What is an Achilles Tendon Rupture?

The Achilles tendon connects the calf muscle (gastrocnemius) and the soleus muscles of the lower leg to the heel. While tendons are strong, they are not particularly flexible, and thus can only be stretched so far before becoming inflamed, or even tearing/rupturing. An Achilles tendon rupture occurs when the force on the tendon is greater than the strength of the tendon.

Most ruptures occur during a forceful stretch of the Achilles tendon while the calf muscles contract. A rupture is especially likely to occur if the foot is ‘dorsiflexed’ (i.e., the toes are drawn away from the ground, up toward the shin) while the lower leg moves forward and the calf contracts.

Treatment of an Achilles Tendon Rupture

Partial tears are sometimes treated by surgery followed by time in a cast. A completely ruptured Achilles tendon requries surgery followed by up to 12 weeks in a cast. Since the tendon shortens as it heals, a heel lift is typically used for six or more months starting when the cast comes off. Physical therapy is also initiated at that point to help restore flexibility and strength.

What is Achilles Tendonitis?

The Achilles tendon connects the calf muscle (gastrocnemius) and the soleus muscles of the lower leg to the heel. While tendons are strong, they are not particularly flexible, and thus can only be stretched so far before becoming inflamed, or even tearing/rupturing.

Achilles tendonitis refers to inflammation of the Achilles tendon as a result of overuse. Soreness and aching of the Achilles tendon are signs that you need to reduce your activity level and rest your Achilles tendon immediately. Failure to adjust your activity level can result in the development of chronic tendonitis.

Treatment of Achilles Tendonitis

Reduce your training/activity as soon as you notice pain or tenderness of the Achilles tendon. Cease speed training and hill running and gently stretch the calf muscle when the muscle and tendon are still warm. Do not stretch excessively, as this can aggravate the problem.

Calf strengthening exercises, such as toe raises, can reduce the stress on the Achilles tendon (weak/fatigued calf muscles are shorter/tighter). Wall stretching can also help. As long as you adjust your activity level accordingly, it may not be necessary to completely stop. Consider cross-training.

In the case of a severe injury, seek the opinion of a trained medical professional.

What is a Calf Pull, Strain, or Tear?

The “calf muscle” is actually comprised of two muscles — the gastrocnemius and the soleus — located on the back of the lower leg. These muscles are together known as the triceps surae. A strained/torn calf occurs when the calf muscle is separated from the Achilles tendon. This injury most commonly occurs during acceleration or sudden changes in direction.

A calf strain is similar to an Achilles tendon rupture, but occurs higher up in the back of the leg. As with an Achilles tendon rupture, you might hear a “pop” and feel a sudden burst of pain when you strain your calf.

Treatment of a Calf Pull, Strain, or Tear

This injury is typically treated by following the R.I.C.E. regimen. Pain and inflammation can also be reduced through the use of anti-inflammatories.

Pulled calf muscles can be avoided via proper stretching/warmups. In the case of a severe injury, seek the opinion of a trained medical professional.

What is Delayed Onset Muscle Soreness

The term delayed onset muscle soreness (DOMS) is used to describe the discomfort that is often felt 24-72 hours after exercising. While DOMS is often attributed to a buildup of lactic acid, there is little empirical support for this view.

Rather, it seems more likely that DOMS is a byproduct of microscopic tearing of muscle fibers caused by over-exertion. The extent of these micro-tears, and thus the amount of discomfort that they cause, largely depends on the type of exercise and the level of exertion.

Whatever the cause, the symptoms associate with DOMS can include muscle pain, inflammation, stiffness, and weakness.

Treatment of Delayed Onset Muscle Soreness

Perhaps the best course of action is to prevent DOMS before it happens. Warming up before exercise and cooling down afterwards, along with proper stretching, can help to reduce the incidence and severity of DOMS. It is important to keep in mind, however, that excessive stretching can cause DOMS.

