Lower Limb Injuries

This contains information about lower limb injuries

Management of the Injured Tendon: Difficulties in Diagnosis and Treatment

Abstract

Background: Tendon injury is a painful and often debilitating affliction, which commonly presents to the sports medicine professional. Researchers have often struggled to determine the most appropriate way to manage this condition. Despite the plethora of literature on management strategies, there appears to be little stemming from sound scientific evidence. Objective: The aim of this is to identify studies that demonstrate a greater understanding of the pathophysiology of tendon injury and evaluate the most effective management strategies for this difficult condition. Methods: A systematic review of the literature was conducted. Results: The current review found support for the early use of corticosteroid injections, despite long term detrimental effects. The review also demonstrated exercise therapy designed to stretch and strengthen will be more effective in the long term. Conclusion: Individuals with tendinopathy should perform a regular strengthening and flexibility regime as early as possible. Patients with pain limiting daily activities may benefit from corticosteroids injections, to allow them to perform activities with reduced pain.

Management of the injured Tendon

Initial Management of an Acute Injury

Once an injury occurs, whether to muscle, bone or ligament, it is imperative that you seek the most appropriate treatment for this. Injury often varies in severity, and therefore symptoms will differ. The most common signs of inflammation are heat, redness, swelling, pain and loss of function, not all of these symptoms may be present and some may even appear at a later date.

When you suspect you have sustained an injury to soft tissue (Muscle or Ligament) you must first minimize the symptoms of inflammation. The first 24 hours following the initial injury are critical in management. The following acronym is designed to control the bleeding and thus reduce inflammation and scar formation.

R: Relative Rest

I: Ice

C: Compression

E: Elevation

Relative Rest

Following any musculoskeletal injury, depending upon the severity, may require some immobilization, generally research suggests that a short period of reduction in motion can result in a stronger scar, which will be able to withstand more force, thus improving tissue regeneration and promotion of parallel alignment (Brukner and Khan 2012).

It is important however not to rest the injured area for too long, extended periods of immobilisation can weaken not only the injured tissue but also the surrounding areas, making return to activity a slow process.

Ice

One of the most important components of inflammation recovery, is the application of ice, Ice has been thought to reduce tissue metabolism, thus reducing blood flow and accumulating fluid, which results in reduction of swelling. Application of ice should happen as soon after injury as possible and should continue for the first 48 hours.

Two application procedures have been suggested, continuous and intermittent.

Continuous: 20 mins every 2 hours

Intermittent: 10 mins, with 10 mins rest then another 10 mins ice every 2 hours.

There are a number of ways to apply ice, with the most common being reusable packs (which can be kept in the freezer and used when required), Chemical ice packs (these are one use, disposable packs which are good for travelling, can be an expensive long term option tho), and frozen veg (frozen peas** have been found to be a good alternative to ice, as they conform to the body easily and can be re frozen for further uses).

** Mark bag with do not eat.

Prolonged exposure to ice can cause burning or nerve damage.

Compression

To reduce bleeding and swelling compression should be applied to the injury site, this should be used during and after ice application. The pressure should be firm but not to tight that it causes pain.

When using a bandage pressure should be initially applied distal to the injury and with slight overlap move proximal to one handbreadth above the injured area.

Elevation

The injured limb should be, where appropriate be raised above the heart, to reduce the pressure within the injured structure. This will also help in reducing the accumulation of fluid into the area, which will therefore reduce swelling.

Precautions in the Acute Stages

During the initial 72 hours there are a number of things that the injured person should avoid

Heat: Which will increase blood flow to the injured site, therefore increasing swelling,

NO hot baths, showers, saunas etc

Alcohol: this can mask the level of pain and severity of the injury

Aggravating Activity: Can result in worsening of the injury or re-injury

Massage and aggressive manual therapy: can increase blood flow, thus increasing swelling and risking further injury.

Medial Tibial Stress Syndrome

Medial Tibial Stress Syndrome: Common Cause of Shin Pain

What is it?

Medial tibial stress syndrome (MTSS), commonly referred to as “shin splints” has received a lot of attention within the literature, often found to be a difficult condition to manage. Shin Splints is a term which has been used to encompass all causes of shin pain including, compartment syndrome, stress fractures and MTSS. It is therefore understandable why such a term can become misleading as to the nature of such a complex and painful condition. The tibia (shin) is the larger of the two long bones located at the front of the lower leg.

