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Copyright 2012 - Releaf
common sports injuries
Lower leg
Shin Splints
Calf Strain
Ankle Sprain
Anterior Compartment Syndrome
Fibula Fracture
Achilles Tendinitis
Achilles Bursitis
Peroneal Tendonitis
location
Aching and throbbing pain down the inside of your shins that flares up when you run or walk long distance.  There may be swelling and heat generated from area too, pain may be felt when you point your toes downwards.
Tear in calf muscle which often occurs when a intensive quick movement is made/attempted.  The region of the injury is usually  where the muscles join the achilles tendon.
Damage to one or more of the ligaments on the outside of the ankle.  The pain can range from mild to very sever.  This type of injury is graded 1 to 3 (see calf strain grading).
Pain on the outside of the Shin Bone Muscle especially when foot is pulled upwards or flat when running.
Lower leg small bone break/fracture outside shin
Back of Ankles "Achilles Heel" slow pain develops to degenerative condition (large tendon in body)
Back of Ankle "Achilles" heel area
Pain is felt outside/lateral near or just below ankle bone.  There might also be pain experienced on heel with light swelling.
what why how
Over doing it, increase in activity doing too much too soon!  Running for example excerts force upto eight times your body weight.  Running down hill, or on slanted tilted, crowned roads.  Running in worn-out footwear.  Doing sports with frequent starts and stops, such as squash or tennis. Overpronation; the tibia bone is forced to twist in the opposite direction.  Too much twisting can lead to shin splints.  Warning!  Continueing exercise "running with shin splints" will create micro tears in tibialis anterior and surrounding muscles (shine bone area).  Further damage will promote collagen breakdown and the first steps to tendinosis or chronic tendonitis.


The Gastrocnemius and Soleus muscles (calf's).  The indications of calf strain include;  Sharp sudden pain at back of calf muscle.  Hinders walking correctly and bruising may appear.  Like most strains the calf is graded from 1 to 3 in severity.  With grade 1 minor tear, with up to 10% of fibres involved. A grade 2 tear involves up to 90% of the muscle fibres and a grade 3 is over 90% of fibres torn, or a full rupture. This usually occurs at the muscular tendinous junction or the achilles tendon itself.
Grade 1:
A twinge of pain in the back of the lower leg and may be able to play on. Followed by tightness and aching over next few days.
Grade 2:
A sharp pain felt in the back of the lower leg, especially when walking and running.  Followed by swelling and some bruising in the calf.  Will be aching and tight for several days if not more.
Pain on resisted plantar flexion.
Grade 3:
A severe and immediate pain at the back of the leg, often at the muscular tendinous junction.  
You will not be able to contract the muscle and there will be noticeable bruising and swelling.
In the case of a full rupture, often the muscle can be seen to be bunched up towards the top of the calf.
Usually twisting of or turning over the ankle will cause sprain, depending on rotation extent and history (previous damage, weakness) will cause swelling and bruising.  A Sprain is the stretching and or tearing of LIGAMENTS (sprain ligaments/strain muscles).  A inversion sprain (lateral ligament) where the ankle turns over so sole of foot faces inwards, damaging the ligaments on the outside of ankle.  With a Sprained ankle (most common damage sustained) is damage to the anterior Talofibular Ligament (connects Talus = the ankle bone with the Fibula = smaller of two bones in the lower leg).
The cause is generally that the muscle has become too big for the sheath that protects and surrounds it.  ACS  Anterior Compartment Syndrome can be acute or chronic the large muscle on outside of shin "tibialis anterior" becomes too big (swelling/stressed) for the sheath and the main movement of the muscle that of assisting foot upwards and outwards (dorsiflexion and eversion) becomes painful and restricted especially when running "foot may feel flat and a slap like sansation experienced when foot hits surface"   Indications of ACS include intensive pain and discomfort on outside of shin bone lower leg muscle.  When pulling foot upwards especially against resistance weakness is experienced.  Swelling and tenderness of calf muscle area, pain when foot toes are directed downwards and calf muscle group is stretched out.
What are the signs of fracture!
Sudden pain and swelling in lower leg (outer area) with loss of leg function and inability to place weight on leg.  Lump, bump can be felt (deformity will be present).

