Technical Foundations for Injury Management - PowerPoint Presentation

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Technical Foundations for Injury Management

Part 4: Achilles, adductor, and quad taping and wrappingSlide2

Injuries of the Lower Body

Contusions

Myositis

Ossificans

Quadriceps

Tensoring

Tendonitis and Tenosynovitis

Achilles Tendon

Taping/Wrapping

Sprains (ACL, PCL, LCL, MCL

)

Patellofemoral Pain Syndrome

Meniscal TearSlide3

Contusions

Recall contusions:

A muscle “bruise”

Occur from falling, a direct blow or repeated blows from a blunt object or strike to body part, crushing underlying muscle fibres and connective tissue without breaking skin

Can become serious and 10-20% of thigh contusions lead to myositis ossificansSlide4

Myositis Ossificans

Characterized

by bone formation (calcification) in the muscle belly at the site of the

contusion.

Causes

: Severe Contusions,

re-injury

to a contusion, inadequate rest from a contusion, receive massage too soon or too vigorously following injury, mistreatment of a contusion (no RICE) etc…Very often on the anterior surface of the thigh but can be found in other locations tooSlide5

Myositis OssificansSlide6

Symptoms of Myositis Ossificans

Severe pain

during activities such as squatting, going up and down stairs, running, jumping, hopping, lunging or kicking.

Swelling

, tenderness and bruising may also be present in the quadriceps muscle, along with an inability to bend the knee as far as usual whilst keeping the hip straight.

Patients

may also be unable to walk without a limp

.A visible increase in size of the quadriceps muscle may be detected due to bleeding and swelling. A noticeable lump or ‘woody’ feeling in the belly of the injured muscle, an increase in morning pain, pain with activity or night pain and a clinical history demonstrating an initial improvement in range of movement followed by a period of deterioration.Slide7

Myositis Ossificans

If suspected, seek

professional advice from a sports injury specialist or doctor as soon as possible.

They

will

advise

conservative treatment initially which will include rest, possible immobilization of the affected limb for 3 or 4 weeks. This may give time for the body to reabsorb the calcification.

An X-ray of the muscle can be done to see when it is safe to start rehabilitation and strengthening exercises. In particularly severe cases surgery can be performed to remove the bone growth.Slide8

Quadriceps

TensoringSlide9
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Tendonitis vs Tenosynovitis

Tendinitis

 is

an

inflammatory, repetitive stress injury of a tendon, commonly affecting athletes and active

individuals

and after degeneration of the tendon – which can lead to tendinosis (see next slide)Tenosynovitis is tendinitis with inflammation of the tendon sheath lining. Symptoms: pain with motion and tenderness with palpation. Chronic deterioration or inflammation of the tendon or tendon sheath can cause scars that restrict motion.

Diagnosis

is clinical, sometimes supplemented with imaging. Treatment includes rest, NSAIDs, and sometimes corticosteroid injections.

TenosynovitisSlide13

Tendonitis vs Tendinosis

Research

, however, indicates that when there is ongoing or chronic pain from a tendon such as the Achilles, the tendon is not persistently inflamed but actually

becomes degenerative

, with thickening, scar tissue, and sometimes partial tearing.

This

degenerative condition of the tendon is referred to as

tendinosis. Understanding the difference is changing how tendon “overuse” injuries are treated and is crucial to effective management of these conditions.Slide14

TenosynovitisSlide15

Summary:

Tendonitis

 means inflammation of a tendon. The term tendonitis is usually used for tendon injuries that involve acute injuries accompanied by

inflammation

.

Tendinosis

 means chronic

degeneration without inflammation and eventually potential tearing of a tendon. The main problem is failed healing of repeated minor injuries rather than inflammation.Tenosynovitis means inflammation of the sheath that surrounds a tendon. (The sheath is called the synovium.)Slide16

Achilles Taping and WrappingSlide17

AnchorsSlide18

Anchors cont.Slide19

Fan StripsSlide20

Fan Strips cont.Slide21
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Anatomy of the Knee

The knee is the largest synovial joint in the body and it is one that allows for free movement.

