Download LOWER EXTREMITY INJURIES

Objective 3: Recognize
common injuries to the
lower extremity…
 Bones
• Femur
• Patella
• Tibia
 Tibial Tuberosity
 Medial Malleolus
• Fibula
 Lateral Malleolus
 Bones
• Tarsals
 Calcaneus
 Talus
 Metatarsals
 Phalanges
 Joints
- Knee
• Tibiofemoral – allows
knee
flexion/extension
• Patellofemoral
 Joints
– Foot & ankle
• 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
 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
 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
 Major Tendons
• Patellar Tendon –
attaches the
quadriceps muscle to
the tibia
• Achilles Tendon –
attaches the calf
muscles to the
calcaneus
 Ankle
Ligaments
• Anterior Tibiofibular –
resists forced
dorsiflexion and
rotation of the talus
• Anterior Talofibular –
resists plantarflexion
and inversion forces
• Deltoid – resists
eversion forces
Muscle
Location
Function
Quadriceps Femoris
 Rectus Femoris
 Vastus Medialis
 Vastus Lateralis
 Vastus Intermedius
Anterior Thigh
Extends the knee
Hamstrings
 Semimembranosus
 Semitendinosus
 Biceps Femoris
Posterior Thigh
Flexes the knee
Tibialis Anterior
Anterior lower leg
Dorsiflexion of ankle
Gastrocnemius
Posterior lower leg
Plantar flexion of ankle; assists
in knee flexion
Soleus
Deep to the gastrocnemius
Plantar flexion of the ankle
Tibialis Posterior
Posteromedial lower leg
Inversion of the foot/ankle
Peroneus Longus
Lateral lower leg
Eversion of the foot/ankle
Peroneus Brevis
Lateral lower leg
Eversion of the foot/ankle
Thigh Contusion
Mechanism of
Injury
Signs and
Symptoms
Severe impact to Pain, loss of function,
the thigh
swelling, decreased
musculature
ROM
Treatment
Prevention
Strategies
Ice, compression
Protective
equipment
with knee flexed.
MUST be managed
appropriately to
avoid complications.
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.
MCL Sprain
Mechanism of
Injury
Valgus force or
tibial external
rotation
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.
LCL Sprain
Mechanism of
Injury
Varus force or
tibial internal
rotation.
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:
- deceleration
- foot planted
- rotation
- valgus stress
Contact:
hyperextension
w/foot planted
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 Video
PCL Sprain
Mechanism of
Injury
-Falling on bent
knee
- direct force to
front of knee
- rotational
forces
Signs and
Symptoms
Treatment
Hears or feels a “pop”, RICE, restore ROM
minimal swelling,
and strength.
posterior tibial sag.
Surgery is
controversial.
Prevention
Strategies
Lower extremity
strengthening
and conditioning.
Medial Meniscus Injury and
Surgery Video Link
Meniscus Tear
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
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.
McConnell taping or
bracing.
Lower extremity
strengthening
and conditioning.
Patellar Tendinitis – “Jumper’s Knee”
Mechanism of
Injury
Repetitive
deceleration
Signs and Symptoms
Vague pain and
tenderness of patellar
tendon that worsens with
running/jumping
activities.
Treatment
Rest, ice, NSAID
medications, patellar
strap, friction
massage, and lower
extremity
strengthening.
Prevention
Strategies
Progressive
increase in
frequency/intensity
of training. Lower
extremity
strengthening and
conditioning.
Patellofemoral Syndrome
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
McConnell taping,
orthotic foot insert.
Prevention
Strategies
Lower extremity
strengthening and
conditioning.
Medial Tibial Stress Syndrome – “Shin Splints”
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
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.
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
foot mechanics.
cup, orthotic foot
inserts.
“Turf Toe”
Mechanism of
Injury
Hyperextension
sprain of the great
toe. MP joint. Can
be related to either
trauma or overuse.
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.