Fibula fracture (stress fracture). The Fibula is the smaller of the two shin bones, on the outer part of the lower leg. It can be felt as the bony lump on the outside of the ankle this is the most common area for a fracture to occur (malleolus bony part of ankle). Note that a broken bone is the same as a fractured bone. A fracture may be full, partial or hairline, but are all referred to as a fracture.
A Traumatic fracture of the Fibula occurs when the ankle is sprained or impact felt on outside lower leg and part of the bone is pulled away with the ligament “avulsion fracture”.
Achilles Tendonitis comes in two flavour’s acute and chronic;
Acute
Is a gradual onset of achilles pain that develops over days or even hours after exercise at the back of the ankle, stretching above the heel bone.   Pain may diminish upon activity/exercise and rest over days the symptoms often fade, until next training session or heavy activity and is then very tender to touch.
Chronic achilles tendonitis may follow on from acute tendonitis if it goes untreated or is not allowed sufficient rest.
Chronic
A gradual build-up of pain in achilles over a period of weeks, or even months. Pain is experienced while exercising and is constant especially when going uphill or up stair case.  Stiffens up overnight, swelling, lumps and bumps soon appear and very painful on touch, heat and redness appear. A click sound may be experienced when moving ankle or running fingers over achilles.
It is estimated that achilles tendonitis accounts for 11% of all running injuries. The Achilles tendon is the large tendon at the back of the ankle. It connects the large calf muscles (Gastrocnemius and Soleus) to the heel bone (calcaneus) and provides the power in the push off phase of the gait cycle (walking and running).
Achilles tendonitis is now being referred to as achilles tendinopathy because it is no longer thought to be an inflammatory condition. The main finding is usually degenerated tissue with a loss of normal fibre structure.

Achilles tendonitis can be either acute, meaning occurring over a period of a few days, following an increase in training, or chronic which occurs over a longer period of time. In addition to being either chronic or acute, the condition can also be either at the attachment point to the heel or in the mid-portion of the tendon (typically around 4cm above the heel). Healing of the achilles tendon is often slow, due to its poor blood supply.  Achilles tendonitis is an overuse injury. Too much too soon (hit the running track without adequate preparation is a classic cause). There other factors that can contribute to developing the condition;
Increase in activity (distance, speed or hills). Inadequate recovery and repair change of footwear or training surface or weak calf muscles.
Decreased range of motion at the ankle joint, usually cause by tight calf muscles.
Running up hills - the achilles tendon has to stretch more than normal on every stride. This is fine for a while but will mean the tendon will fatigue sooner than normal.
Overpronation = feet which roll in when running can place an increased strain on the achilles tendon. As the foot rolls in (flattens) the lower leg also rotates inwards which places twisting stresses on the tendon.
Wearing high heels constantly shortens the tendon and calf muscles. When exercising in flat running shoes, the tendon is stretched beyond its normal range which places an 'abnormal' strain on the tendon.
Caused by excessive friction, such as use of heel tabs, or wearing of shoes that are too tight or too large.  Stiff boots, ice skates, cricket and or bowling shoes can have this effect;  friction, and the pressure can be relieved by widening the heel area "cutting tab"
Potential caused be result of ankle inversion or secondary to overuse injury.  Running on cambered surface, pronation of foot, tight muscles located in calf (most commonly soleus), result of excessive load on the lateral muscles.  Common Sport Injury for Dancers, Basket Ball and Volleyball players.  The Peroneus longus and brevis tendons cross the ankle within a fibros tunnel and share the same tendon sheath at the near the fibula, after which running up the leg they hve their own tendon.  
treatment
Initially rest and stop sports activity especially if runner.  Ice 3 to 4 times day for upto 10 minutes at time, sports tape can be applied and the use of compression socks is benificial and will help relieve inflammation.
Treatment
What can you do?
Applying R.I.C.E. (Rest, Ice, Compression, Elevation) is essential.
Cold therapy should be applied as soon as possible to help to quickly stop any internal bleeding.
Use a compression bandage or sleeve.
See a sports injury professional who can advise on treatment and rehabilitation.
Wear a heel pad to raise the heel and shorten the calf muscle hence taking some of the strain off it. It is a good idea to put heel pads in both shoes or one leg will be longer than the other creating an imbalance and possibly leading to other injuries including back injuries.  Sports injury specialist will:
Prescribe anti-inflammatory medication (beneficial in the first few days after the injury).
Use ultrasound treatment.
Sports massage applied to calf muscles after the initial acute phase.
Follow suitable rehabilitation and exercise program.
Once the initial healing has taken place it is essential the lower leg is fully strengthened in order to reduce the likelihood of re-injury or adverse effect on future performances.