Causes

MTSS is a chronic overuse syndrome, extremely common in activities, which involve weight bearing such as running. It has also been described as a common source of shin pain in military personnel. Pain associated with MTSS is often as a result of the following:

  • Over pronation: during the stance phase of gait the foot pronates to absorb shock and to adapt to uneven terrain, it is the soleus muscles job to resist unwanted pronation, therefore when the foot over pronates it places a repetitive stress on the tendons insertion on the tibia.
  • Training Errors: New training programs, sudden changes or increases to training, and inadequate recovery can all impact the repetitive overuse placed on the shinbone. Gradual progression and training increases will allow the musculoskeletal system to adapt to the loads imposed on them.
  • Muscle imbalances in strength and flexibility: It is all too common in runners to focus solely on their running and to neglect the strength and flexibility of their muscles. Tightness and weakness of the lower limb muscles can cause improper mechanics increasing the likelihood of developing MTSS.
  • Inappropriate footwear:  Appropriate running shoes should be the most important purchase by any runner, altered foot mechanics such as over pronation can cause internal rotation of the tibia, and fibula, which causes all structures to be forced into unwanted positions.

Symptoms

  • Pain due to MTSS is typically of gradual onset, pain is typically only associated with activity which often goes away once warmed up, that can often return when activity has stopped. The longer the injury goes untreated the more chronic the issue becomes, individuals may begin to notice pain during normal daily activities.
  • Pain is usually diffuse felt along the medial (inside) border of the tibia (shin bone). When a more focal area of tenderness is felt there may be a possibility of a stress fracture.
  • The pain felt can often be quite sharp, which may often be too painful to continue activity

Management

Early management of this condition is essential, initial reduction of the aggravating activity is important to reduce the stress on the tibia and leg musculature. The following are self-management strategies, which can be adopted.

  • In the initial stages when pain is present you may benefit from ice application (15mins every 2 hours) and some non-steroidal anti-inflammatory medication (NSAIDS).
  • Initiation of flexibility and strengthening programmes for the gastrocnemius/soleus complex and the anterior shin muscles. Beginning a proprioceptive training program will assist in regaining stability in the foot and ankle.
  • Correcting any training errors, following a guided program may ensure you don’t take on too much too soon. Altering the direction of your routes to ensure you are not running on the same cambered pavements.
  • Self massage with a foam roller.
  • Wearing the correct footwear, visiting a specialist footwear store such as Run 4 It will ensure you are measured correctly for the most appropriate shoe for your running style.

Sports massage and mobilisations have been found to be an effective method of reducing the pain associated with MTSS, increasing the mobility at the joint and improving the muscles flexibility, will enable the individual to perform the necessary strengthening exercises which are essential to ensure a speedy return to running. Sports Injury Scotland will provide diagnosis and treatment of any musculoskeletal injury offering advice on not only the management of pain, but direction on how to avoid recurrence.

 

Plantar Fasciitis

Plantar Fasciitis

What is it?

The plantar fascia is a broad band of connective tissue, which not only supports the arch of the foot, but also plays an important role in normal foot biomechanics. The fascia is designed to support the longitudinal arch of the foot. It attaches at the base of the heel bone and runs the length of the foot to insert into the bases of each toe. The plantar fascia is placed under tension during preparation for toe off during gait; the fascia is designed provide static support by tightening to stiffen the foot to allow affective propulsion.

Causes

Plantar fasciitis is a common overuse injury, particularly seen in runners with research indicating can account for 8-10% off all running injuries. This has been though to be due to repetitive microtrauma at the point of insertion. Some of the most common risk factors include:

  • Pes Planus (Flat feet): this causes excessive mobility in the foot, placing additional strain on the fascia due to increased stretching forces and reduced arch support. (Over pronation)
  • Pes Cavus (High arch): generally causing increased stiffness within the arch, and subsequently reducing the shock absorption properties of the foot. (Excessive supination)
  • Training errors: increases in mileage, changing terrain and inadequate recovery can place the individual at increased risk of developing plantar fasciitis, new runners who take on too much too soon are particularly at risk.
  • Muscle imbalances in strength and flexibility: research has suggested that tightness in the posterior muscles (hamstrings, gastrocnemius and soleus) may contribute to developing this condition. Poor strength and conditioning of the hip flexors, abductors and tibialis anterior muscles have been found to possibly contribute to the development of plantar fasciitis.
  • Inappropriate footwear: Appropriate running shoes should be the most important purchase by any runner, altered foot mechanics such as over pronation can cause excess stress on the plantar fascia. Wearing adequate footwear will enable the foot to function more effectively, which will subsequently reduce the impact on the more proximal structures.

