, it is painful and muscles continue to swell in a hypoxic environment.
Nerves are the first structures to show signs of hypoxia
Compartment Evaluation Test strength x 10 Stretch muscle Palpate for firmness Examine skin.
Left Leg Anterior
Anterior Compartment Area of Sensory Deprivation
Left Leg LATERAL
Sensory deprivation to plantar foot. Pain on palpation middle to lower third of postero- medial tibia. Deep Posterior
Measuring Compartment Pressures
It is not how high the pressure is during running; it is how long it takes to return to normal. 20 Ideal Bad Insertion
GENERAL TREATMENT GUIDELINES Stretching, gradual motion before activity. Icing after activity. Stretching, stretching Modification of activity
PERIOSTITIS: an inflammation of the outer covering of the bone. FASCIITIS: and inflammation of the fascial covering of the muscle.
Shin Splints and M.T.S.S…..History of excessive weight bearing (jumping,running, or standing for prolonged periods of time, in combination with improper shoes.
Shin Splints and M.T.S.S. Associated with varus alignment (bowlegs) of the lower extremity and excessive pronation. Improper footwear may be a factor.
GENERAL TREATMENT Icing Stretching Strengthening Motion Control of foot.
SHIN SPLINTS Tibialis Posterior is eccentrically working to slow down the internal rotation of the leg on the foot during pronation of the foot. Muscle thought to pull away from bone.
MEDIAL TIBIAL STRESS SYNDROME Soleus muscle slows down the internal rotation of the tibia on the foot during pronation. Pain in lower medial third.
ACHILLES TENDON Gastrocnemius, Soleus, Plantaris Tendon and Paratenon
Grade I No discomfort prior to activity. No limitations. Stiffness after activity.
Grade II Discomfort before activity. Pain during activity. Pain and tightness after. Nodules
Grade III Pain and stiffness before activity. Pain limits quality and quantity of activity. Very painful after.
Achilles Tendon Rehab
I CING BEFORE AND AFTER ACTIVITY
Stretching of Achilles. Squeezing lump out of tendon. Curtail injurious activity and substitute other fitness activities. Heel lifts in shoes.
Achilles Paratenonitis Irritation of the paratenon. Caused by overuse. Rubbing of paratenon on the achilles tendon. Pain, crepitation. STOP! Icing, stretching.
ACHILLES RUPTURE Previous multiple minor trauma. Passive stretch plus active contraction TEAR!
EXAMINATION History Palpation Thompson Test Strength Testing
Ruptured Achilles Tendon Tear 1” above heel or at musculotendinous junction. Palpate for gaps. Manually test for strength. Have athlete do single leg toe raise.
Impact absorbed by shoe, muscles, bones (joints). Too strong of a muscle pull on one sideof the bone
ACTIVITY PAIN s.p. Pain at onset, reduced on warm-up, after pain c.s. Pain escalates as activity continues. s.f. Pain before activity, same during and the same after.
NIGHT PAIN s.p. No night pain. c.s. No night pain. s.f. Deep aching pain that wakes athlete.
REPEATED MUSCLE CONTRACTIONS s.p. No effect. c.s. Cause a slowing and a weakening of contraction (x10) s.f. No effect.
SENSORY CHANGES s.p.No Changes. c.s Potential changes corresponding to compartment. s.f.No Change.
MUSCLE STRETCH s.p.No change. c.s. Stretching a muscle within the affected compart. will increase pain. s.f. No change.
The Lower Leg. ANATOMY Bones Tibia Fibula MUSCLES The muscles are in four compartments with 2-4 muscles in each compartment Compartments are.
Common Injuries Sports Medicine I. Heel Bruise Absorbs impact from sports activities Absorbs impact from sports activities Disabling contusion Disabling.
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Preventing Injury in the Lower Leg and Ankle Achilles Tendon Stretching –A tight heel cord may limit dorsiflexion and may predispose athlete to ankle injury.
Injuries to the Lower Leg, Foot and Ankle. Lower Leg Injuries Caution! Graphic Picture.
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INJURY DIAGNOSIS AND TREATMENT REMEMBER, WE ARE NOT DOCTORS!! We can help NARROW down injuries and give basic first aid… ALWAYS CONSULT A DOCTOR!
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