Lower Extremity Injuries and Exercise

Anatomy
 Causes of Hamstring Strain

 Inadequate warming up and poor stretching

 Muscle weakness or an imbalance in the
muscle strength within the hamstring muscles
 Muscle weakness or an imbalance between
the hamstrings and quadriceps
 Poor footwear
 Recurrent injury when the muscle hasn't
completely healed from the previous damage
Lower Extremity Injuries and Exercise

Hip : Adductor Strain

Adductor Strain
An adductor muscle strain is an acute injury to the
groin muscles on the medial aspect (inside) of the
thigh.
Although several different muscles can be injured, the
most common are the Adductor Longus, Bravis,
gracilis and Magnus.
Adductor / Groin Strain
Groin strains range from a grade 1 to a grade 3 strain and are
classified as follows:

Grade 1: A small number of muscle fibres are torn resulting in

some pain but allowing full function.

Grade 2: A significant number of muscle fibres are torn with

moderate loss of function.

Grade 3: All muscle fibres are ruptured resulting in major loss

of function.
Causes
Most commonly, Adductor strains occur during acute muscle
contraction, such as when kicking, pivoting or skating.

Factors that can predispose a patient to injury include:-

Poor groin flexibility,

Muscle weakness (especially of the groin or gluteus)
Inadequate conditioning of the groin muscles
Muscle tightness
Inappropriate training or technique
Poor biomechanics
Poor posture
Decreased fitness
Fatigue
Causes………

Inadequate warm up
Joint stiffness (particularly the lower back, hip and knee)
Poor pelvic and core stability
Inadequate rehabilitation following a previous groin injury
Neural tightness
Muscle imbalances

Risk increases with:

Sports involving acceleration such as sprinting, soccer, football,
hockey.
Sports with repeated movements such as soccer, martial arts,
and gymnastics.
Failure to warm up, stretch or be properly conditioned.
Symptoms and Preventions
Sudden onset of pain in the inner thigh.
Inability to continue activity after initial onset of pain
Patients with this condition may also experience swelling,
muscle spasm, weakness, tightness, tenderness and
bruising in the inner aspect of the thigh and groin.

Preventions
Most (but not all) strains can be avoided through proper warm up
and stretching before activity.
Stretching should include the hip, thigh and knee
If injury does occur, avoid premature return to activities.
 Management of Adductor Strain
Initial treatment includes activity modification,
which may temporarily include crutches.

 ICE Therapy and anti-inflammatory medication

are appropriate for acute muscle strains.

As symptoms improve, gentle stretching and

strengthening exercises are appropriate.
 HIP DISLOCATION
A hip dislocation occurs when the ball shaped head of the
femur (thigh bone) moves out of its socket on the pelvis.

It typically takes a major force to dislocate the hip. Car

collisions and falls from significant heights are common
causes and, as a result, other injuries like broken bones often
occur with the dislocation.

A hip dislocation is a serious medical emergency. Immediate

treatment is necessary.
 Symptoms of a Hip Dislocation

The patient will be in severe pain, unable to move the joint

at all.

The leg may appear at an awkward angle often with one leg
lying across the other.

The greater trochanter of the Femur will be prominent and

easily felt.

There will be swelling around the joint.

Knee of the injured leg will be angled toward opposite leg.

 Causes of hip dislocation
The hip joint consists of the head of the femur and the acetabulum of the
pelvis - the socket into which the ball fits.

The joint is supported by some very strong ligaments and makes the hip
joint a very stable joint. Therefore, a lot of force is required to dislocate it.

Dislocations most often occur from road traffic accidents or falls.

Hip dislocations occur more easily in children than in adults.

These occur usually from a backward force on a flexed knee, when the hip is
also flexed. Dashboard injuries are the predominant cause of this.
 Management of Hip Dislocation
Seek medical attention immediately.

DO NOT attempt to move the leg or hip back into place.

Once at hospital, X-rays will be taken to rule out fractures,

MRI or CT Scans may be used if blood vessel, nerve
or other soft tissue damage is suspected.

Provided there are no significant associated injuries then

the patient will be given an anaesthetic or sedative to allow
the doctor to manipulate the bones back into place.
 KNEE SPRAIN

A knee sprain is an injury of the ligaments,

tough bands of fibrous tissue that connect the
bones of the upper and lower leg at the knee
joint. The knee joint has four major ligaments.
 Knee Sprain

Anterior cruciate ligament (ACL) — The ACL and the

posterior cruciate ligament (PCL) bridge the inside of the
knee joint, forming an "X" pattern that stabilizes the knee
against front-to-back and back-to-front forces.

The ACL typically sprains during one of the following knee

movements: a sudden stop; a twist, pivot or change in
direction at the joint; extreme over straightening
(hyperextension); or a direct impact to the outside of the
knee or lower leg. These injuries are seen among athletes in
football, basketball, soccer, rugby, wrestling, gymnastics and
skiing.
Knee Sprain

Posterior cruciate ligament (PCL) — The PCL works with

the ACL to stabilize the knee. It most often sprains
because of a direct impact to the front of the knee, such
as hitting the knee on the dashboard in a car crash or
landing hard on a bent knee during sports.

In athletes, PCL injuries are most common among those

who play football, basketball, soccer and rugby.
Knee Sprain
Medial collateral ligament (MCL) — The MCL
supports the knee along the inner side of the leg.
Like the ACL, the MCL can be torn by a direct
sideways blow to the outside of the knee or lower
leg, the kind of blow that can happen in football,
soccer, hockey and rugby.

