A Quick Review Of Common Lower Limb Injuries
I thought I would write a little blog reviewing some of the more common lower limb injuries that typically occur and present to the Osteopathic practice for treatment. This idea comes off the back end of teaching rehabilitation to 4th year Osteopathy students at Victoria University over the last 2 weeks.
Plantarfasciitis is a common overuse condition affecting the plantar fascia (the undersurface of the foot). It is often characterized by pain and discomfort under the arch of the inside of the foot and where it attaches onto the calcaneus. Typically clients will present with pain with walking, especially first thing in the morning after rising. The majority of the time the pain and discomfort will improve with mobility and will be more sore initially with activity after rest.
Causes: There are many causes for plantarfasciitis. Some clients might have just overdone it with regards to activity (unaccustomed walking), perhaps they have been wearing inappropriate footwear that has also aggravated this. There may also be some biomechanical joint restrictions in the foot and ankle that could be causing it.
Treatment & Management: Typically ice and rest can help a lot with regards to the clients symptoms. Reviewing the individuals activity levels and footwear are also important. In some cases, clients may benefit from an orthotic to help support the foot. Treatment typically involves soft tissue massage, mobilitations of the foot and ankle and taping. Exercises can also be prescribed to help improve the strength of the intrinsic muscles of the foot. In some cases clients may need to look at other treatment options such as shockwave therapy and corticosteroids if symptoms don’t improve.
The lateral ankle sprain is probably one of the most common lower limb injuries. It is typically related to playing sport or walking where one falls and twists their ankle. Trauma such as this results in an injury to the lateral ankle ligaments (most commonly the anterior talofibular ligament). Individuals will also like strain their peroneal muscles. The ankle will often swell up. Ankle sprains are categorized into either a Grade 1 sprain (approximately 25% ligament injury), Grade 2 (approximately 50% ligament injury) and a Grade 3 sprain (rupture of the ligament). These injuries can take anywhere between 1-2 and 6-8 weeks to full resolve.
Treatment & Management: Treatment and management in the acute early phase is especially important. The RICER Acronym: Rest, Ice, Compression, Elevation and Referral are important to follow for the first 24-72 hours. Some individuals may need to use crutches. Following this period, hands on manual therapy, taping and early rehabilitation can commence. One thing that all individuals should be aware of is that they may need to undergo an X-ray for severe ankle sprains to rule out any small fractures.
The achilles is another one of those areas of the lower limb where many injuries typically occur. Typically these injuries are as a result of overuse, resulting in pain in the achilles area (where the calf meets the foot at the calcaneus). Common causes include: Overuse such as walking or running where there has been too large of an overload. Poor footwear, activity types, biomechanical issues in the foot/ankle and further up the body can also contribute to this condition.
Common Signs & Symptoms: Achilles Tendinopathy signs and symptoms are very similar to Plantarfasciitis. Typically individuals are more aware of their symptoms first thing in the morning, with the start of activity or after prolonged rest.
Treatment & Management: There are a variety of different treatment and management strategies for the achilles tendinopathy. The first port of call is usually rest, ice and addressing footwear. Manual therapy such as massage, stretching, mobilisation of the foot and ankle and taping are also very useful. Eccentric exercises are also commonly prescribed for the rehabilitation of the achilles tendinopathy. These conditions are similar to the Plantarfasciitis in that it can take anywhere between 4-6 weeks and 6-12 months to improve. In some more severe cases, cortisone injections, autogulous blood injections and shockwave therapy may be required.
Often known as the Old Man’s Injury. Calf strains often occur during sport or activities such as running. Typically the individual may feel some tightness or a strain in their gastrocnemius or soleus muscle. Like the ankle sprain that involves grading of the ligament injury. Muscle strains are also graded depending on their severity of pain and strength.
Treatment & Management: In the acute phase we need to again focus on Rest and Ice. Gentle stretching, strengthing and mobility exercises often follow as the injury starts to subside. Hands on treatment such as stretching, soft tissue massage and taping are also useful for encouraging return to normal activities.
Shin Splints are another overuse injury affecting the lower limb. Shin splints can occur within the anterior, medial or posterior compartment of the lower leg. Shin splints is a general term that can be used to describe a variety of injuries to the lower leg, such as periostitis, stress fractures and compartment syndrome. It is important to have your injury assessed by a qualified practitioner (Osteopath, Physiotherapist, Chiropractor or GP) to rule out stress fractures. Treatment and management will be based on the exact diagnosis of the injury. For those who have stress fractures, a CAM boot may be prescribed. For those with compartment syndrome, Rest, Ice and Manual Therapy will often be prescribed.
As you can see from the various injuries described above, there are many different types of injuries that occur in the lower limb. Some of these are as a result of trauma, whereas others are as a result of overuse. When it comes to managing these injuries correctly, it is always recommended to have them seen by a qualified practitioner (Osteopath, Physiotherapist, Chiropractor or GP) so that an appropriate treatment and management plan can be prescribed. More often than not, those individuals who don’t address their injuries, will often notice that the injury takes much longer to heal or that they increase their risk of further recurrence. The number one risk for injury to any area of the body is a past history of injury to that area. By seeing your Osteopath, you will be able to put together the appropriate treatment and management plan to ensure full recovery and prevent recurrence.
Osteopath Heath Williams is the owner and director of Principle Four Osteopathy. Principle Four Osteopathy is one of Melbourne City CBD 3000 leading Osteopathic clinics. The Osteopathy clinic is located at 29 Somerset Place (near the corner of Little Bourke & Elizabeth St).
Bookings can be made by calling 03 9670 9290 or booking online @ www.principlefourosteopathy.com
Services Include: Osteopathy, Functional Movement Screening, Exercise Prescription and Rehabilitation and Ergonomic Assessments
Conditions treated include: Back Pain, Neck Pain, Shoulder Injuries such as rotator cuff strains/tears, subacromial impingement complaints, frozen shoulder and biceps tendinitis, elbow injuries such as tennis and golfers elbow, repetitive strain injuries in the wrist and hand, hip injuries, knee complaints, ankle sprains, achilles tendinitis, plantarfasciitis, ankle sprains and much more.