Symptoms

  • Pain associated with plantar fasciitis is usually of gradual onset; it is typically painful at the beginning of activity, which often eases, only to return once activity ceases. If left untreated the pain increases to the point where weight bearing is painful and made worse with activity.
  • Pain is usually described as being worse in the morning, this is due to the foot being held in a plantarflexed position which when standing this movement is rapidly reversed.
  • Pain is typically felt on the medial (inside) aspect of the heel at the insertion to the calcaneus.

Management

As with any overuse injury, early management is essential, the longer it goes untreated the more difficult treatment would be.

  • In the initial stages it’s best to avoid any aggravating activities, any activity, which doesn’t cause pain, can be performed, for example swimming, cycling and cross trainer.
  • Anti inflammatory medication and ice may be beneficial in the early stages
  • Initiation of a strength and flexibility program, with particular emphasis placed on stretching the posterior muscles and strengthening of the hip flexors and abductors.
  • Wearing the correct footwear, visiting a specialist footwear store such as Run 4 It will ensure you are measured correctly for the most appropriate shoe for your running style.
  • Self massage to the plantar fascia with a massage ball.

Sports massage and mobilisations have been found to be an effective method of reducing the pain associated with plantar fasciitis, increasing the mobility at the joint and improving the muscles flexibility, will enable the individual to perform the necessary strengthening exercises which are essential to ensure a speedy return to running. Sports Injury Scotland will provide diagnosis and treatment of any musculoskeletal injury offering advice on not only the management of pain, but direction on how to avoid recurrence.

Calf Strains

Calf Strains

What is it?

The calf muscle is part of a group of muscles called the triceps surae, which includes the gastrocnemius, soleus, and plantaris muscle. The gastrocnemius has 2 heads and acts on the knee and ankle joint, the deeper soleus acts only on the ankle. The triceps surae group share a common tendon, the achilles which attaches into the calcaneus (heel bone).

Causes

Strains to the gastrocnemius are more common than soleus, injury to this muscle group is most common on medial aspect (gastrocnemius), lateral aspect (soleus) and can also occur at the musculotendinous junction (Where muscles join to achilles tendon). Injury to the triceps surae group is most often the result of the following:

  • Sudden acceleration from a stationary position or sudden eccentric contraction, i.e. stepping onto a kerb and the heel suddenly drops.
  • Previous injury: a previously poorly managed strain will have resulted in the build up of scar tissue, which is characteristically shorter and weaker than normal healthy muscle tissue.
  • Training Errors: Taking on too much too soon, ignoring warning signs, taking inadequate rest can all contribute to calf injury.
  • Poor flexibility and muscle conditioning: inadequate strength and flexibility can affect the overall function of the muscles and joints. Poor balance in the musculature can cause overload to occur increasing an individual’s risk of injury.
  • Inappropriate footwear: Appropriate running shoes should be the most important purchase by any runner, altered foot mechanics such as over pronation can cause internal rotation of the tibia, and fibula, which causes all structures to be forced into unwanted positions

Symptoms

  • Individual often complains of a sharp tearing sensation in the muscle at or near the musculotendinous junction.
  • Often painful to walk/run, stairs and hills may often cause pain.
  • There may be swelling and bruising present depending on the extent of the tear.
  • There is usually pain while stretching and contracting the muscle.
  • Depending on the grade of injury (Grade 1: few fibres torn, minimal pain and disruption to gait; Grade 2: anything from a few fibres to just before a complete rupture, usually significant pain and disruption to activity and Grade 3: Complete rupture, often reduced pain due to complete rupture of nerve endings, there will be significant disruption to activity) will depend on the management of this injury.

Management

  • Reduction of any pain and swelling is essential, rest from aggravating activity, and the use of ice, compression and elevation are essential in the early stages (first 24-48 hours). Non-steroidal anti-inflammatory medication may be used at this stage to minimise pain.
  • Cross training as soon as pain allows (Swimming, cycling, cross trainer)
  • Initiation of flexibility and strengthening program as soon as the pain has reduced. Progression through non-weight bearing to gradual weight bearing to full to single leg exercises will ensure the muscle is appropriately loaded.
  • Correction of any training errors.
  • Self massage with a foam roller (only when pain and swelling have gone completely to avoid further injury)
  • As over pronation and under pronation can significantly affect the function of the foot, wearing the correct footwear is essential, visiting a specialist footwear store such as run 4 it will ensure you are measured correctly for the most appropriate shoe for your running style. N.B. It is not advisable to get fitted for running shoes if you are experiencing pain and discomfort following injury, as this may alter your normal running technique.

