The plantar fascia is a band of connective tissue on the bottom of your foot that runs from your heel, up to the front of your foot. It plays a role in providing support to the foot and acting as a shock absorber during activities. The plantar fascia is an important structure for the overall biomechanics of the foot. There are times when the plantar fascia can get irritated and inflamed, which may cause pain during daily activities. Plantar fasciitis, inflammation of the plantar fascia, is common in athletes involved in running sports. Tight calf muscles, as well as a high body mass index, have been known to predispose individuals to the development of plantar fasciitis. The onset of pain is typically gradual, and is often worse the first thing in the morning, or after prolonged walking or running. Treatment of this condition focuses on looking at and addressing any predisposing factors. Rehab exercises focus on flexibility in the gastrocnemius and soleus muscles that make up the calf, and on loosening up the tissues in the bottom of the foot, as well as strengthening the muscles in the lower leg and foot. When done consistently, stretching and strengthening have proven an effective form of treatment for this condition.
Shin splints is a general term that refers to exertional leg pain or leg pain that is brought on by activity. Anterior shin splints are related to dysfunction of structures of the anterior compartment of the leg. Medial tibial stress syndrome is the clinical phrase that refers to medial shin splints. In general, shin splints involve pain in the lower 2/3rds of the leg that is brought on by exercise. In anterior shin splints the pain is localized to the anterior compartment. In MTSS, pain is localized to the lower 2/3rds of the medial aspect of the posterior border of the tibia. Commonly this condition is brought on by prolonged activity. Other causes may include changes in foot posture, improperly fitting shoes, old shoes, large changes in activity, and large increases in activity. Pain will often decrease or go away with a decrease in activity. The best form of treatment is prevention. This can be done by allowing a greater number or longer duration of rest intervals during activity. Additionally, cross-training or completing lower impact activity can help to prevent the onset of shin splints. Other forms of treatment after the onset of the condition include a thorough stretching program that is completed before and after activity, strengthening exercises for the leg and the foot and treatment of underlying conditions that may predispose an individual to the condition. It has also shown to be beneficial to ensure you have proper fitting shoes for your foot.
Ankles sprains are a common injury in athletics and account for about 15% of overall injuries. Additionally, almost half of the athletes who sustain an ankle sprain will go on to have chronic pain and instability due to lack of proper rehab and premature return to activity. Ankle sprains most commonly occur to the lateral ligaments of the ankle. Three ligaments make up the lateral ligament complex:
- Anterior Talofibular Ligament
- Calcaneofibular Ligament
- Posterior Talofibular Ligament
The ATFL is the ligament most commonly injured during a lateral ankle sprain. The cause of lateral ankle sprains is often inversion of the plantarflexed foot or when “the foot rolls inward.” A sensation of tearing or a “pop” is commonly felt. An athlete will often feel intense pain initially, with the pain improving soon after. Most times an athlete is even able to return to practice or competition, but describes the pain as worsening over the next few hours. This occurs due to the inflammatory process of injury. The ankle will often swell up, be tender to touch, and produce pain with movement. Initial treatment focuses on protecting the sprained ankle, while helping to reduce pain and swelling. An athlete may even be provided crutches or a walking boot for the first couple of days to allow the sprain to calm down. Treatment also focuses on early mobilization of the injured ankle through range of motion exercises. Once an athlete has pain-free motion, they can progress to working on strengthening of the muscles around the ankle and improving balance before being able to return to their sport. Completing proper rehabilitation before getting back into activity can help to prevent the occurrence of chronic ankle issues.
Patellar Tendonitis, sometimes referred to as “jumper’s knee,” is the most common overuse condition that affects the knee. It is caused by overuse with playing surface potentially playing a role. It typically manifests as pain near the insertion of the tendon at the bottom of the patella (kneecap). This condition often involves an insidious onset of pain at the front of the knee that begins soon after repetitive running and jumping activities. The pain will usually go away with rest but then return with activity. There are four different classifications of tendonitis that are based on pain and the overall impact of pain. These classifications help when trying to determine the best treatment plan. Treatment is often successful with an adequate lower extremity stretching and strengthening program when done consistently.
Acute injuries to the thigh are common in athletics and represent about 10% of the overall injuries that occur in sports. The quadriceps muscles are the four muscles that make up the front of the thigh. They include:
- Rectus Femoris
- Vastus Lateralis
- Vastus Medialis
- Vastus Intermedius
Strains to the quadriceps muscle group is often an indirect mechanism that is caused by a forceful stretching of the muscle as the muscle is actively contracting. Risk factors for a quadriceps strain includes inadequate stretching and warm-up, and a muscle imbalance present. This can be prevented through the implementation of a proper stretching and warm-up protocol before activity. Muscle imbalances can be addressed during the off-season. A patient will often describe a feeling of the muscle being “pulled” and may also describe a tightening sensation. They will commonly be tender to the touch of the quadriceps muscle group. Initial treatment focuses on protecting the injured area while working to decrease pain and prevent or limit swelling. Crutches may be provided to an athlete if they have a tough time walking around. Once the pain has subsided and an athlete has full range of motion, they can progress through strengthening and sport-specific exercises before being reintroduced to their sport.
