LEG

Overview:

Several injuries can occur in the lower extremity that may or may not be associated with a particular joint. These typically present as muscle strains (or pulls) that can limit one’s abilities and become nagging and chronic.

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Quadriceps Strain: 

The term ‘quadriceps’ refers to a powerful set of muscles on the front of the thigh that serves primarily to extend (or straighten) the knee joint. 4 primary muscles make up the quadriceps complex – the rectus femoris, vastus lateralis, vastus intermedius, and vastus medialis. These four muscles originate on the femur (except for the rectus femoris) and come together to form the patellar tendon. The rectus femoris originates on the pelvis and serves as a hip flexor and an extensor of the knee.

Muscle strains usually occur when a muscle is stretched beyond its limit, tearing the muscle fibers. They frequently occur near the point where the muscle joins the tendon’s tough, fibrous connective tissue. A similar injury occurs if there is a direct blow to the muscle. Muscle strains in the thigh can be quite painful.

 

Once a muscle strain occurs, the muscle is vulnerable to reinjury, so it is essential to let the muscle heal properly and follow your doctor and physical therapist’s preventive guidelines. Physical therapy treatment will initially focus on rest, ice, and compression (RICE). As recovery progresses, treatments will expand to include strengthening and flexibility exercises, instrument-assisted soft tissue mobilization, and a functional progression back to sports and activity. Physical therapy will also focus on contributing factors that may have made the individual more susceptible to injury, including patient education on dynamic warm-ups, appropriate stretching, and deconditioning/fatigue.

 

Hamstring Strain: 

Hamstring muscle injuries (“pulled hamstrings”) frequently occur in athletes. They are especially common in athletes who participate in sports that require sprinting, such as football, soccer, baseball, and basketball. The term hamstring refers to the muscles in the back of the thigh. Three muscles make up the hamstring muscle complex – the semitendinosus, semimembranosus, and biceps femoris. All three muscles originate on the pelvis at the ischial tuberosity and insert below the knee on the medial and lateral tibia. The hamstrings serve to flex (bend) the knee and extend (straighten) the hip.

A hamstring injury can be a slight pull, a partial tear, or a complete tear. Injuries are graded on a 1-3 scale. Most hamstring injuries occur in the thick, central part of the muscle or where the muscle fibers join tendon fibers. An avulsion injury, where the muscle is torn entirely from the bone, can occur at the ischial tuberosity. This injury requires surgery.

A hamstring strain results from muscle overload that occurs when the muscle is contracting as it lengthens. This happens in sprinting activities when the muscle is contracting during push-off. Risk factors for suffering a hamstring strain include deconditioning, inflexibility, muscle imbalance, muscle fatigue, and activity level. Physical therapy treatment will initially focus on rest, ice and, compression (RICE). As recovery progresses, treatments will expand to include strengthening and flexibility exercises, instrument-assisted soft tissue mobilization, and a functional progression back to sports and activity. Physical therapy will also focus on contributing factors that may have made the individual more susceptible to injury, including muscle imbalances, patient education on dynamic warm-ups, appropriate stretching, and deconditioning/fatigue. Early treatment with a plan that includes the RICE protocol and physical therapy has been shown to result in better function and quicker return to sports.

 

Calf Strain:  

The calf consists of 9 different muscles. The gastrocnemius and soleus are the largest and most active muscles in the region. They work along with the plantaris muscles, which attach to the heel bone. The other six muscles in the calf help promote knee, toe, and foot movements. A calf strain is an injury to the back of the leg muscles and is caused by overstretching or tearing any of the calf’s nine muscles. It can happen suddenly or develop slowly over time. Walking, climbing stairs or running can be painful, difficult, or impossible with a calf strain.

Typically, individuals who sustain a calf strain notice a sudden, sharp pain in the back of the leg. The most common muscle injured when a calf strain occurs is the medial gastrocnemius. This muscle is on the inner side of the back of the leg. The injury usually occurs just above the midpoint of the leg (between the knee and ankle). This area of the calf becomes tender and swollen when a muscle strain occurs.

The severity of the injury usually guides the treatment of a calf strain. Physical therapists can help guide treatment that may speed your recovery. Specific modalities, such as ultrasound or therapeutic massage, may be helpful in addition to exercise-based therapy. It would be best to work with your physical therapist to determine the treatment appropriate for your condition.

 

Hamstring and calf treatment

Plans may include:

• Ultrasound, electrical stimulation, and/or other methods to help control your pain. Physical therapists are experts in prescribing pain-management techniques that reduce or eliminate the need for medicines, including addictive opioids.

• Range-of-motion exercises.Your strain may be causing increased tension in your hamstring or calf. Your physical therapist may teach you range-of-motion (movement) techniques to restore normal motion in your muscles.

• Manual therapy.Your physical therapist may provide “hands-on” treatments to move your muscles and joints gently. These techniques help improve motion and strength. They often address areas that are difficult to treat on your own.

• Muscle strengthening.Muscle weaknesses or imbalances can contribute to calf muscle strain. They can also be a result of your injury. Based on your condition, your physical therapist will design a safe muscle strengthening program just for you. It will likely include your core (midsection) and lower body muscles. Your physical therapist will choose activities that are right for you based on your age and physical condition.

• Functional training.Once your pain, strength, and motion improve, you will need to transition back into more demanding activities safely. To reduce tension on your hamstring or calf muscle, you will need to learn safe, controlled movements. Following your physical therapist’s guidelines will also reduce your risk of repeated injury. Your physical therapist will create a series of activities based on your unique condition to teach you how to move correctly and safely.