Common Injury Conditions PDF

COMMON INJURY CONDITIONS Metatarsalgia Metatarsalgia, or forefoot pain, is considered a symptom of another condition in the foot, such as Morton’s neuroma (Bauer et al. 2014). The condition can be acute as a result of high-impact activities, but it typically results from an overload of the plantar...

COMMON INJURY CONDITIONS Metatarsalgia Metatarsalgia, or forefoot pain, is considered a symptom of another condition in the foot, such as Morton’s neuroma (Bauer et al. 2014). The condition can be acute as a result of high-impact activities, but it typically results from an overload of the plantar foot structures over time from kinetic chain compensation. The clinician must first determine and address the causative factors for this condition to ensure that the releases are sustained. If the foot continues to be irritated, the tissue lesions will likely return. Common Signs and Symptoms • Pain at and between the metatarsal heads • Point tenderness over and between the metatarsal heads • Decreased ability to bear weight on the affected structures Common Differential Diagnoses • Morton’s neuroma • Sesamoid fracture • Metatarsal stress fracture • Hallucis rigidis Clinician Therapeutic Interventions • Determine the root of the patient’s condition (e.g., faulty biomechanics, particularly at the first and second metatarsals, plantar warts, leg length discrepancy, training alteration, surface change, shoe alteration). • Consider requesting a radiograph or MRI to rule out fracture and nerve impingement at the forefoot and midfoot areas. • Scan and treat the structures in the order presented in the Treatment Points and Sequencing box. However, base your treatment sequencing off the most dominant (tender) points first. • Follow PRT with thermal ultrasound or laser, joint and/or neural mobilization, and myofascial massage. Treatment Points and Sequencing 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Plantar interossei and lumbricals Flexor hallucis brevis Plantar aponeurosis Abductor hallucis Abductor digiti minimi Dorsal interossei Posterior tibialis Medial gastrocnemius Soleus Popliteus • Implement open- and closed-chain strengthening for the intrinsic foot, pretibial, hip, and core muscles. • Implement PNF stretching of the triceps surae complex and plantar foot tissues. • Consider using a metatarsal pad to spread and elevate the metatarsals, but base its use on patient response. • Address any other insulting factors or conditions. • Slowly progress the patient to dynamic physical activity. Patient Self-Treatment Interventions • Perform self-release on a daily basis or when irritated. • PNF stretch the plantar foot structures and triceps surae complex after exercise on a daily basis. Do not stretch if it produces pain because doing so may result in additional tissue lesions. • Perform self-massage for five to eight minutes daily after stretching. • Ice-massage the affected area when irritated. If greater relief occurs with heat, apply heat (e.g., warm whirlpool or Jacuzzi). (Note: Consult with the clinician about where you are in the healing process, which will determine whether to apply heat or ice.) T. Speicher, Clinical Guide to Positional Release Therapy, Champaign, IL: Human Kinetics, 2016). For use only in Positional Release Therapy Course 2–Sport Medics. 65 COMMON INJURY CONDITIONS Plantar Fasciitis When the arch is irritated, the engagement of the windlass mechanism places strain on the plantar tissues (Bolgla and Malone 2004), which can activate the myotatic reflex and reinitiate the inflammatory process. Therefore, the clinician must work to determine how best to limit reengagement of the myotatic reflex to prevent the patient from entering a chronic cycle of inflammation every time he takes a step or bears weight. Converse to the traditional therapeutic approach of using an aggressive stretching protocol to treat this condition, the PRT approach is to release the tissue lesions prior to stretching and to avoid causing pain with any therapeutic intervention because doing so often reengages the myotatic reflex and tissue lesions. Common Signs and Symptoms • Pain at the medial heel or within the arch (or both), particularly upon waking ambulation • Sharp, burning pain upon landing or pushoff, a dull constant pain at rest, or both • Pain that subsides with the cessation of weight bearing Common Differential Diagnoses • Heel spur • Posterior tarsal tunnel syndrome • Calcaneal fracture Clinician Therapeutic Interventions • Determine the root of the patient’s condition (e.g., faulty biomechanics, movement faults, heel spur, leg length discrepancy, training, surface, shoe alteration). • Consider performing a biomechanical analysis to evaluate faulty mechanics that may be overloading the plantar fascia. • Consider requesting a radiograph to rule out a heel spur or calcaneal fracture if the pain is located at the heel and has been chronic. • Scan and treat the structures in the order presented in the Treatment Points and Sequencing box. However, base your treatment sequencing off the most dominant (tender) points first. 66 Treatment Points and Sequencing 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Plantar aponeurosis Flexor hallucis brevis Plantar interossei and lumbricals Dorsal interossei Posterior tibialis Medial gastrocnemius Soleus Popliteus Semitendinosus Pes anserine Iliotibial band Adductor magnus Gluteus medius Piriformis Psoas • Follow PRT with thermal ultrasound, PNF stretching, and myofascial massage of the plantar fascia. • Using KT Tape or arch taping in the initial stage of rehabilitation helps to reduce pain in some patients. • Apply instrumented soft-tissue mobilization (ISTM) if recalcitrant tissue adhesions are present. • Implement open- and closed-chain strengthening for the intrinsic foot, pretibial, hip, and core muscles with a focus on controlling eccentric internal rotation during ambulation. • Have the patient use temporary or custom orthotics initially and, most important, upon waking ambulation and throughout the day to prevent reirritation. • Slowly progress the patient to dynamic physical activity. Patient Self-Treatment Interventions • Perform self-release on a daily basis or when irritated. Some patients report significant relief with self-release upon waking. • Use a supportive sandal or shoe upon waking to flatten the arch when stepping out of bed. • PNF stretch the plantar fascia and gastrocnemius soleus complex after exercise on a T. Speicher, Clinical Guide to Positional Release Therapy, Champaign, IL: Human Kinetics, 2016). For use only in Positional Release Therapy Course 2–Sport Medics. COMMON INJURY CONDITIONS daily basis. Do not stretch if it produces pain because doing so may result in additional tissue lesions. • Use a night splint or plantar fasciitis sock if it helps. • Perform self-massage for five to eight minutes daily after stretching. • Ice-massage the plantar fascia on a stretch when irritated. If greater relief occurs with heat, apply heat (e.g., warm whirlpool or Jacuzzi). (Note: Consult with the clinician about where you are in the healing process, which will determine whether to apply heat or ice.) T. Speicher, Clinical Guide to Positional Release Therapy, Champaign, IL: Human Kinetics, 2016). For use only in Positional Release Therapy Course 2–Sport Medics. 67