Lower leg rehabilitation

Question 1

What are some common lower leg injuries?

Answer 1

• Shin splints
• Gastrocnemius strain
• Medial tibial stress syndrome
• Superior tib/fib sprain
• Peroneal strain
• Peroneal tendon subluxation
• Compartment syndrome

Question 2

What are some common methods of injury?

Answer 2

• Impact (ground reaction forces)
• Overstretch
• Eccentric loading
• Traumatic

Question 3

What are the symptomatic phases of gait?

Answer 3

• Toe off
• Midstance
• Heel strike

Question 4

What are some ways to protect the calcaneus from heel impact?

Answer 4

• Adjust the surfaces
• Cushion footwear
• Shock absorbing insoles
• Heel pads

Question 5

When are the dorsiflexors under eccentric load the most?

Answer 5

Downhill running

Question 6

When are the plantar flexors under eccentric load the most?

Answer 6

• Uphill running

- Forefoot running

Question 7

What are some causes of shin splints?

Answer 7

• Interosseous membrane inflammation
• Pereosteal pain (tibia/fibula)
• Stress fractures
• Acute myositis (dorsiflexors)
• Tendinitis (dorsiflexors)
• Anterior/posterior compartment syndrome

Question 8

What are some common contributing factors to lower leg injuries?

Answer 8

• Muscle imbalances
• Inflexibility: gastrocs/solues
• Biomechanics: foot pronation/supination, trendelenberg

Question 9

What are some examples of strengthening exercises?

Answer 9

• Heel raises
• Straight knee: gastrocs
• Bent knee: soleus
• Heel walks: dorsiflexors
• Toe walks: gastrocs/soleus
• Downhill walks: dorsiflexors (eccentric)

Question 10

What are some different joint mobilizations that can be done?

Answer 10

• Superior tib/fib joint: anterior/posterior, superior
• Talocrural joint: anterior/posterior, traction
• Sub talar joint: medial/lateral, traction

Question 11

What is pes planus?

Answer 11

Pronation of the foot

Question 12

What is pes cavus?

Answer 12

Supination of the foot

Question 13

What is pes equinus?

Answer 13

Achilles tightness

Question 14

What are some important characteristics that footwear should have?

Answer 14

• Rocker action
• Foot support
• Shock absorption
• Stability

Question 15

What are some ways to treat achilles tendonitis?

Answer 15

• Control inflammation
• Control stress: heel lift
• Manage chronic fibrosis: friction massage
• Increase flexibility: wedge board
• Increase strength
• Increase tensile strength: eccentric training
• Sport specific
• Biomechanics

Question 16

What is the Alfredson’s protocol of achilles tendinopathy?

Answer 16

• 2X/day, 7 days/week, 12 weeks
• Knee extended and flexed
• 3 sets X 15 reps of each
• Muscle soreness during the first 1-2 weeks should be expected

Question 17

What are the steps of the Alfredson’s protocol?

Answer 17

• Body weight in injured side (in plantar flexion)
• Lower heel beneath forefoot
• Only load eccentrically
• Use non-injured leg to get back to the starting position
• Continue even if there is pain (to a certain point)

Question 18

What are the parameters for the achilles drop stop program?

Answer 18

• 3 set X 20 resp
• Both legs, slow drops, 7 days
• Both legs, quick drops, 7 days
• Single legs, slow drops, 7 days
• Single legs, quick drops, 7 days

Question 19

What are some ways to treat anterior compartment syndrome?

Answer 19

• Control swelling and pain: rest
• Increase dorsiflexion flexibility: kneeling plantar flexion
• Increase plantar flexion flexibility: wedge board
• Address biomechanics: pronation
• Surgery may be required: fasciotomy

Question 20

What is medial tibial stress syndrome?

Answer 20

Periosteal pain along the medial tibia

Question 21

What are some causes of medial tibial stress syndrome?

Answer 21

• Biomechanical: pronation
• Overuse
• Footwear
• Running surface

Question 22

What are some ways to treat medial tibial stress syndrome?

Answer 22

• Control pain
• Control inflammation
• Decrease the stress
• Increase flexibility
• Strength
• Proprioception
• Progressive return to activity