LOWER EXTREMITY INJURIES Objective 3 Recognize common injuries
LOWER EXTREMITY INJURIES Objective 3: Recognize common injuries to the lower extremity…
Knee Anatomy - Bones • Femur • Patella • Tibial Tuberosity Medial Malleolus • Fibula Lateral Malleolus
Knee Anatomy - Joints • Tibiofemoral – allows knee flexion/extension • Patellofemoral
Knee Anatomy – Muscles Muscle Location Function Quadriceps Femoris 1. Rectus Femoris 2. Vastus Medialis 3. Vastus Lateralis 4. Vastus Intermedius Anterior Thigh Extends the knee Hamstrings 1. Semimembranosus 2. Semitendinosus 3. Biceps Femoris Posterior Thigh (Vastus Intermedius lies deep to Rectus Femoris) Flexes the knee
Quadriceps
Knee Anatomy – Soft Tissues Major Tendons • Patellar Tendon – attaches the quadriceps muscles to the tibia
Hamstrings
Knee Anatomy – Soft Tissues Menisci of the knee • Lateral Meniscus – Joint cartilage that deepens the knee joint. • Medial Meniscus – Joint cartilage that deepens the knee joint. Has a deep attachment to the MCL. • Outer 1/3 has a blood supply, rest is avascular.
Knee Anatomy – Soft Tissues Ligaments of Knee Medial Collateral (MCL) Resists valgus forces Lateral Collateral (LCL) Resists varus forces Anterior Cruciate (ACL) Resists anterior translation of the tibia Posterior Cruciate (PCL) Resists posterior translation of the tibia
Femur PCL Lateral Meniscus Later al Me niscu s Femur ACL Medial Meniscus LCL MCL LCL Tibial Tuberosity Fibula Tibia Fibula
Knee Injuries
Thigh Contusion Mechanism of Injury Common Injuries Signs and Symptoms Severe impact to Pain, loss of function, the thigh swelling, decreased musculature ROM Treatment Prevention Strategies Ice, compression Protective with knee flexed. equipment MUST be managed appropriately to avoid complications.
Thigh Contusion cont…
Common Injuries Muscle Strains – Quadricep/Hamstring Mechanism of Injury Signs and Symptoms Treatment Prevention Strategies Sudden stretch Pain, spasm, loss of RICE, flexibility Proper warmor sudden function, swelling, and strengthening up, stretching contraction possible deformity. exercises. and strengthening.
Grades of Strains and Sprains Grade 1: Fibers are stretched, but not torn Grade 2: Fibers are mildly torn to partially torn Grade 3: Fibers are completely torn
Muscle Strains cont…
What Injury?
What Injury ?
MCL Sprain Mechanism of Injury Valgus force or tibial external rotation Common Injuries Signs and Symptoms Pain medial knee, mild swelling, joint stiffness, possible joint instability. Treatment RICE, ROM and strengthening exercises, restrict activity until asymptomatic. Prevention Strategies Lower extremity strengthening and conditioning.
What Injury?
LCL Sprain Mechanism of Injury Varus force or tibial internal rotation. Common Injuries Signs and Symptoms Treatment Pain lateral knee, mild RICE, ROM and swelling, possible joint strengthening laxity. exercises, restrict activity until asymptomatic. Prevention Strategies Lower extremity strengthening and conditioning.
ACL Sprain Mechanism of Injury Noncontact: - decellereation - foot planted - rotation - valgus stress Contact: hyperextension w/foot planted Common Injuries Signs and Symptoms Hears or feels a “pop”, rapid swelling, joint instability. Treatment Prevention Strategies RICE, restore ROM and Lower extremity strength, surgery strengthening and required to reconstruct conditioning. the ligament.
ACL injury occuring https: //www. youtube. com/watch? v=1 l. Fb. Ct Dt. Ws. M https: //www. youtube. com/watch? v=Pzp. OE d. Udo. M 4 https: //www. youtube. com/watch? v=Ln. L 4 a Fy 3 Pu. M
ACL Strain cont…
Inside the Knee: ACL
https: //www. youtube. com/watch? v =q 96 M 0 j. Rqn 7 k Animated ACL reconstruction Actual ACL reconstruction https: //www. youtube. com/watch? v =9 Eg. RHfole. Lc
Surgical Reconstruction of the ACL
PCL Sprain Mechanism of Injury Common Injuries Signs and Symptoms -Falling on bent Hears or feels a “pop”, knee minimal swelling, - direct force to posterior tibial sag. front of knee - rotational forces Treatment RICE, restore ROM and strength. Surgery is controversial. Prevention Strategies Lower extremity strengthening and conditioning.
Meniscus Tear Common Injuries Mechanism of Injury Weight bearing with rotational force. Signs and Symptoms Swelling, joint line pain, loss of motion, locking or giving way. Treatment RICE Avascular area: Surgically trimmed and smoothed. Vascular area: Surgically repaired. Prevention Strategies Lower extremity strengthening and conditioning.
Patellar Subluxation/Dislocation Mechanism of Injury Common Injuries Signs and Symptoms Combination of Obvious deformity, foot planted, pain, swelling, limited deceleration, and ROM. change of direction. Treatment Prevention Strategies RICE and immobilization initially, then ROM and strengthening exercises. Mc. Connell taping or bracing. Lower extremity strengthening and conditioning.
How do your Patellas move?
