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 Golfer’s Elbow?

Golfer’s elbow, formally known as medial epicondylitis, is similar to tennis elbow except that it affects the other side of the elbow. The primary symptom is pain at the inside of the elbow (i.e., the medial epicondyle) which can increase with the flexing of the wrist, and can also radiate down the forearm.

Golfer’s elbow is caused by overuse of the wrist flexors, which pull the hand down. This can result in small tears in the flexor tendon, which attaches to the medial epicondyle. The end result is inflammation and pain. As the tendon heals, scar tissue can form.

Golfer’s elbow is also known as Little League elbow.

Treatment of Golfer’s Elbow

The first step in treating Golfer’s Elbow is to discontinue activities that cause the pain. Following the R.I.C.E. treatment regimen is known to be helpful in reducing pain and swelling. Anti-inflammatory medications might also be helpful. In chronic cases, a cortisone injection might relieve the pain/discomfort.

Physical therapists may be able to use ultrasound to help heal the damage. They should also be able to prescribe strength and flexibility exercises. In some cases, a wrist brace or splint might be required. If non-surgical forms of treatment do not solve the problem, surgery might be recommended. Seek the advice of a trained medical professional.

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.

Please see golfer’s elbow for a description of, symptoms associated with, and treatment options for Little League elbow.

What is Plantar Fasciitis?

Plantar fasciitis is a chronic foot injury that is common in athletes that perform repetitive flexion/dorsiflexion of the toes. The plantar fascia is the tough, fibrous band of tissue that connects the heel bone to the base of the toes. With each step, the plantar fascia is stretched, and the arch flattens to absorb the heels impact on the ground. Because the plantar fascia is not very flexible, repetitive stretching can result in small tears.

The classic sign of plantar fasciitis is heel pain during the first steps of the day. That plantar fascia shortens overnight resulting in pain when it is first stretched. Pain associated with recent weight gain or a sudden change in exercise pattern is also a sign of plantar fasciitis. While heel spurs can be a sign of plantar fasciitis, with about half of all patients with plantar fasciitis having spurs, they are typically not the cause.

Individuals with flat feet, high arches, and/or tight achilles tendons may be predisposed to plantar fasciitis. Rapid weight gain, a rapid increase in the intensity or duration of activity, shoes with improper/poor cushioning, and/or prolonged standing can increase the likelihood of plantar fasciitis.

Treatment of Plantar Fasciitis

Perhaps the most important treatment for plantar fasciitis is to avoid activities that irritate the condition, including walking barefoot on hard surfaces. The use of footwear with proper arch support is also important. Other treatments include weight loss and/or stretching of the achilles tendon and/or plantar fascia.

Taping the heel and arch may help to reduce pain, as can medial longitudinal arch supports. Massaging the fascia by rolling the foot over a 3-4 inch diameter tube can also be an effective treatment.

As directed by a physician, non-steroidal anti-inflammatory drugs (NSAIDS) can be used in conjunction with these other treatments for a period of 2-4 weeks. Strengthening exercises include crumpling a hand towel with the toes or pulling a weighted towel across the floor with your toes. Following exercise, place a cold pack or ice bag on the heel at the most tender spot. Remember, ice shouldn’t be applied for longer than 15-20 minutes without a break.