1. anterior tibiofibular
2. anterior talofibular
3. calcaneofibular
4. posterior talofibular

• tibialis anterior
• extensor hallicus longus
• extensor digitorum longus

• Tom, Dick, and Harry
• posterior tibialis
• flexor digitorum
• flexor hallicus

• gastrocnemius
• soleus
• (achilles tendon)

• posterior tibial artery (behind medial malleolus)
• pedal pulse (between navicular and cuneiform
• capillary refill
• And in order to determine if the extremity is receiving sufficient blood flow

give a wide base for balance and to propel the body forward

(notice the size difference between 1-5 ray)

KNOW THE 3 ARCHES!

transverse AKA anterior metatarsal arch

• should be centrally located below the leg and perpendicular to the floor

1. ability to point toes
2. 15° of dorsi flexion (10° required for normal gait)

1. when the foot is in neutral position, the talus fits tightly into the talocrural joint
2. the talus is wedged shaped, with the narrow end being the posterior end
3. when the ankle is plantar flexed (up on toes) the talus does not fit as tightly into talocrural joint because the narrow end has moved up

1. the lateral malleolus extends more distally than the medial malleolus
2. when the foot is everted it runs into a bony block of the lateral malleolus (THIS IS NOT TRUE WHEN INVERTED)

• a tight achilles tendon
• can cause gastroc/soleus muscles to interfere with reaction time and propioception to predispose the ankle to sprains

• lots of fine bones have incredible forces to disperse and engineer
• required to help with shock absorbtion and then become a rigid lever to propel the body forward

• plantar fascia & spring ligament
• tibialis anterior
• flexor hallicus longus
• flexor digitorum longus

• fractures
• sprains
• strains (to achilles)
• compartment syndrome
• shin splints
• plantar fasciitis
• Morton's foot
• Bunions

• most often caused by contact to the lower leg and foot
• micro traumas or stress fractures

• fibular fracture
• metatarsal fracture
• Jone's fracture
• stress fractures of the metatarsals, navicular or tibia
• avulsion fracture of the 5th metatarsal (involving peroneal brevis or calcaneofibular ligament)

• swelling and/or deformity at the site of fracture
• point tenderness on the bone
• reports a snap or pop was hear or felt, crepitus
• inability to bear weight on effected leg

• initial care (ice, elevation, support)
• watch and treat for shock if necessary
• carefully immobilize the foot and leg using a splint or ace wrap and crutches
• arrange for transport to a medical facility or physician referral

Lateral Sprains!

80-85% of all ankle sprains are lateral or inversions sprains

• 70% 
• and due to changes in neuromuscular proprioception

• pain
• mild disability
• point tenderness
• little laxity
• little or no swelling

• pain 
• mild to moderate disability
• point tenderness
• loss of function
• some laxity
• moderate to severe swelling

• pain and severe disability
• point tenderness
• loss of function
• laxity
• and moderate to severe swelling

• initial care (RICE)
• apply a horseshoe-pad with ace wrap
• crutches for a painful gait 
• heel to toe pattern
• no walking on the toes
• improper gait leads to irritated joint, more swelling, etc.
• ankle brace to support walking

• taping or bracing may reduce the number of ankle injuries
• but so does a strong, flexible, ankle with good reaction time
• adhesive taping supports the ankle only for a short period of time
• bracing may be better than taping
• bracing combined with some high-top shoes may be helpful

• tight musculature that prevents adequate ankle ROM
• increased workout times or running distances
• hard, uneven, or uphill surfaces
• often associated with explosive jumping

• swelling and deformity at the site of injury
• athlete may report a pop or snap associated with the injury (no foot movement with a gastroc squeeze)
• pain in lower leg that ranges from mild to extreme
• "squeakie tendon"
• loss of function (strength), mainly in plantar flexion 

• initial care (RICE)
• immobolize with air cast, or splint
• for chronic condition: FLEXIBILITY, heel lift, night splint, reduced workload

