Category Archives: Leg

common running injuries

Common Running Injuries

- Blog, Leg, Sports and Fitness

Physical therapy for runners
Running can be great for your health, but if an injury occurs never be afraid to seek help. The best treatment for injuries for runners is early management and education on self-care specific to the injury. We’ve compiled a list of common running injuries below. If you are experiencing lasting pain that affects your ability to complete your run or activities throughout your day, don’t modify your behavior – talk to your physical therapist.

IT (Iliotibial) Band Syndrome

  • Common Causes: Improper footwear, Increasing mileage and/or intensity too quickly are all things that lead to common running injuries
  • Symptoms: Usually occurs after a short period of running with sharp pain on the outside of the knee

For more information click here

Piriformis Syndrome

  • Common Causes: Increasing mileage and/or intensity too quickly, Poor running mechanics, Usually associated with weak hips and core can lead to common running injuries.
  • Symptoms: Local pain and tightness in the buttock with possible tingling or numbness down the back of the leg. Most noted during prolonged sitting.

Shin Splints

  • Common Causes: Improper footwear, Lack of flexibility in calves, running on hard surfaces can also lead to common running injuries.
  • Symptoms: Throbbing or aching pain along the front of the shin. Usually occurs during and/or following a prolonged run or walk.

For more information click here

Plantar Fasciitis

  • Common Causes: Improper footwear, Change in running surface, Calf tightness, increasing mileage and/or intensity too quickly can lead to common running injuries.
  • Symptoms: Deep ache and/or sharp pain in the bottom of the heel. Most commonly felt in the morning or following prolonged sitting

For more information click here

Runner’s Knee

  • Common Causes: Increasing mileage and/or intensity too quickly, Poor running mechanics lead to common running injuries.
  • Symptoms: Swelling, Aching pain behind and/ or around the kneecap, pain walking up and/or downstairs.

Achilles Tendinitis

  • Common Causes: Improper footwear, Increasing mileage and/or intensity too quickly lead to common running injuries.
  • Symptoms: Swelling, painful to the touch, lack of flexibility along the back of the lower leg close to the heel.

For more information click here

 

shin splints

7 Ways Physical Therapists Treat Shin Splints

- Blog, Leg, Sports and Fitness

Ways physical therapists treat shin splints.

Here are 7 ways a physical therapist can help treat pain and symptoms associated with shin splints:

Pain Reduction: The RICE principle is the first step to recovery (rest, ice, compression, and elevation). Manual therapy and Kinesiotaping may also speed up recovery and reduce swelling.

Gait and Footwear Analysis: An analysis of how a person walks and runs is an important part of treatment. The wrong mechanism of walking can transmit a great deal of force through the shin to the knee and hip. In such situations, physical therapists will correct gait patterns and recommend footwear with shock-absorbing capacity.

Muscle Stretches and Strengthening: The tibial and peroneal muscles are attached to the shin and must be stretched adequately before any form of exercise. Physical therapy includes various stretches of the foot that will help stretch and warm up these muscles. Strengthening damaged muscles can also help.

 Activity Modification:  Physical therapists may suggest alternative activities to minimize stress on the shinbones. These can include swimming and cycling.

Increase Range of Motion (ROM): Exercises for the hip, knee, ankle, and foot improve blood circulation, reduce inflammation and relieve pain. A home exercise program may also be implemented.

Arch Support:  The absence or collapse of a normal foot arch can lead to shin splints. Physical therapists will recommend appropriate orthotics that can be custom-made for the patient and provide the proper amount of arch support.

Return to Sport: If you are an athlete, your therapist may tailor exercises that are specific to strengthening the areas needed to perform your sport. Modified use of your muscles may also be discussed and implemented. Return to your sport may be gradual to prevent re-injury.

To learn more about shin splints please visit our PTandMe injury center on this website by clicking here.

Physical Therapy Appointment

walking zombies

How Much Walking Can Zombies Do?

- Blog, General Information, Leg

walking zombies

As Halloween approaches it’s hard not to consider our monster what-if’s. So we just decided to go with it and take a look at just how far our limbs can carry us without sustaining injury, assuming they weren’t eaten during the unfortunate event that caused us to turn into zombies in the first place. Zombies quite frankly do a lot of walking; most of it is rather aimless but all in all they seem to cover quite a bit of distance. If we were doomed to spend eternity in a constant state of walk/run/hobble we would likely find that zombies might experience many of the same injuries that our fellow runners face.  Here’s a few that we came up with.