The MCL can be injured by a severe knee twist during

skiing or wrestling, particularly when a fall twists the
lower leg outwards, away from the upper leg.
Knee Sprain

Lateral collateral ligament (LCL) — The LCL supports

the outer side of the knee. It is the least likely knee
ligament to be sprained because most LCL injuries are
caused by a blow to the inside of the knee, and that
area usually is shielded by the opposite leg.
Knee Sprain……..

So a knee sprain simply means that one of the Knee

ligaments has been overstretched and that some or all of
the fibres have been damaged.

This usually occurs when there is a force through the

knee eg. a tackle in sport or sudden twisting of the knee
eg. when falling awkwardly.

**So any movement that overstretches the knee can

result in a knee sprain. It may affect one of more of the
ligaments depending on the severity of the injury.
 Symptoms of Knee Sprain
Significant knee swelling within a few hours after injury

Severe knee pain prevents from continued participation in sport.

Stiffness of the Knee.

Black-and-blue discoloration around the knee

Knee instability

Difficulty bending and straightening the knee

Pain at the knee

 Management of Sprained Knee

PRICE :Usually, the best course of action is

to follow the PRICE principles:-
Protect, Rest, Ice, Compression, Elevate to
reduce pain and swelling and to speed up
healing.
 Ankle Sprain & Strain

The ankle is a large joint

made up of three bones:
1.The shin bone (tibia)
2.The thinner bone running
next to the shin bone (fibula)
3.A foot bone that sits above
the heel bone (talus)
Ankle Sprain
An ankle sprain is an injury to the
ligaments that surround and
connect the bones of the leg to
the foot.
The injury typically happens when
you accidentally twist or turn
your ankle in an awkward way.
This can stretch or tear the
ligaments that hold your ankle
bones and joints together.
Ankle Sprain……….

All ligaments have a

specific range of motion
and boundaries that allow
them to keep the joints
stabilized. When ligaments
surrounding the ankle are
pushed past these
boundaries, it causes a
sprain. Sprained ankles
most commonly involve
injuries to the ligaments
on the outside of the
ankle.
 Symptoms of a Sprained Ankle

Swelling
Pain
 Bruising (contusion, appears on the skin
due to trauma)
 Difficulty in walking
 Stiffness in the joint
 Management / Treatment of Ankle Sprain

 Protection, Rest, ice, compression

Splinting or casting
 Medication
 Physical therapy
 More severe cases may require surgery
to repair the ligament(s).
 The Achilles Tendon: The “Heel Cord”
Runs down the back
of the low leg
 Connects the calf
muscle to the heel bone
 Helps to raise the heel
off the ground
Causes of the Achilles Tendon tear
Can be a complete tear or partial tear
 Occurs when the tendon is stretched too much
 Can occur with jumping, pivoting, sudden
accelerations in running
 Common among “weekend warriors”
 Symptoms of an Achilles Tendon Tear

Sudden pain
 Pain may then subside to a dull ache
 Popping or snapping sensation
 Swelling
 Difficult to walk (especially upstairs or uphill)
and difficult to rise on toes
 Treatment Options for an Achilles Tendon Tear
Non-surgical treatment

 PRICE Treatment
 Wearing a cast, walking boot(a type of medical shoe used to
protect the foot and ankle after an injury or surgery), or brace

Higher likelihood of re-tearing the tendon

Surgery
May increase push-off strength
 May improve muscle function and ankle movement
Lower likelihood of re-tearing the tendon
 Abdomen Injuries
Before going for abdomen injuries, lets first understand the
abdomen.

The abdomen (commonly called the belly) is the body space between
the thorax (chest) and pelvis.
The diaphragm forms the upper surface of the abdomen. At the level
of the pelvic bones, the abdomen ends and the pelvis begins.

The abdomen contains all the digestive organs, including the

stomach, small and large intestines, pancreas, liver, and gallbladder.
These organs are held together loosely by connecting tissues that
allow them to expand and to slide against each other. The abdomen
also contains the kidneys and spleen.
Abdomen………

Many important blood vessels travel through the

abdomen, including the aorta, inferior vena cava, and
dozens of their smaller branches.

In the front, the abdomen is protected by a thin, tough

layer of tissue called fascia.

In front of the fascia are the abdominal muscles and

skin. In the rear of the abdomen are the back muscles
and spine.
Abdomen Muscles
 Injuries to the Abdomen
Abdominal contusion
An abdominal contusion is caused by a direct blow to the
abdomen, which results in bruising of the superficial
abdominal skin or deeper to musculature.

An abdominal contusion may involve an injury to the skin, or

the muscles beneath the skin.

The signs and symptoms of an abdominal contusion are pain

and tightness in the area of the injury.

The treatment is ice and an elastic wrap to provide

compression to help decrease swelling and bruising.
 ABDOMEN STRAIN
An abdominal muscle strain is a stretch or tear of a muscle or tendon
in your belly, usually of the rectus abdominus muscle, although other
muscles in the stomach area such as the internal obliques or external
obliques can be affected.

A strain may also be called a "pulled" muscle. You may strain your
muscles during an activity like lifting or twisting or even hard coughing
or sneezing.

It occur mostly in weightlifters, throwers, gymnasts, rowers, wrestlers,

pole vaulters and other sports which involve fast whole body
movements and changes of direction.

If the athlete returns to training before the injury is allowed to heal

fully then repeated injuries and chronic inflammation of the tendon
may occur.
 Symptoms of Abdomen Muscle Strain
 Muscle pain immediately after an injury.

 Inflammation over an area of the rectus abdominis,

usually at the bottom of the muscle where it inserts
into the pelvis.

 Stiffness and discomfort

 Problems flexing or pain while stretching the muscle

 Pain when touching the area

 Management of Abdomen Muscle Strain

The treatment is ice and an elastic wrap

to provide compression to help
decrease swelling and bruising.
Strengthening Exercises for Lower Extremity