• being kicked in the leg
• can result in swelling within the compartment

• pain and swelling in lower leg
• there may be a loss of sensation or motor control to the lower leg and/or foot
• there can be a loss of pulse in the foot
• inability to extend the big toe or dorsiflex the foot

• apply ice and elevate- DO NOT APPLY COMPRESSION
• if there is numbness, loss of movement, or loss of pulse to the foot, seek medical advice immediately, MEDICAL EMERGENCY!
• non-weight bearing transport

1. soft tissue inflamation- muscle away from bone (shin splints)
2. compartment syndrome
3. stress fractures

• mechanical error
• bony alignment or shoes
• MOI is often a tight achilles tendon (equinas deformity)
• training error
• too much distance
• hard surface
• all three conditions present
• lower leg shin pain
• progressive pain that limits conditioning
• increased pain when on toes
• the posterior tibialis is overworked in this position trying to stabilize the heel

What are some sights and symptoms of shin pain, shin splints, medial tibial stress syndrome, and/or medial tibial stress injury?

• lower leg pain either medially or posteromedially
• a chronic problem that progressively worsens & limits conditioning
• increased pain when on toes (posterior tibialis is overworked in this position trying to stabilize the heel)

What is the first aid and management for shin pain, shin splints, medial tibial stress syndrome, and/or medial tibial stress injury?

• apply ice, flexibility, changes in work load
• use of NSAIDs may be helpful
• athlete may need to have his or her gait analyzed for biomechanical deficiencies, look at shoes

• the plantar fascia is a dense collection of tissues that traverses from the plantar aspect of the metatarsal heads to the calcaneal tuberosity
• if this tissue becomes tight or inflamed by overuse or trauma, it can produce pain and disability

• extreme pain in the plantar aspect of the foot with the first steps taken after getting out og bed in the morning
• pain eases with subsequent steps
• athlete also has point tenderness in the region of the calcaneal tuberosity

• rest, alternative training
• ice, anti-inflammatories
• stretching the achilles tendon complex and plantar fascia
• orthotics, shoe selection

• typically involves either a shortened 1st metatarsal or an elongated 2nd metatarsal bone
• this results in shifting weight bearing to the 2nd metatarsal instead of along the 1st metatarsal, which results in pain throughout the foot during ambulation

• a problem with the nerve between the 3rd and 4th metatarsal heads
• pain radiates to 3rd and 4th toes
• a neuroma is an abnormal growth on a nerve
• tight-fitting shoes may be the cause, going barefoot may help
• this condition is best cared for by a physician

• can be inflamed bursae 
• or joint deformities

• chronic bunions should be evaluated by a physician
• pain relief with toe spacer and stretching exercises

• RICE
• protected weight bearing
• use crutches if there is not a heel to toe gait
• stay out of flip flops, use shoes with supportive arch

• plantar and dorsi flexion
• ABC's
• monkey toes
• achilles flexibility

• swimming
• jump rope
• trampoline
• surgical tubing
• balance activities

1. normal walk, balance on two feet, balance on one foot, hop on two feet, hops on one foot ----> ready to start jogging
2. jogging to more speed, speed to cutting, cutting to agility activities

• medial collateral
• lateral collateral
• anterior cruciate 
• posterior cruciate

• outer rim has the blood supply
• responsible for lubrication and nourishment of the knee joint, weight distribution, and assistance with joint biomechanics
• helps provide stability by deepening the joint surface contact area
• designed for shock absorbtion

bow legs

[image]

knock knees

[image]

hyper extension

[image]

How do you measure leg length?

(structural vs. functional)

• structural or true leg length: ASIS to MEDIAL malleolus
• functional: umbillicus to medial malleolus

• result frrom an extremely traumatic event
• also a stress fracture in the femoral neck region

• pain at the injury site
• difficulty walking on the affected leg
• swelling and/or deformity
• athlete may report a pop or a snap at time of injury

• extreme pain
• dislocation at the joint

• the injury must be splinted
• refer athlete to the nearest medical facility

• history of forceful impact to the area and a feeling of tightness
• swelling may occur in affected area
• inability to forcibly contract the muscle
• difficulty walking with affected leg