IT (Iliotibial) Band Syndrome is caused by improper footwear and the increasing of mileage and/or intensity too quickly. Symptoms manifest after a short period of running with a sharp pain on the outside of the knee.

Piriformis Syndrome is commonly caused by increase in mileage and/or intensity, and poor running mechanics associated with weak hips and core. The symptoms include local pain and tightness in the buttocks with possible tingling or numbness down the back of the leg.

Shin Splints, caused by improper footwear, lack of flexibility in the calves and running on hard surfaces, they cause a throbbing or aching pain along the front of the shin usually occurring during or following a prolonged walk or run.

Runner’s Knee, caused by increasing distance and/or as well as poor running mechanics. It’s symptoms include swelling and aching pain behind and/or around the kneecap and pain walking up and down stairs.

Now, how do we combat these injuries?

Always begin activity with a light warm up 10 minutes spent following that light rustle in the woods would serve you better than an all-out sprint towards your next unsuspecting victim

Stretch, reaching overhead to get the foot on the ledge or bending down to get to the snack hiding under the car

Rest, when that same snack locks you in a closet just go with it you could use the break.

And lastly shoes. Proper footwear is essential so let’s hope that you weren’t turned on flip flop day or in those 6 inch heels.

But in all seriousness whether you are a runner, walker, pro, novice, or zombie you never have to live in pain. Don’t be afraid to seek help if injury occurs, the best treatment for an injury is early management and education.

 

Isokinetic Devices

Isokinetic Devices for the 21st Century Therapist

- Blog, Leg

Isokinetic Devices

Isokinetic devices have had their time in the spotlight of the rehab world. Like an actor past his prime, these monstrous machines mostly sit in dark lonely corners collecting dust. Some get used regularly but only as a place for sitting and storing odds and ends. However, companies such as CSMi (Computer Sports Medicine Inc.) among others have revived this once proud and prominent piece of equipment and have applied modern technology and rehab principles to bring about a new golden age of isokinetic devices and rehab.

Historically, isokinetics was introduced in the late 1970s and hit it’s stride in the 1980s through the 90s. Various protocols were created in this time and have been researched extensively creating the body of knowledge we now have. Unfortunately, isokinetics lost favor as healthcare laws changed and the industry started the search for more low-cost treatment regimens.

ISOKINETIC DEVICES TESTING
There are now fewer therapists who know how to use the equipment and most that do are unaware of the improvements that have been made over the last twenty years. Historically, joints are measured at two or three varying speeds but only in the concentric mode of contraction. While this is still the gold standard of testing, it fails to assess the all important eccentric mode of contraction. Recently, CSMi introduced the interrupted stoke test on their machine, the Humac Norm, which allows the therapist to separate concentric and eccentric modes. Our muscles function as eccentric controllers of motion and the ability to test this provides us with a better view into the muscle’s strength and function.

There are other testing modes available as not all patients are appropriate for isokinetic testing. Isometric testing is something all therapists use daily in the form of manual muscle testing(MMT). However, this is not a precise measurement and can vary between therapists. Testing a patient isometrically on a machine is a safe, effective and precise test for your older, untrained and post-surgical patients. It provides an exact amount of torque as compared to the MMT 5-point system. Additionally, proprioception can be assessed for either velocity or joint position matching.

TREATMENT
In addition to testing, isokinetic devices offer various treatment modes are where these machines show their true capability. Continuous Passive Motion can be utilized for regaining range of motion, reducing swelling and pain, reducing apprehension and muscle guarding and regaining musculotendonous mobility.

Active Assisted Programs can be utilized to regain end-range motion and multi-angle isometrics can be utilized to increase joint stability and neuromuscular control within the entire available range of motion. Also, proprioception training can be utilized to enhance positional and motion control.

Strength training with eccentric loading allows for targeted strengthening by isolating the eccentric beginning in slower speeds and progressing into deceleration training to mimic plyometric loading.

Isotonic strengthening programs are available for various purposes. One is power training which is utilized to increase concentric explosiveness. Another is used to prepare patients for an independent gym program. Finally, dynamic isotonic control training includes the ability to load the concentric and eccentric motions at different torques and utilizes games and other programs as visual feedback to the patient.