Sports massage and mobilisations have been found to be an effective method of reducing the pain associated with calf injury, increasing the mobility at the joint and improving the muscles flexibility, will enable the individual to perform the necessary strengthening exercises which are essential to ensure a speedy return to running. Sports Injury Scotland will provide diagnosis and treatment of any musculoskeletal injury offering advice on not only the management of pain, but direction on how to avoid recurrence.

Iliotibial Band Friction Syndrome


Illiotibial Band Friction Syndrome

What is it?

The iliotibial band (ITB) is a thickening of the fascia that envelops the thigh, it acts as a lateral stabiliser of the knee and is an extension of the tensor fascia late and gluteus maximus muscles, which then travels down the outside of the thigh to insert into the front of the tibia (shin).

Causes

ITB friction syndrome has been described as a non-traumatic overuse injury, which is extremely common in runners. Injury to this structure in runners is most often due to:

  • Training errors: Generally when runners take on too much too soon, i.e. increasing their distance too quickly, doing more sessions than their bodies can handle and inadequate recovery periods between sessions can all contribute to pain at the ITB. New runners are particularly vulnerable to this as it is often easy to embark on a new running program without fully understanding the progressions.
  • Muscle imbalances in strength and flexibility: a common mistake in runners is the sole focus on improving their running, without focus on the strength and conditioning of the muscles and joints required. Adequate strength will give the joints stability which when running, which will reduce pressure on structures like the ITB. Recently researchers have discovered that poor conditioning of the hip musculature can increase an individual’s risk of developing ITB friction syndrome.
  • Surface and terrain: repetitive running on the same routes and surfaces with various cambers can cause alterations in an individual’s biomechanics, leading to imbalances.
  • Inappropriate footwear: Appropriate running shoes should be the most important purchase by any runner, altered foot mechanics such as over pronation can cause internal rotation of the tibia, and fibula, which causes all structures to be forced into unwanted positions. Wearing adequate footwear will enable the foot to function more effectively reducing the impact on the more proximal structures.

Symptoms

  • Initially the pain is of gradual onset; often not sever enough to notice, which often goes ignored. Around the outside of the knee can become tender and may be warm and swollen.
  • The pain is typically described as coming on at a specific distance or time during a run.
  • Pain can increase when running down hill, coming down stairs and with any repeated flexion and extension exercise of the knee.

Management

Early management of this condition is essential, initial reduction of the aggravating activity is important to reduce the stress on the ITB. The following are self-management strategies, which can be adopted.

  • In the initial stages when pain is present you may benefit from ice application (15mins every 2 hours) and some non-steroidal anti-inflammatory medication (NSAIDS).
  • Initiation of flexibility and strengthening programmes for the hip, and core musculature is essential to reduce the pressure of the ITB.
  • Correcting any training errors, following a guided program may ensure you don’t take on too much too soon.
  • Self massage with a foam roller.
  • Wearing the correct footwear, visiting a specialist footwear store such as Run 4 It will ensure you are measured correctly for the most appropriate shoe for your running style.

Sports massage and mobilisations have been found to be an effective method of reducing the pain associated with ITB pain, increasing the mobility at the joint and improving the muscles flexibility, will enable the individual to perform the necessary strengthening exercises which are essential to ensure a speedy return to running. Sports Injury Scotland will provide diagnosis and treatment of any musculoskeletal injury offering advice on not only the management of pain, but direction on how to avoid recurrence.

Knee Pain in Runners: Are more proximal structures to blame?

Two of the most common injuries to present to the sports injury clinic in runners are iliotibial band friction syndrome (ITBFS) and Patellofemoral pain syndrome (PFPS) (Brukner and Khan 2007 and Ellis, Hing and Reid 2006).  ITBFS is characterized by pain and tenderness on the lateral aspect of the knee, which is usually due to repetitive flexion/extension movement where the iliotibial band pops over the lateral femoral condyle, causing increased friction (Pettitt and Dolski 2000). PFPS has been described as pain and tenderness on the anterior aspect of the knee, this is thought to be due to a maltracking of the patella as a result of tightness/weakness in the quadriceps muscle group (Crossley, Bennell, Cowan and Green 2004). The iliotibial band begins as an expansion of the gluteus maximus and tensor fascia late muscles and runs down the lateral aspect of the knee to insert in to the lateral aspect of the tibial condyle (Palastanga, Soames and Palastanga 2008). The Patellofemoral joint is the articulation between the posterior surface of the patella and the patellar surface of the femur and the architecture of this joint allows a mechanical advantage in the quadriceps (Vastus lateralis, medialis, intermedialis and the rectus femoris) (Palastanga et al 2008). The gluteus maximus, tensor fascia late and the rectus femoris are 2 joint muscles in that the act upon the hip and the knee, thus weakness within these muscles can impact the function of the knee joint (Hamill and Knutzen 2010).