• adductors 
• hamstrings

• a sharp pain in the affected area
• swelling in the immediate area
• muscle weakness
• inability to contract the muscle forcibly
• discoloration of the area 1-2 days later
• a defect is visible in severe cases

• ice and compression
• athlete should rest, and if necessary use crutches

• muscle balance and flexibility
• between quads (within 10% strength, ability to handle body weight, heel can touch glutes or functional ROM)
• between hamstrings (within 10% strength, 60-65% strength of quads, 90º of hip flexion or functional ROM)

• inflammation can be cause by trauma or overuse
• prepatellar bursa is susceptible to direct trauma

• swelling and tenderness at the site
• pain when increased external pressure is applied
• athlete may report direct trauma to knee or it may be due to overuse

• application of ice and compression
• reduced activity for a short time
• in chronic cases, anti-inflammatory agents might be helpful (physician monitored)

• injury may be caused by a quick cutting motion that generates a great deal of abnormal force within the knee
• instead of moving normally, the patella moves laterally & may dislocate/sublux

• recent growth spurts
• females
• long limbed
• minimal musculature

• severe pain and abnormal movement of the patella when injury occured
• swelling
• patella may be obviously out of place
• extreme pain along the medial aspect of the patella
• unwillingness of the athlete to let you move the patella laterally

• RICE
• splint the entire leg (if it is an initial injury)
• transport to a medical facility (initial injury)
• physician referral & rehap (chronic subluxation)

• pain and tenderness around the patellar tendon complex that may spread to the tibial tuberosity
• swelling in the area
• decreased ability to use the quadriceps
• if inflammation continues, area over tibial tuberosity may become solid when palpated

What first aid should be applyed for someone suffering from Osgood-Schlatters?

• ice and compression
• refer to physician for specific diagnosis
• until inflammation subsides, rest or modified activity is important

• pain and tenderness around the patellar tendon complex that may spread to the tibial tuberosity
• may also be painful above the patella
• decreased ability to use quadriceps for running or jumping
• symptoms worsen with activity

• ice
• refer to physician for possible anti-inflammatory medications
• rest, modification of activity will be helpful
• develop quad strength, including VMO, using multi jointed activites
• maintain/develop quad and achilles flexibility

difference between a straight line drawn from the ASIS and the center of the patella and a line drawn from the center of the patella through the center of the tibial tuberosity

[image]

• pop or snap when the injury occured
• may not see any significant swelling
• may or may not be painful on the the joint line
• loss of ROM
• athlete may be able to continue participating
• a feeling the knee is "giving out" periodically

• ice and compression
• have athlete use crutches, if gait isnt normal
• refer athlete to a physician

• anterior cruciate
• posterior cruciate
• lateral collateral 
• medial collateral

• cutting maneuvers when running
• direct blows to the joint
• valgus stress --> damage to MCL
• varus stress --> damage to LCL

• tibia moves forcefully in an anterior direction
• when the femur gets pushed backwards while the tibia is held in place
• quick rotational movements
• the stronger the quadriceps activation during eccentric contraction, the greater the likelihood of ACL injury, especially in female athletes

• athlete reports the knee was forced beyond its normal range of motion
• athlete reports having a snapping or popping sensation at the time of injury
• initial intense pain, then a more numbing sensation
• pain deep in the joint
• profuse swelling around the knee
• athlete indicates the knee feels unstable

• immediately apply ice and compression
• have athlete walk on crutches, elevate leg when possible
• refer to a physician

• have good balance, strength, and flexibility in the quads, hamstrings, and gastrocs
• feet should prevent excessive pronation, with shoes/tape/brace
• jump and landing training programs
• agility and balance training

• control pain and swelling
• RICE
• crutches
• regain ROM
• wall slides
• use opposite leg
• bike peddling
• pool work
• Regain strength
• closed kinetic chain activities
• wall sits, squats, lunges, chair scoots
• balance progression
• two legged, one leg, change planes, unstable surface
• jumo rope
• trampoline
• Functional activities-progression
• double toe raises, jumps in place, jumo on one leg, sprint, cutting
• sport specific activities
• injured knees are at a greater risk for osteoarthritis, esp in women