ARGUMENTS AGAINST ISOKINETICS
One argument against isokinetics concerns patellofemoral, post-op ACL and knee osteoarthritis patients. Open chain knee extension has been labeled public enemy number one for these patients and while this has been examined extensively, steps such as limiting the range of motion, using anti-shear devices and techniques, altering patient positioning and matching the appropriate treatments to the patient reduces shearing and compression, improves safety and ultimately debunks this myth.

Now, I know that critics of isokinetics will also argue that isolating muscles is not functional. That would be true if a therapist utilized these machines as the sole treatment. But by incorporating it into an eclectic approach, patient outcomes are maximized. Your lower extremity patients will still perform scapular and thoracic control exercises and you will still strengthen the core. Soft tissue work and joint mobilization will still be needed and functional training must still occur. However, if one link in the chain is weak, the entire chain will fail. Utilizing these machines throughout the course of rehab to find and isolate those weak links is what will take your patient’s recovery of function to the next level. This is true for all of your extremity patients, nit just knees. Remember, a functional movement cannot occur with a dysfunctional or unbalanced segment.

This information was written by Daniel Bodkin, PT, DPT, ATC – STAR Physical Therapy, Columbia (North), Tennessee
Established in 1997 with one clinic and one mission – to serve. Today, STAR Physical Therapy has grown to offer that direct service in more than 60 clinics, and while they’ve grown, one thing that has not changed is their commitment to you, their communities, and their employees. Their foundational mission is “To Serve.” Their commitment to the patient and physician is to provide clinicians that are “great mechanics of the human body™.” For more information click here.

lower limb amputation

Lower Limb Amputations

- Blog, Foot, Leg

LowerLimbAmputations_FBsize

The goal for every patient with a lower limb amputation is to walk normally again.
A patient with a lower limb amputation faces many challenges when it comes to walking safely in a variety of walking surfaces and without exerting excessive energy. Generally, the higher the amputation level, the more we can expect to see gait deviations or difficulty walking. This is because with each segment of the anatomy is lost to amputation, more muscle, sensory receptors and leverage are also lost. A Physical Therapy treatment program can be designed to assist a patient return to a “normal” walking pattern in terms of posture, step length, stability, balance, rate of speed, and limb positioning.

GAIT TRAINING
Almost all patients with a lower limb amputation will benefit from physical therapy and gait training at some point in their recovery to help them return to a more normal walking pattern. Pre-amputation exercises will assist the patient in arm and leg strengthening to help them prepare for using a walker during gait training with their prosthesis. After amputation surgery a prosthetist will work with the patient to fabricate and align a prosthesis to assure that it will optimize the patients walking pattern.

WHAT TO EXPECT DURING PHYSICAL THERAPY

  • The physical therapist will typically work with the patient 3 days per week

  • The physical therapist and prosthetest will remain in close communication with gait training is occurring since any changes in the prosthesis will affect the gait pattern

  • Initially physical therapy is focused on standing and walking with enough stability to ensure safety (this initial gait training is performed in parallel bars with the assistance of the physical therapist holding the patient with a gait belt for additional safety)

  • Initial gait training is supplemented with strength and flexibility exercises for the legs and trunk muscles since strong trunk and leg muscles make it easier to progress the patient’s gait training

  • The physical therapist will also work with the patient to improve balance and coordination to help the patient develop a more normal step length and walking speed

Physical therapists use many different techniques during gait training sessions

leg amputee

LEARNING HOW TO WALK AGAIN
Specialized Treatment Techniques

  • SPLINTER SKILLS: Technique where the walking pattern is broken down into a sequence of events that are practiced individually before putting them all together to build the walking pattern
  • WHOLE WALKING: Technique in which the entire gait pattern is performed all at one time without thinking about the individual components of walking therefore relying on the body’s natural tendency to find the most stable and energy efficient way to walk

BUILDING CONFIDENCE
Once the patient feels confident and the physical therapist believes that it is safe, a walker can be used instead of the parallel bars. When using a walker, the focus will change to helping the patient walk on uneven surfaces such as outdoors and walking around obstacles or stepping up and down stairs.

Even patients who have walked with a prosthesis for years can benefit from gait training for a “tune up” of their walking skills or to learn a new skill such as side stepping, tandem walking or even running.