While the R.I.C.E. regimen may alleviate the symptoms associated with DOMS, the often diffuse nature of this sort of muscle soreness makes it difficult to apply in many cases. Nonetheless, there is evidence to suggest that rest, ice, compression, and elevation all have the potential to speed recovery.

Active recovery, which involves light aerobic exercise to increase blood flow throughout the body, has been suggested as a means for minimizing the occurrence of DOMS in the first place, as well as for reducing symptoms once it occurs. While anti-inflammatories such as ibuprofen may be effective at reducing the discomfort and inflammation associated with DOMS, they do nothing to reduce weakness.

Finally, though massage has been suggested as an effective treatment for DOMS, the data here are mixed. Likewise, it has been suggested that nutritional supplements such as vitamin C and fish oil may help to alleviate the symptoms of DOMS, but there is little in the way of scientific support for this view.

What is a Groin Pull, Strain, or Tear?

A pulled groin occurs when the adductor muscles of the inner thigh are stretched beyond their limits. This stretching can result in small muscle tears that cause pain/swelling. In severe cases, these muscles can be completely torn or ruptured.

The adductors are muscles in the upper thigh that run for the pelvis to the femur. They pull the legs together when they contract, and also help to stabilize the hip joint. Proper warm up and stretching is the key to prevention of a pulled groin.

Treatment of a Groin Pull, Strain, or Tear

Groin pulls are typically treated following the R.I.C.E. regimen. Potentially aggravating activity should be avoided for 1-2 weeks following the injury. Anti-inflammatory medications can also be used to reduce pain and inflammation for up to a week following the injury.

Once inflammation subsides, a stretching program followed by a low-intensity strengthening program should be initiated. Once normal activity has been resumed, the affected region should be iced following exercise to minimize swelling.

Pulled groins can best be avoided via proper stretching/warmups, as well as post-workout stretching. In the case of a severe injury, seek the opinion of a trained medical professional.

What is a Hamstring Pull, Strain, or Tear?

The hamstring consists of three muscles that run down the back of the leg from the pelvis to the lower leg bones — the biceps femoris, semitendinosus, and semimembranosus. Hamstring injuries can range from minor strains to a total rupture of the muscle.

Hamstring pulls are caused by excessive stretching of these muscles resulting in a sudden, sharp pain in the back of the thigh. Following such an injury, the knee may not be able to extend beyond 30-40 degrees without pain.

Treatment of a Hamstring Pull, Strain, or Tear

Hamstring pulls are typically treated by the R.I.C.E. regimen. Anti-inflammatories can be used to reduce pain and inflammation. Once swelling and pain subsides, a stretching program can be initiated. The injured muscle should ultimately be rehabilitated through a strengthening program to prevent re-injury.

Pulled hamstrings can best be avoided via proper stretching/warm ups, as well as post-workout stretching. In the case of a severe injury, seek the opinion of a trained medical professional.

What are Heel Spurs?

Heel spurs are bone growths on the bottom of the heel where muscles and other soft tissue attach to the heel bone. Early signs of heel pain are typically due to plantar fasciitis. Heel spurs can develop when this pain is ignored and the chronic inflammation increases the stress on the fascia (i.e., the tough, fibrous band of tissue that connects the heel bone to the base of the toes). The end result is bone growth on the bottom of the heel.

Treatment of Heel Spurs

Conservative treatment includes taping of the foot, anti-inflammatory medications, and possibly cortisone injection. An exercise regimen, night splints, and physical therapy can be used in an attempt to reduce inflammation. Custom orthotics can be used to reduce the stress and strain on the plantar fascia, effectively reducing symptoms. If these conservative treatments fail, surgery may be indicated. In such cases, you should seek the opinion of a trained medical professional.

What is a High Ankle Sprain?

The term “high ankle sprain” refers to the stretching and/or tearing of the syndesmotic ligaments of the ankle. The syndesmotic ligaments of the ankle include the anterior tibiofibular ligament, the interosseous ligament, and the posterior-fibular ligaments. These three ligaments connect the tibia (i.e., shin bone) and fibula (i.e., calf bone) just above the ankle.