Patellar Tendinitis – “Jumper’s Knee” Mechanism of Injury Repetitive deceleration Common Injuries Signs and Symptoms Treatment Prevention Strategies Vague pain and tenderness of patellar tendon that worsens with running/jumping activities. Rest, ice, NSAID medications, patellar strap, friction massage, and lower extremity strengthening. Progressive increase in frequency/intensity of training. Lower extremity strengthening and conditioning.
Patellar tendon Strap with pre-wrap!
Patellofemoral Syndrome Common Injuries Mechanism of Injury Signs and Symptoms -Tight hamstring and calf muscles -Increased Q-angle -Weak quadriceps muscles -Poor foot mechanics Tenderness of one or more patellar edge, dull ache, crepitus, pain with compression, positive Apprehension test. Treatment NSAIDs, quadricep strengthening, sleeve with buttress and/or Mc. Connell taping, orthotic foot insert. Prevention Strategies Lower extremity strengthening and conditioning.
Lower Leg and Ankle
Anatomy Bones • Tarsals Calcaneus Talus Metatarsals Phalanges
Terms to Help You Tibio = Tibia Fibular = Fibula Talo = Talus Calcaneo = Calcaneus Phalangeal = Phalanges Break down the words on the upcoming slides! Don’t panic!!! Anterior = Posterior = Lateral = Medial = Superior = Inferior = Sub =
Foot and Ankle Articulations • Tibiotalar (ankle joint) Allows plantar and dorsiflexion • Subtalar Joint between talus and calcaneus Allows inversion and eversion • Midfoot – where tarsals meet metatarsals • Metatarsal Phalengeal (MP) Allows toe flexion and extension • Interphalengeal (PIP & DIP) Allows flexion and extension of toe segments
Ligaments of the Ankle Anterior Inferior Tibiofibular Ligament • Resists forced dorsiflexion and rotation of talus Posterior Inferior Tibiofibular Ligament Deltoid Ligament • Resists eversion
Ligaments of the Ankle Anterior Talofibular Ligament • Resists plantarflexion and inversion Posterior Talofibular Ligament Calcaneofibular Ligament
Soft Tissues Tendons Achilles Tendon – attaches the calf muscles to the calcaneus
Soft Tissues Muscle Location Function Gastrocnemius Posterior Lower Leg (superficial to soleus) Plantarflexion; assists in knee flexion Soleus Posterior Lower Leg (deep Plantarflexion to the Gastroc) Tibialis Anterior Lower Leg Dorsiflexion of ankle Tibialis Posterior Posteromedial Lower Leg Inversion of foot/ankle Peroneus Longus Lateral Lower Leg to top of Eversion of foot/ankle foot Peroneus Brevis Lateral Lower Leg to 5 th Metatarsal Eversion of foot/ankle
Gastrocnemius and Soleus Plantarflexion (Gastroc. assists with knee flexion)
How to Stretch the Gastrocnemius and Soleus
Tibialis Anterior - dorsiflexion of the ankle Feet flat on the floor Heels stay on floor Lift your toes as high and as fast as you can for 30 seconds
Tibialis Posterior Palpate a neighbor’s Tibialis Posterior “Dig” behind the medial tibia from the knee to the ankle (be careful, it will be tender on most people (Inversion of ankle and foot)
Peroneus Longus and Peroneus Brevis Eversion of the ankle and foot Evert your ankle and foot while palpating the lateral lower leg
Medial Tibial Stress Syndrome – “Shin Splints” Common Injuries Mechanism of Injury Repetitive running activities. Signs and Symptoms Diffuse pain in distal medial tibia, increasing with activity. Treatment Correct faulty foot mechanics with footwear, or orthotic foot insert, calf stretching Prevention Strategies Appropriate footwear for activity, lower leg flexibility and strengthening, orthotic foot inserts.
Ankle Sprains – Lateral/Medial Common Injuries Mechanism of Injury Inversion: forced inversion and plantar flexion “rolling” Eversion: forced eversion of ankle – high risk for fracture. Syndesmosis (high): forced inversion with rotation of the talus. Signs and Symptoms Pain, swelling, decreased ROM, possible joint laxity. Treatment RICE, symptomatic modalities, taping and/or bracing. Prevention Strategies Appropriate footwear for activity, lower leg strengthening, proprioceptive training, taping and/or bracing of joint.
Common Injuries Plantar Fasciitis Mechanism of Injury Tight calf muscles, poor arch support, possible leg length discrepancy, over striding while running. Signs and Symptoms Medial heel pain, particularly in the morning; pain with forced dorsiflexion of the toes. Treatment Prevention Strategies Calf stretching, plantar Calf flexibility, fascial stretching, heel correction of faulty cup, orthotic foot mechanics. inserts.
Roll your foot out!
“Turf Toe” Mechanism of Injury Hyperextension sprain of the great toe. MP joint. Can be related to either trauma or overuse. Common Injuries Signs and Symptoms Pain at MP joint of great toe, increasing with extension of the joint. Treatment Steel toe insoles or taping, symptomatic modalities. Prevention Strategies Appropriate footwear, correction of faulty foot mechanics.
Activity Review on Butcher Paper outline the following body structures by tracing a group member • Anterior lower extremity (femur down to ankle) • Posterior lower extremity (femur down to calcaneus) • Lateral lower leg • Lateral ankle After drawing the outline, fill in all the structures for each of the body parts Go through your review sheet to do this Include bones, muscles, tendons, and ligaments
Handouts
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