In analyzing ones gait, first contact is on the heel and outside of the foot;
followed by a shift of body weight continuing forward toward the arch and
toes.
If the foot is weak or tired and/or the footwear is not supportive, then
the arch can flatten more than normal, which is excessive pronation.
Flattening of the arch (excessive pronation) places pressure on the arch
and stretches the plantar fascia (which supports the arch) and can create
inflammation at the attachment on the heel.
This repetitive, excessive pronation, is the main contributor to many lower
extremity, overuse injuries. As the achilles tendon attaches on the back
of the heel, and if the the foot is in excessive pronation, there is an increased
torque or pull on the tendon, which can cause inflammation.
- Tight calf muscles ( the gastroc and/or soleus) and tight achilles tendon.
- Often with increasing age, there is decreasing flexibilityIncreasing the amount or intensity of training ? uphill running, or stair
climbing
- Flat pronated feet add stress to the soleus and rigid, high arched feet add
stress to the gastroc
- Poor support on the inside of a shoe or in the shoe?s foundation/upper can
add to the stress on the foot ? thus increasing calf stress
- Change in the heel height of one?s shoes (from training shoes to racing flats,
heels to flats etc.)
TREATMENT - ADVICE GIVEN MOST OFTEN IN CURRENT LITERATURE
The 3 S's Stretching, Strengthening, and Supporting, along with ICE and REST
have been found to be the simplest and most effective treatment for these
injuries.
Stretching of the calf (both gastroc and soleus) muscles and Achilles tendon
can help eliminate or prevent many problems with the achilles tendon.
Strengthening of the calf muscles once the inflammation is gone, can help
prevent further injury.
Avoid hill or stair running until symptoms disappear.
Supporting the foot with the proper shoes and insoles, can prevent or eliminate
the vast majority of increased stresses on the lower extremity.
Make sure that the heel collar does not dig into the achilles. Look for a
cut out of the heel (heel notch)
Runner's Knee
SYMPTOMS
- Pain
Along the medial (inner) aspect of the kneecap or just below the kneecap
- More pronounced when using stairs or going up/down hills
- Worse after prolonged sitting with the knees bent
- More of a dull ache
- Cracking or grating in the knee
- Eventually, knee may want to "catch" and may feel like it wants to give out
DEFINITION
Softening of the cartilage on the patella (kneecap).
Roughening of the cartilage under the patella caused by the kneecap not tracking
properly (patella does not glide smoothly over the femur/thigh bone).
May also be referred to as Chondromalacia Patella.
One of the most common knee problems in running and other sports (may occur
at any age).
PRIMARY CAUSES
Excessive Pronation -
Pronation is a normal movement of the foot, that allows the arch to flatten
to a degree, which helps the body to absorb shock and adapt to different
ground surfaces.
In analyzing ones gait, first contact is on the heel and outside of the foot,
followed by a shift of body weight forward, toward the arch and toes.
If the foot is weak or tired and/or the footwear is not supportive, then
the arch can flatten more than normal, which is excessive pronation.
Flattening of the arch (excessive pronation) increases stresses on the foot,
which can further contribute to ankle, knee, hip and low back problems (a
chain reaction).
This repetitive, excessive pronation, is the main contributor to many lower
extremity, overuse injuries
CONTRIBUTING FACTORS
- Mechanical conditions including wide hips (females) knock knees, patella
alta (high patella) and subluxating patella.
- Over pronation of the foot.
- Weakness of the quad, especially the VMO (Vastus Medialis Oblique Muscle)
which runs along the inner aspect of the thigh and connects at the knee
- Overuse, or an increase in hill running or stair use
- Too large of a Q-angle at the knee (this is the angle of quad muscleęs effective
pull on the kneecap) Less than 12 degrees is normal and greater than 15 degrees
is abnormal
TREATMENT - ADVICE GIVEN MOST OFTEN IN CURRENT LITERATURE
The 3 S's
- Supporting, Stretching, and Strengthening, along with ICE and
REST, have been found to be the simplest and most effective for these injuries.