Pain in both of these structures is common in runners, and may be due to training errors, incorrect footwear, and structural weaknesses/imbalances in the lower limb and pelvis (Brukner and Khan 2007).  For year’s therapist have tried to determine the best treatment for ITBFS and PFPS (Crossley et al 2004 and Ellis et al 2006). Recently researchers have begun to investigate the relationship the hip musculature in particular the abductors have with these two conditions (Ferber, Kendall and Farr 2011, Powers 2010 and Wilson, Kernozek, Arndt, Reznichek and Straker 2011). Weakness in the gluteus maximus, medius and tensor fascia late will impact on the ability to stabilize the pelvis while running (Burnet and Pidcoe 2009 and Powers 2010). Contraction of these muscles on the weight bearing side, keep the opposite side level, to avoid pelvis drop, which subsequently leads to a rotation at the femur and increased heel lift to ensure the foot clears the floor, thus placing additional stresses at the knee joint (Wilson, Kernozek, Arndt, Reznichek and Straker 2011). The forces experienced in the lower limb while running can be as great as 8X the body weight with each stride taken (Hamill and Knutzen 2010).

Individuals suffering from knee pain will generally experience pain either on the outside of the knee (Iliotibial Band) or the front of the knee (Patellofemoral joint). pain generally starts as a dull ache typically at a specific time or distance in the case of iliotibial pain and generally near the end of the run with patellofemoral pain, Correct diagnosis is essential in the management of either condition. examination typically involves testing the hip/knee joints, with treatment focusing on strengthening areas of weakness and stretching areas of tightness.

Unfortunately without treatment this type of pain will most likely recur, therefore it is essential to seek advice about the best way to manage this. below are a couple of preventative exercises that will assist in keeping your lower body strong and conditioned for running.

Squats with Band around the knee

Side Lying Leg Lifts

Clam

Hip Hikers

Single leg squats

Step ups

The above exercises can be done at home with minimal equipment and should be performed 2-3 times per week performing 2-3 sets of 10-15 repetitions per side where appropriate.

For anyone looking for more information on the above, I recently gave a presentation on the relationship gluteus medius weakness has on patellofemoral pain syndrome. I have attached this here.

Gluteus Medius Weakness and Its Relationship with Patellofemoral Pain Syndrome

 

Importance of Stretching

Lower Back StretchAbdominal StretchHip Flexor Stretch

Increases in societies sedentary lifestyles mean we are becoming less and less active, inactivity can lead to muscle stiffness, weakness and imbalances, which can have a negative impact on daily life.

Low back and neck pain are among of the most common outcomes of poor flexibility and poor working postures. We are sitting at our desks for longer, therefore maintaining postures for extended periods, which can subsequently reduce flexibility in certain muscles and increase length in others creating imbalance. it is important to not only asses seated posture but to perform regular stretching exercises to minimise pain and dysfunction.

Reductions in flexibility can have a negative impact on performance, a reduction in gastrocnemius (calf) muscle length and dorsiflexion (Toe towards the knee) can increase the need for hip flexion to lift the knee higher so the foot can clear the ground, therefore placing additional stress on those muscles, which subsequently increases stress on the lateral hip and lower back. Pain may not necessarily show in the gastrocnemius or ankle, but may present in the hip and/or lower back. Like all methods of training flexibility should form part of an overall program.

Sports such as running may appear not to have massive range of motion requirements, however research has demonstrated that it may not be large single joint range required but the combination of joints working together. Gait (walking/running) forms one of the most complex series of actions that the body goes through. performing a stretching routine following all exercise sessions will limit the risk of further imbalance, therefore reducing the likelihood of injury.

This Stretching Program is a general list of stretches that will cover all aspects of the core and legs. For more information on the types of stretching you should be doing and when please contact us on info@sportsinjuryscotland.co.uk also if you are struggling with an injury and would like an appointment, please call 0141 2214300

References

Glynn, A. and Fiddler, H. (2009). The Physiotherapists Pocket Guide to Exercise: Assessment, Prescription and Training. Churchill and Livingston, China.