Formed from the articulations between the:

Femur

Tibia

Fibula

Patella

Designed for linear movement only – flexion and extensionAs a result, most injuries occur when rotational forces are applied to the jointSlide23

Anatomy of the Knee

Static (stationary) support is provided by ligaments and menisci

Medial Collateral Ligament (MCL)

Lateral Collateral Ligament (LCL)

Anterior Cruciate Ligament (ACL)

Posterior Cruciate Ligament (PCL)Slide24

Anatomy of the Knee – Knee Sprains

The medial and lateral collateral ligaments provide stability to the medial and lateral surfaces of the joint. When the knee is functioning properly, (walking or running straight), not much stress is placed on these

structures.

Tears

occur in these areas when

varus

or valgus stresses are applied to the joint, particularly if the leg is bearing all of the weight. Slide25

Anatomy of the Knee

The cruciate ligaments are generally considered the most important ligaments, and the anterior cruciate is the most essential. Not only is it responsible for keeping the femur from sliding forward on the tibia (anterior drawer), but it also provides critical support for the rotational component of knee flexion and extension.

A person with complete ACL tears will find walking down stairs unsupported or even getting into a car extremely challenging.Slide26

Anatomy of the Knee

In the past decade, there have been a dramatic increase in ACL injuries, particularly in young women who do gymnastics, soccer, volleyball and basketball. These sports are non-contact in nature, but involve landing, cutting and deceleration with rotation.

One the factors that may lead to injury that has been found consistent literature, is that weakness of the hip abductor muscles (

gluteals

) can be a contributing factor.

As with most knee injuries, ACL injury will require support from a brace in linear and rotational movement.Slide27

Menisci

Other

static structures that maintain the integrity of the knee joint include the menisci. The functions of menisci are:

Reduce friction

Provide for a greater articulating surface

Provide shock

absorption

There is a medial and a lateral meniscus Slide28

Meniscal Tear Symptoms

Minor:

may

have slight pain and swelling. This usually goes away in 2 or 3 weeks.

Moderate:

cause at the side or center of your knee. Swelling slowly gets worse over 2 or 3 days. This may make your knee feel stiff and limit how you can bend your knee, but walking is usually possible. You might feel a sharp pain when you twist your knee or squat. These symptoms may go away in 1 or 2 weeks but can come back if you twist or overuse your knee. The pain may come and go for years if the tear isn't treated.Severe: pieces of the torn meniscus can move into the joint space. This can make your knee catch, pop, or lock. You may not be able to straighten it. Your knee may feel "wobbly" or give way without warning. It may swell and become stiff right after the injury or within 2 or 3 days.Slide29

Mensical Tear Treatment

Usually diagnosed by a physiotherapist or specialist but MRI scans often used to confirm

The

menisci also do not heal well due to their limited blood supply. Once the meniscus is torn, it usually will not heal without medical intervention such as surgery.

Treatment:

Rest

, ice, wrapping the knee with an elastic bandage, and propping up the leg on

pillowsPhysical therapySurgery to repair the meniscusSurgery to remove part of the meniscusSlide30

Patellofemoral Syndrome

Sometimes referred to as “runners knee”

Symptoms:

knee pain (especially when bending knees,

squatting, jumping, or using the

stairs, particularly when going down.

Occasional

knee buckling, in which the knee suddenly and unexpectedly gives way and does not support your body weight. Also common to have a catching, popping, or grinding sensation when you are walking or when you are moving your knee.Causes:Patellofemoral pain syndrome may be caused by overuse, injury, excess weight, a kneecap that is not properly aligned (patellar tracking disorder), or changes under the kneecap.Slide31

Patellofemoral Syndrome Treatment

Patellofemoral pain syndrome can be relieved by avoiding activities that make symptoms worse.

Avoid sitting, squatting, or kneeling in the bent-knee position for long periods of time.

Avoid bent-knee exercises

, such as squats or deep knee bends.

Taking

nonprescription

anti-inflammatory drugs such as Advil to relieve pain and swellingIce and restPhysical Therapy exercises. Exercises may include stretching to increase flexibility and decrease tightness around the knee, and straight-leg raises and other exercises to strengthen the quadriceps muscle.Taping or using a brace to stabilize the kneecap.Surgery