Supporting the foot with proper shoes and insoles, can prevent or help to
eliminate the vast majority of lower extremity problems due to faulty biomechanics.
One of the easiest and most effective solutions is to add a simple over the
counter insole that provides a forgiving support for both the arch and heel.
Stretching of the hamstring, quad, calf and IT Band with help to decrease
pressure at the kneecap.
Strengthening of the quad, especially the VMO (vastus medialis oblique muscle)
will help the kneecap to glide more correctly through the groove at the knee
joint.
Avoid downhill running or going up/down stairs.
Avoid exercises done with the knee bent unless being done as an isometric
Physical Therapy including exercise, ultrasound, iontophoresis and patellar
mobilization
Shin Splints
SYMPTOMS
- Aching along front of shin, at beginning of or after activity
- Pain along inside (medial) part of lower leg
- Generally develops gradually over weeks or months
- May have swelling in lower leg (in area of pain)
DEFINITIONS
Shin Splints -
Common, umbrella term used to identify pain along the shin or front of lower
leg.
More specific names for this condition are based on the area of the pain
and the anatomy involved (see below). Injury generally occurs as a result of overuse
Stress Fracture - posterior
Most often occurring on the tibia (shin bone) and along the bottom third
of the lower leg.
Often undetectable on x-ray until 10-14 days after pain starts.
Compartment Syndrome - anterior or posterior
The four divisions of muscles in the lower leg (anterior, lateral, posterior-superficial
and deep) are each covered by thick tissue called fascia that surround the
muscles completely.
During exercise, muscle volume increases by 20%, increasing pressure within
each compartment. Such pressure can affect blood vessels and nerves in the
lower leg potentially causing pain and damage to tissue and nerves.
Tibial Periostitis - posterior
An inflammation of or trauma to the covering of the bone in shin (periostium).
Over-exertion causes small tears of the muscle from the covering of the bone
(periostium).
Pain is most pronounced in the lower 3rd of the posterior tibia.
Medial Tibial Stress Syndrome - posterior
Stress to the muscles along the front medial side of the shin
Generally occurring along the bottom third of the inside of tibia (shin)
PRIMARY CAUSE
Excessive Pronation -
Pronation is a normal movement of the foot, that allows the arch to flatten
to a degree, which helps the body to absorb and adapt to different ground
surfaces.
In analyzing ones gait, first contact is on the heel and outside of the foot;
followed by a shift of body weight continuing forward, toward the arch and
toes.
If the foot is weak or tired and/or the footwear is not supportive, then
the arch can flatten more than normal, which is excessive pronation.
Flattening of the arch (excessive pronation) places pressure on the arch
and can cause some rotation into the lower leg. This repetitive movement
can cause overuse problems from the foot to the back.
If excessive pronation occurs from lack of support, then, increased stresses
can be placed on the lower leg and contribute to overuse problems
CONTRIBUTING FACTORS
- Muscular imbalances of lower leg (calf muscles and anterior leg muscles)
- Insufficient shock absorption
- Poor Biomechanics/Improper foot positioning while running
- Worn out or inappropriate shoes (shoes should typically be replaced after
300-500 miles)
- Sudden increase in exercise or running (too much-too soon)
- Incorrect individual training plan
- Flat pronated feet
TREATMENT - ADVICE GIVEN MOST OFTEN IN LITERATURE
The 3 S's - Supporting, Stretching, and Strengthening - along with ICE and
REST have been found to be the simplest and most effective treatment for
these injuries.
Stretching of the calf ( both gastroc and soleus muscles) and achilles tendon.
Strengthening of the anterior leg muscles (that pull the foot and toes up).
Supporting the foot with proper shoes and insoles, can prevent and eliminate
the vast majority of lower leg problems due to overuse.
Physical therapy including massage, ultrasound and exercises