O’Hora, J., Cartwright, A., Wade, C. D., Hough, A. D. and Shum, G. L. K. (2011). Efficacy of static stretching and proprioceptive neuromuscular facilitation stretch on hamstring length after a single session. Journal of Strength and Conditioning Research, 25(6), 1586-1591.

Chen, C. H., Nosaka, K, Chen, H. L., Lin, M. J., Tseng, K. W. and Chen, T. C. (2011). Effects of flexibility training on eccentric exercise muscle damage. Medicine and Science in Sport and Exercise, 43(3), 491-500.

Perrier, E. T., Pavol, M. J. and Hoffman, M. A. (2011). The acute effects of a warm up including static or dynamic stretching on counter movement jump height, reaction time and flexibility. Journal of Strength and Conditioning Research, 25(7), 1925-1931.

Wong, D. P., Chaouachi, A., Lau, P. W. C. and Behm, D. G. (2011). Short durations of static stretching when combined with dynamic stretching do not impair repeated sprints and agility. Journal of Sports Science and Medicine, 10, 408-416.

Top 5 Exercises for Calf Pain

Gastrocnemius and Soleus Muscle

The gastrocnemius and soleus muscle are part of a powerful group of muscles located at the back of the lower leg. Both muscles insert into the calcaneus (heel bone) via the powerful Achilles tendon. The Gastrocnemius (commonly known as the calf) muscle is the largest of the 2 muscles and is located on top of the Soleus, it has 2 heads, which originate above the knee. This muscle is responsible for flexing the knee and planterflexion (pointing the toe) of the ankle. The Soleus muscle which is located under the Gastrocnemius, originating below the knee joint. The Soleus is responsible for planterflexion of the ankle and inversion of the foot.

Pain within this area can be due to a number of reasons, including muscle tightness through training, pain following a tear or Achilles soreness. General muscle soreness through exercise can be alleviated through stretching, strengthening and adequate recovery. Injury to any structure should be evaluated by a sports medicine professional.

Exercises

3 Point Calf Raise (on or off a step)

Calf Raise with toes inwardCalf Raise with toes centredCalf Raises with toes outward

The above exercises ensures you will target the entire gastrocnemius/soleus complex, as well as hitting the medial and lateral portions.

In the early stages this exercise should be performed on two feet and on the floor as you strengthen you can progress to doing this off a step and then move onto single leg adding weight as you improve.

Alphabet mobilisation

Alphabet Mobility for the ankle joint

While the typical action of the ankle is plantarflexion (point the toe), dorsiflexion (toe toward knee), inversion (sole of foot inward) and eversion (sole of foot outwards) the foot/ankle performs a highly complex series of movements to enable locomotion. Stiffness in the ankle joint can cause pain not only at the joint but also within the gastrocnemius and soleus muscles, which may limit performance. Performing mobility exercises such as the alphabets will ensure the ankle is put through a wide range of motion including combination movements, which is more true to real life.

Sitting on a stable surface, isolate the ankle as shown and trace the alphabet with your foot/ankle joint. using small letters first progressing to large letters as this gets easier. ensure each letter is done individually.

Gastrocnemius Stretch

Gastrocnemius Stretch

Standing against the wall, put the leg you wish to stretch behind you, keeping both feet pointing forwards, bend your front knee and shift your body weight forwards, till you feel the stretch in your calf.

Try to maintain a straight line from your shoulder to your heel.

Soleus Stretch

Achilles Stretch

Half Kneeling, place hands on the floor. Bring the ankle to be stretched close to your bottom keeping the sole of your foot on the floor.

Bring your chest forwards, and shift your weight over the sole of your foot. Keep your heel on the floor.

Tibialis Anterior Stretch

Tibiallis Anterior Stretch

Kneeling, sitting on your calves, ensure your feet are flat and lean backwards. if you do not feel this stretch you can put a rolled up towel under your toes. You should feel the stretch along the front of your shin.

Some of the most effective exercises can be added easily into your normal training regime, it is also important to note that preventing the injury from occurring in the first place will ensure you continue your training with minimal disruption. Below is some common exercises to stretch and strengthen this often injured area. Stretches should be held for 30-45 seconds and repeated on both sides. position should be taken to a point of stretch and not pain.

For any further information on the above please contact us at info@sportsinjuryscotland.co.uk or to book an appointment call 0141 2214300