• structural support
• surrounds and protects spinal cord
• supports body weight
• serves as attachment site for muscle, tendons, and ligaments
• allows movement of neck and back in all directions

• nucleus pulposus 
• nucleus fibrosus

• kyphosis
• lordosis
• scoliosis

abnormal rounding of the thoracic vertebrae

"hunch-back"

[image]

[image]

excessive curvature of the lumbar region

"bubble butt"

[image]

lateral rotary deviation of the spine

[image]

• hip flexors
• hamstrings
• abdominal muscles
• erector spinae

when the condition of spondylolysis is bilateral, and the affected vertebrae can slip forward

[image]

• lower back pain that worsens during hyperextension
• radiating pain to the buttocks and upper thighs

What is some treatment for Spondylolysis and Spondylolisthesis?

• rest
• drug therapy
• core stability exercises
• exclusion from certain sports
• surgery

• localized muscle spasm
• pain that does NOT radiate into buttock or lower extremety
• acute postural abnormalities associated with recent trauma

• frequent use of supine position
• soft support for lumbar region
• application of ice
• teach neutral spine & core stability exercises

• intense local or radiating pain
• sensory loss or burning/tingling sensation in lower extremity
• muscle spasm and postural abnormalities

• ice, heat, or estim
• teach body positioning (neutral spine)
• drug therapy
• frequent use of supine position through the day

• maintain, develop flexibility
• hip flexors
• hamstrings
• regain strength, core stability exercises
• abdominals & paraspinals
• lying down, sitting & standing, with movement
• weight room cautions
• aerobic cautions

• functional disk pressure
• lying down
• standing
• sitting, highest disk pressure is from sitting with a forward lean to pick up weight
• sleeping
• on back- pillow under the knees
• on side- pillow between the knees
• on stomach- pillow under the hips
• log roll to get in and out of bed
• activity
• pain with flexion
• swim
• pain with extension
• stationary bike

• attachment of lower extremeties to trunk
• protection of internal organs
• muscle attachments
• birth process, in females

• athlete complains of severe anterior thigh or groin pain
• experiences pain when walking

• prepubescent boys
• tall boys w/ recent growth spurts
• overweight boys
• late-maturing boys

• abnormal pain in pelvic region
• swelling at the injury site, usually accompanied by visual or palpable deformity
• pain elicited when iliac crests are pressed together

• contusion to the ASIS (region)
• extremely painful and debilitating

• very visible swelling, pain, and discoloration at injury sight
• may walk with limp

• athlete should rest or at least modify activity

• long distance runners
• soccer players
• any athlete receiving repetitive loading on the area

• refer to a physician
• condition often responds well to rest, ice, and over-the-counter anti-inflammatory medications
• it may take 3 months to a year to recover

• testicular contusion
• lacerations
• ruptured testicle
• torsion of spermatic cord

• extreme pain & point tenderness
• MOI of a direct blow
• assuming fetal position

• apply ice and allow athlete to rest lying down
• in cases of swelling, un-descended testicle, or pain that doesnt resolve itself, refer to a physician

arises from the canal that transports the vessels and nerves that go to the thigh and lower limb

(more common in females)

• store red blood cells
• regulate RBCs in circulation
• destroy old RBCs
• produce antibodies

• shock
• abdominal rigidity (muscle spasms)
• positive rebound test: pain with palpation and an increase in pain with a release of pressure used to palpate
• nausea, vomiting
• Kehr's sign: radiating pain into the left shoulder and down one third of left arm
• delayed bleeding (the spleen can splint itself)

• abdominal rigidity
• positive rebound test

• pain at McBurney's point
• passive leg hyperextension that produces lower right quadrant pain
• mild to severe cramps
• associated nausea, vomiting
• low grade fever, 99-100 degrees
• abdominal rigidity
• positive rebound test

• a direct blow
• dehydration
• medications
• kidney infection
• kidney stones

• shock
• nausea, vomiting
• rigidity of the back muscles
• hematuria- blood in the urine