Achilles Tendinitis

• Overuse injury Care:•Increase flexibility•Gradual progression•Orthotics/heel lift•Foot mechanics

Shin Splints

• Posterior or Anterior• Cause

– Repetitive stress– Rapid increase in

training– Weak tibialis anterior

• S/S– Pain/ache– Gradual increase

• Care– PIER– Achilles, Tib Post/Tib Ant

stretching– Taping– Gradual return

The Knee

The Knee Joint – AnteriorThe Knee Joint – Anterior

Patella

Medial (Tibial) collateral ligament

Patellar ligament

Tibial tuberosity

Tibia

Quadriceps tendon

Fibula

The Knee Joint Anterior (deep)The Knee Joint Anterior (deep)

Femur

Lateral (Fibular) collateral ligament removed

Medial (Tibial) collateral ligament removed

Lateral Meniscus

Tibial Tuberosity

Fibula

Lateral Condyle Medial Condyle

Medial Meniscus

Tibia

Posterior cruciate ligament

Anterior cruciate ligament

The Knee Joint – PosteriorThe Knee Joint – Posterior

Femur

Adductor magnus tendon

Medial head of gastrocnemius tendon

Semimembranosus tendon

Medial (Tibial) collateral ligament

Lateral (Fibular) collateral ligament

Fibular head

Lateral head of gastrocnemius tendon

Oblique popliteal ligament

Fibula

Tibia

The Knee Joint – Posterior (deep)The Knee Joint – Posterior (deep)

Anterior cruciate ligament

Popliteal tendon

Lateral meniscus

Lateral (Fibular) collateral ligament

Medial (Tibial) collateral ligament

Medial meniscus

Posterior cruciate

Femur

Fibula

Tibia

Posterior meniscofemoral ligament

MCL Sprain• Most common acute

knee injury• Mechanism:

– Valgus force– Weak VMO’s, weak

proprioception

• S/S– Loss of stability (test)– Swelling (wipe test)– Pain on palpation

• Care:– PIERS– Brace/tape up to a year– Surgery infrequent

• LCL Sprains

ACL Sprain

• Weak hamstrings, hip ER, squatting with a knee valgus motion

• Many mechanisms• S/S

– Pop, “dislocated”, anterior drawer test, swelling

ACL Sprain Care

• PIER• Crutches• Brace for 1 year-career• Surgery**• Proprioception training

• PCL Sprains

http://www.youtube.com/watch?v=q96M0jRqn7k

Meniscus Tears

• Alone or paired with ACL/MCL tears• Rotational force while weight bearing (meniscus

is squeezed between tibia and femur)• S/S

– Locking at 10 degrees of flexion– Clicking– Pain

• Treatment:– Surgery

Chronic Knee Injuries

• Patella Femoral Syndrome– Uneven tracking of patella– Weak hip LR, tight ITB, weak VMO’s– Crepitus, pain, pain on stairs/squatting– PIER, fix cause, taping to correct tracking

ITB Syndrome (Runner’s Knee)

– Tight ITB, pronated foot

– Point tenderness, pain during flexion

– PIERS, ITB treatment, correct imbalances, reduce distances

Patellar Tendinitis“Jumper’s Knee”

• Frequent jumping, repeated stress • Pain between patella and insertion• Treatment:

– PIER– Strap– stretch (quads) and strengthen

22

Common Strains

Quadriceps Adductors Hip flexors Hamstrings Rotator cuffs

23

Hamstring Strains

• Most frequently strained muscles• Mechanism:

– Rapid contraction in a lengthened position– E.g. sprinting and running

• Due to strength imbalance– Hamstring strength < quadriceps strength

Emphasize hamstrings and quadriceps equally

Using the handout and “Blue” Textbook:

• For each of the following, describe the:– Mechanism– S/S– Treatment

• Lateral Epicondylitis (p183)• SC Joint Sprain• AC Joint Sprain• Glenohumeral joint dislocation

Chiropractor vs Physiotherapist

• Compare chiropractors and physiotherapists (page 193 and page 194)

Physiotherapy Modalities