The hamstring muscle group is comprised of three different muscles:
- Biceps Femoris
These muscles act to flex or bend the knee extend the hip. While walking and running, they provide support to our knee, help to move our leg forward, and control the overall momentum during both walking and running. Injury to this muscle group is common in sports that involve explosive movements such as kicking, running, and jumping. Most commonly the injury occurs due to a lack of flexibility or the presence of a strength imbalance between the hamstrings and the quadriceps muscle groups on the same leg, or the hamstring groups on opposite legs. Additionally, improper warm-up, decreased conditioning, and general fatigue may also predispose and athlete to sustaining a hamstring strain. This injury often becomes chronic due to a lack of proper rehab and early reintroduction back into sport. It is important to properly rehabilitate following a muscle strain of the hamstrings in order to a strain from becoming a chronic condition. Rehab focuses on improving flexibility and strength, addressing any other predisposing conditions, while allowing proper time for the muscle to heal.
A groin strain is a general term that refers to an injury of the hip adductor muscles. This muscle group includes the:
- Adductor Magnus
- Adductor Longus
- Adductor Brevis
Other muscles that may be involved include the iliopsoas, rectus femoris, and the sartorius. A groin strain is often caused by a forceful stretching of the muscle while the muscle was contracting such as a change of direction or a slip of fall causing the leg to slide away from the body. A patient with often have pain over the higher portion of the muscles of the groin and thigh, possible swelling, and sometimes bruising may also be present. Initial treatment involves avoiding aggravating activities or motions. Crutches may be used initially if it is too painful to walk. Once the initial pain subsides, treatment is focused on appropriate stretching and strengthening of the muscle group before progressing back into activity. A groin spic is a wrap that may be used initially to help support and provide compression to the area, but it may even be worn when an athlete returns to their sport to help provided continued support and comfort.
Medial epicondylitis is a condition that is also referred to as golfer’s elbow. This condition is not as frequent as lateral epicondylitis. It is a condition that involves the pronator teres and the flexor carpi radialis origins at the medial aspect of the elbow. The flexor carpi ulnaris and the palmaris longus may also be involved in some cases. Medial epicondylitis is caused by repetitive trauma that results in microtears in the muscle. The repetitive trauma stems from repetitive stress or overload that is common in sports such as tennis, racquetball, squash, and throwing. The condition is typically diagnosed by pain and tenderness localized to the inside of the elbow during resisted wrist flexion and pronation. An athlete may also experience a decrease in their grip strength. Treatment is often able to be performed nonoperatively and focuses on modifying or stopping the activity that is causing pain. Additionally, strengthening and range of motion exercises are used as an effective form of treatment. Consistent completion of a stretching and strengthening program can help to ensure the condition does not become chronic.
Lateral epicondylitis is also known as tennis elbow. It is a condition in which the wrist extensor muscles become irritated and inflamed as a result of repetitive microtrauma that causes fibrosis and microtears. The muscle most commonly affected include the extensor carpi radialis brevis (ECRB). Other muscles affected can include the extensor carpi radialis longus, the extensor carpi ulnaris, and the extensor digitorum communis. The condition is caused by overuse, tightly gripping a racquet, or tightly gripping a heavy object. Raking leaves, baseball, golfing, gardening, and bowling may also result in lateral epicondylitis. An athlete will often have point tenderness at the lateral aspect of the elbow. Pain with wristed wrist extension may also result as well as a possible limit in elbow extension. Treatment is often successful with a combination of flexibility exercises and strengthening exercises. It is important to ensure consistent completion of a stretching and strengthening program to help ensure the condition does not become a chronic condition.
Shoulder impingement can be described as a condition in which the rotator cuff muscle group becomes compressed within the shoulder which limits it’s ability to work properly and then only further intensifies the condition. The condition follows a reactive progression as the development only intensifies leading to further irritation of the muscles, development of a bony spur, and even tearing of the rotator cuff tendons. The progression of shoulder impingement can be explained in three different stages:
- Edema & Inflammation
- Fibrosis & Tendinitis
- Bone Spurs & Tendon Ruptures
Secondary impingement most commonly occurs in younger athletes who participate in overhead sport activities. An athlete will complain of pain and weakness with overhead motions and even describe feelings of their arm going “dead.” The development of secondary impingement most often stems from a glenohumeral (shoulder) joint instability or scapular instability. Often treatment focused on correcting any abnormalities will lead to successful treatment of shoulder impingement. Initial goals of treatment or to reduce pain and regain motion. A program will progress from closed chain exercises to open chain exercises that help with stabilizing the scapula or working on any abnormal scapular movements. Treatment is often very successful with compliant completion of a comprehensive rehab program.