While low ankle sprains are caused by the foot twisting or rolling inward, a high ankle sprain is caused by the foot/lower leg twisting or rolling outward. High ankle sprains can be difficult to diagnose because there is typically much less swelling with a high ankle sprain as compared to a low ankle sprain.

High ankle sprains might be evidenced by pain when the ankle is rotated outward, or when the calf is squeezed (this latter approach is referred to as the “squeeze test”). However, proper diagnosis of a high ankle sprain often requires an x-ray and/or CT scan of the lower leg.

Treatment of a High Ankle Sprain

The recommended treatment of a high ankle sprain depends on the severity of the injury. Recovery times can range from 2-3 weeks for a minor high ankle sprain to six months or longer for a severe high ankle sprain.

In a stable high ankle sprain, the placement of the tibia and fibula remains normal, and the syndesmotic ligaments remain largely intact. A stable high ankle sprain can typically be treated by immobilization for a period of up to six weeks followed by rehabilitation.

In the case of an unstable high ankle sprain, two or all three of the syndesmotic ligaments are torn and the tibia and fibula are free to move around. In such cases, surgery is typically indicated, and a “syndesmotic screw” is used to hold the tibia and fibula in place while the syndesmotic ligaments heal. If surgery is required, recovery can take six months or longer.

What is Iliotibial Band Syndrome (ITBS)?

The iliotibial band (IT band) is a long, flat sheath of connective tissue that extends from the outside of the pelvis, running over the hip and knee, and ultimately inserting just below the knee. The IT band plays a critical role in stabilizing the knee during running.

Repeated rubbing of the IT band over the lateral femoral epicondyle (the bony outside of the knee) associated with repeated flexion/extension of the knee can cause the IT band to become inflamed, resulting in iliotibial band syndrome (ITBS).

The primary symptom of ITBS is pain along the outside of the knee. This pain is typically aggravated by running, particularly downhill. It may not occur immediately during activity, but often becomes more intense as the activity progresses. Pain might also be present at the outside of the hip and/or in the buttocks.

Causes of ITBS include consistently running on a banked surface, such as the should over the road, inadequate warm up or cool down, excessive hill running, or foot/leg abnormalities including high or low arches, supination of the foot, uneven leg length, or bowleggedness.

Treatment of Iliotibial Band Syndrome (ITBS)

ITBS can be treated via the R.I.C.E. regimen. Anti-inflammatories can be used to reduce pain an inflammation. Self-massage and stretching, particularly involving a foam roller, are also known to be effective treatments. It is also important to identify and rectify the underlying cause of the problem to speed recovery and prevent recurrences.

If the discomfort persists, seek the opinion of a trained medical professional.

What is Morton’s Neuroma?

Morton’s neuroma is a painful condition affecting the ball of your foot, typically between the third and fourth toe. This problem, which is caused by a thickening of the connective tissue between the toes that puts pressure on the intermetatarsal plantar nerve, can result in pain or numbness.

Morton’s neuroma produces a sharp burning or stinging sensation in the ball of your foot and/or tingling and numbness in your toes. It may feel as if you have a pebble stuck in your shoe, or that your sock is bunched up beneath your toes.

This problem is often associated with high impact sports such as jogging or running, and can be exacerbated by wearing high heels or tight footwear, such as those associated with skiing and rock climbing.

Treatment of Morton’s Neuroma

The recommended course of treatment for Morton’s neuroma depends on the severity of the symptoms. Reduced activity and ice massage can be used to reduce discomfort and prevent worsening of symptoms. Anti-inflammatories can also be used to reduce discomfort, but should not be viewed as a long-term solution.

Orthotics, including an arch support or a metatarsal bar, are commonly used to treat Morton’s neuroma. Changes to footwear, including the transition to a shoe with a wider toe box, might also be recommended. In some cases, steroid injections are used to reduce inflammation and relieve symptoms.

In severe cases, surgery to relieve pressure on the affected nerve, or to remove the nerve entirely, may be indicated. Seek the advice of a trained medical professional.