Treatment during the initial/acute stage include the following;  RICE = Rest, Ice 10 to 15 minutes every 2 hours up to 3 times a day, Compression sleeve/bandage/ankle support, Elevation gravity to reduce bleeding and swelling.  Following the RICE process and initial 24 hours of rest it is now important to introduce range of motion exercises.
Treatment during the initial/acute stage include the following;  RICE = Rest, Ice 10 to 15 minutes every 2 hours up to 3 times a day, Compression sleeve/bandage/ankle support, Elevation gravity to reduce bleeding and swelling.  Massage therapy to generate new blood supply and nutrients to area.  Biomechanical correction (orthotics may be prescibed).  Analysis of running gait, shoes and training regime may provide solution to correction.
R.I.C.E and rest.  Try heel pads to raise the heel and take some of the strain off the achilles tendon. This should only be a temporary measure while the achilles tendon is healing.
Have running/training shoes checked for your gait and foot type. Seek a good sports injury professional who can advise on treatment and rehabilitation plan.

What can a Sports Therapist do?
Scan with an MRI or Ultrasound, identify the causes and prescribe orthotics or a change in training methods.  Use sports massage techniques.  Create rehabilitation program for you.
surgery may be performed if conservative treatment fails.
If you look after this injury early enough you should make a good recovery. It is important you rehabilitate the tendon properly after it has recovered or the injury will return. If you ignore the early warning signs and do not look after this injury then it may become chronic which is very difficult to treat.
First action is to reduce pain, follow RICE protocal and Stop activity.  Soft tissue therapy is recommended, stretching and mobilisation joints in foot and  muscles and tendons within area.  Footwear assessed, replaced and or heel wedges used to elevate symptoms.  
exercises
Shin raises will help strengthen lower legs "standing flat against wall, keeping your heels in place while you raise and lower your toes 3 sets of 15 holding for 3 seconds while toes are raised.
ROM range of motion exercises such as simple rotation of ankle;  moving up/down left/right.  Then it is critical to break down any scar tissue and generate new blood supply and nutrients to area.  Stretching and soft tissue massage of the lower leg area, calf, ankle and foot.  The use of wobble boardalong with the gradual introduction of non weight bearing exercise then progression to weight bearing to build strength should be followed over next 4 to 6 weeks.
Building strength, flexibility and improving range of motion are important once cause and solution found. A good sports therapist will provide corrective exercises.  A wobble board and various calf muscle stretches and mixture of non and weight bearing would be included over time.
In all cases of suspected fracture you must seek medical treatment (A&E) for the lower leg to be X-rayed.
If fracture present a cast for up to 8 weeks will be required with rest and non-weight bearing advised to help repair bone.  In more complicated cases when damage is sever the use of screws and plates may be used.
Eversion and plantaflexion  exercises non weight and weight beering and resisted should be introduced.
Copyright 2012 - Releaf