Plantar Fasciitis

Hamstring Tightness and Plantar Fasciitis

- Blog, Foot, Leg

Hamstring Tightness_FBsize

Plantar fasciitis is classically characterized by pain in the central to medial plantar heel. It is thought to be caused by chronic inflammation of the plantar fascia due to repetitive strain and trauma to the fascia. There are many other purported causes including, calcaneal spurs and increased intraosseous calcaneal pressure, among others. Many studies have shown inflammatory and histological changes at the origin of the plantar fascia and surrounding structures that are consistent with repetitive strain and degenerative changes including a thickening of the fascia.

Biomechanics has long been looked at when investigating possible causes of injuries. Alteration of the load-bearing characteristics of the foot has been suggested by several studies to be the underlying problem in plantar fasciitis. Microtears and chronic degenerative changes result from the increased tensile stress placed on the fascia due to the changes in biomechanics. Muscle tightness is one factor that can lead to changes in gait mechanics and load bearing of the foot. Hamstring tightness has recently been investigated as a factor in plantar fasciitis and has been shown to induce prolonged forefoot loading due to increased knee flexion during gait. A rapid progression through the contact phase of gait results from increased knee flexion and in turn increases forefoot pressure. The fascia is a fixed-length ligament, so an increase in forefoot pressure results in increased tension at its insertion on the calcaneus. The increased time spent on the forefoot in gait leads to a chronic traction injury that is localized to the hindfoot insertion of the fascia; which is consistent with the symptoms of heel pain.

plantar

Biomechanical deficits have long contributed to injuries. Only recently has hamstring tightness been shown to have an effect on plantar fasciitis. Hamstring tightness affects every step, resulting in a biomechanical deficit which may contribute to a tensile overload of the plantar fasciitis. Recent studies suggest that all patients with plantar fasciitis should be evaluated for hamstring tightness. Physical therapy treatment for plantar fasciitis should include hamstring stretching.

More information about Plantar Fasciitis can be found in the PTandMe injury center.

physical therapy near me

This information was written by Plymouth Physical Therapy Specialists. They are committed to using evidence-based treatments in their practice. This means that their therapists utilize the most current and clinically relevant treatments in their approach to rehabilitation. For more information click here.

Gait Analysis

Keeping Pace – The Value of a Gait Analysis

- Blog, Leg, Sports and Fitness

Gait Analysis

As the warmer weather comes to an end we may just now be seeing the emphatic group of athletes who push their bodies to the limits. Some push too hard and too fast while others endure countless episodes of micro-injury that slowly breaks down their system.  You guessed it – Runners.

For those of us in the medical profession that have the pleasure of working with the running population, we know that they can sometimes be the most challenging group to work with.  That being said they also provide us an opportunity to play a tole in preserving a very important piece of their quality of life. Whether it’s a novice runner who just “got the bug” or an experienced runner who knows of nothing else but to run, they all have something in common: recognizing what they are doing to their body!

In the orthopedic community we see mostly micro-trauma and repetitive use injuries in the form of tendinitis, bursitis, muscle strains and joint pain. During the running season we do our best to control the situation by advising rest, stretching, ice, etc; but what else can we do when eliminating the source of trauma is not a plausible answer? One solution is to speak  their language. How do you run? Running is natural, we just learn how to do it and most runners have never been coached how to run properly, Even very efficient runners can have biomechanical faults that lead to increased stress in any one area. A good rehab program would consist of:

  • Symptom management
  • Education of proper stretches, modifications to footwear, strengthening (including core)
  • Advice on what to do the next time they are injured

Often overlooked is the form they take when running. There is bountiful information to by learned by watching the way someone moves. A single flaw in running mechanics is magnified a thousand times with each foot strike. If we can’t stop someone from invoking trauma to their body, we can teach our runners how to make it less traumatic in the first place.

This is where a video gait analysis comes in handy. A video gait analysis enables us to zoom in on targeted areas and see what is actually going on at various joints. With plenty of normative data and efficient runners for comparison, physical therapist can provide different perspectives for patients.  By slowing down a sequence of strides frame by frame we can not only focus on several links in the chain at once, but we can show runners exactly how their actions are impacting their body. We can also show them targeted angles and body positions which shows runners a side of themselves they are unable to see otherwise.

Formulating a productive plan of care in rehabilitation can now include very specific exercises and technique modification. When added to traditional treatments of common running injuries the overall outcome is enhanced and often more timely. If you are running in pain – ask your physical therapist for a video gait analysis.

Written by the therapists at Plymouth Physical Therapy Specialists.