Running Injuries. Lower Extremity

Transcription

1 Running Injuries Lower Extremity

2 Causes of Overuse Injuries Repetition Surface/Environment Postural Alignment Improper Biomechanics Poor Footwear/equipment Over-training/improper training

3 Stress Injuries Stress Fractures (Femur, Tibia) Osteochondritis Dissecans Medial Tibial Stress Syndrome Heel Spur Morton s Neuroma March Fracture Cuboid Syndrome

4 Overuse Injuries Trochanteric Bursitis Illiopectineal Bursitis Infrapatellar Fat Pad Lesion Plica Syndrome Popliteus Tendinitis Iliotiial Band friction syndrome Achilles Tendonitis Tarsal Tunnel Syndrome Patellar Tracking Problems Bipartite Patella (symptomatic) Osgood-Schlatter s Disease Chondromalacia Patella Anterior Compartment Syndrome Retrocalcanea/achille sbursitis Plantar Facitis Cancaneal Opophysitis

5 Trochanteric Bursitis Etiology Friction/irritation by tensor facia latae during repetitive hip flexion and extension (may also be due to direct trauma) Pathology Inflammation of the bursa of the greater trochanter. snapping hip May progress to thickening of bursa and chronic bursitis

6 Throchanteric Bursitis Cont. Signs & Symptoms Localized p/tenderness on palpation (sidling) Crepitus hip flx/ext p passive hip int/ext rotation with thigh adducted (greater trochanter rotates under tensor facia latae) Audible and palpable snapping during gait Treatment Rest Ice Ultrasound (mechanical effects

7 Trochanteric Bursitis Stretching

8 Iliopectineal Bursitis Etiology Friction/irritation from iliopsoas muscle during repetitive running/jumping Pathology Inflammation of iliopectineal bursa Signs & Symptoms Pain/point tenderness in anterior groin Hip most comfortable in flx/abd/ext rot pain on active/passive int. rotation of hip (stretches bursa iliopsoas muscle over s Treatment: Same as for

9 Infrapatellar Fat Pad Lesions Etiology Compression/impingement within the anterior compartment Pathology Hemorrhage Swelling of the fat pad/ inflammation of the overlying synovium Signs & Symptoms Localized pain/tenderness on palpation Increased pain during terminal knee extension (impingement) Decreased pain during flexion

10 Infrapatellar Fat Pad Lesion Treatment Antiinflammatory (US - mechanical effect, ice) Taping - McConnal Bracing Knee sleeve with butress Px to tolerance Superior Fat Pad, irritated less often

11 Osteochondritis Dissecans/Juvenile Etiology: Acute/cumulative stresses acting on subchondral bone (impingement by tibial spine, impact from patella duringknee flexion) Pathology: Stress fractures of subcondral bone (not articular cartilage_ with w/out fragmentation and loose body. Most Commonly located on lateral aspect of the medial femoral condyle adjacent to attachment of PCL (75%)

12 Osteochondritis Dissecans/Juvenile Signs & Symptoms Insidious onset prior to epiphyseal plate closure walking with tibia externally rotated positive Wilson test x-ray, MRI, Treatment 6-12 weeks healing alter participation to avoid impact

13 Osteochondritis Dissecans/ Juvenile Most Commonly Affected areas

14 Plica Syndrome Etiology Recurrent impingement of the plica between the medical femoral condyle & patella during repetitive knee flx Pathology Chronic irritation, thickening, and fibrosis of synovial plica

15 Plica Syndrome Cont. Signs & Symptoms Medial knee pain increased with activity or prolonged sitting localized tenderness medial border of the patella/medial femoral epicondyle Positive mediopatellar plica test Positive Stutter test Positive Hughton plica test Treatment Anti-inflammatory (US mechanical, ice) Px to tolerance due to intermittent symptoms

16 Iliotibial Band Friction Syndrome Etiology Friction due to repetitive flx/ext of the IT-band over lateral epicondyle Pathology: Inflammation of the ITB over lateral epicondyle Signs & Symptoms Localized tenderness Pain during knee flexion/extension Swelling/crepitus + Ober test (w/active flx/ext)

17 Iliotibial Band Friction Syndrome Cont. Treatment Antiinflammatory (US, Ice, Meds) Gentle Stretching of TFL and IT-band Determine if tibial internal rotation, LLD or Pes Planus Rest (slow return) Pain is the guild

18 Popliteal Tendonitis Etiology: Repetitive traction forces (downhill running) foot pronation/internal tibial rotation, anterior translation of femur on tibial plateau) Pathology: Inflammation of poplitieus tendon

19 Popliteal Tendonitis Signs & Symptoms Pain especially during downhill running Sitting Indian style painful (easier to palpate) point tender vague pain Treatment Antinflamm. (US, ice, meds) Strengthening/stretching Px to tolerance May need cortisone and removal from participation if continues

20 Bipartite Patella Etiology Repetitive Microtruama - forces exerted through quadriceps tendon (downhill) Pathology Congenital anomaly with superimposed avulsion of superolateral patella Less Common (picture) - More common Superolateral corner

21 Bipartite Patella Cont. Signs & Symptoms Pain during activity localized tenderness over superolateral pole/palpable defect inhibition of quadriceps function Treatment Participate to tolerance ice taping/bracing Radical - surgery

22 Lower Leg Anatomy

23 Medial Tibial Stress Syndrome Etiology: Overuse/repetitive stress froces acting on proximal insertions of the FDL/Tibialis posterior muscles (may include soleus) Pathology: Enthesitis of the proximal insertion of the FDL and/or posterior tibialis muscle

24 Medial Tibial Stress Syndrome Signs & Symptoms Persistent aching pain lower 1/3 medial leg Pain aggravated by weight bearing activity (push-off) Localized tenderness on palpation Pain on forced passive DF/knee Flx

25 Medial Tibial Stress Syndrome Cont. Treatment Stretching/strengthening Use pain as a guild (may need total rest) Determine if have pes planus, LLD, Tibial rotation) Pre/post participation treatments

26 Anterior Compartment Syndrome Etiology overuse (muscle hypertrophy) this may also be due to direct trauma) Pathology Intra-compartment swelling/increased intramuscular pressure impeded blood flow, and muscle ischemia with w/out fascial hernia deep peroneal nerve compromise ischemic necrosis of intra-compartment muscles

27 Anterior Compartment Syndrome Cont. Signs & Symptoms aching pain thigh shinny skin paresthesia/hypoesthesia in dorsum of the foot (may have drop foot) Motor Test for deep peroneal nerve, sensory test for deep peroneal nerve (dorsal web space 1st & 2nd

28 Anterior Compartment Syndrome Treatment Physician Referral Intra-compartment testing Possible surgical

29 Muscular Injuries Gluteal Strains Hamstring Strains Quadricep Strains Gastroc Strains Soleus Strains FHL Strains Tibialis Posterior Strain/Tendonitis