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02 June 2010 ~ 2 Comments

Overuse Injuries- Lower Body

In the last post, we talked about how to manage the common symptoms of overuse injuries. This included using Rest, Ice, Compression, and Elevation (aka R.I.C.E.) to reduce pain and swelling. We also reviewed what A-T-A techniques are best for treating this type of injury. The key to treating overuse injuries is to remember that these are injuries that build over time and involve changes not only to the injured muscle but also to the muscles around them. This means that you really have two things to treat- the injury and what actually caused that part of the muscle chain to break. To effectively treat this injury it is important to pay attention to joint range of motion (ROM) and the opposing muscle group (muscles work in pairs, if one is hurt, the other can be a big part of the problem).

To review, typical treatment for an overuse injury looks like this:

1) R.I.C.E. + gentle stretching. There should be no pain with stretching.

2) Start with the injured muscle group. Begin using the foam roller AROUND the injured area. The goal here is to start getting slack into the muscle without aggravating the injury itself. No tennis ball work or active/joint mobilizations. The order should be foam roll around injury -> stretch -> RICE.

3) Begin using the foam roller over the injured area to tolerance. The order should be foam roll around injury-> over injury -> stretch -> RICE.

4) Now that there is slack in the injured muscle, we can go back and assess range of motion (ROM). Are there limitations? Do you feel pressure in the joint? This is where you will add in the joint mobilization techniques. The order should be: foam roll around the injury -> foam roll over the injury -> joint mobilization -> stretch -> RICE

4) Begin using the tennis ball for active mobilizations. The order should be foam roll around injury -> over injury -> joint mobilization -> active mobilization with the tennis ball -> stretch -> RICE.

5) Begin using the tennis ball for cross friction + trigger point. These are the deepest of the soft tissue techniques so you want to save them for last to target specific adhesions and restrictions. Consider this your fine tuning step.

6) That was for the injured muscle. Now you must go back through and repeat steps 2-5 for the opposite muscle group. Go easy! You may find some rather sore spots and areas in these muscles as well. Remember- only progress through the levels when you can do so pain free.

Range of Motion + Muscle Pairs For the Lower Body

For each joint, you will find pictures of what normal ROM looks like, what muscles provide it and what the opposing muscles are. For the latter two, I will include links back to the specific muscle massage posts that best apply.

The Toes (Big and little)

Number of motions: two (this gives you one pair of muscles)

#1 Extension- pulling the toes back towards the top of your foot (or standing up on your toes- this pushes them into extension as shown below; note: when standing. Keep pressure on the ball of your foot.

Key Take Away- you should be able to pull your big toe back like the picture above. If you can’t, you will be unable to push off normally when you walk and run. This can lead to chronically tight calves, achilles, and eventually to abnormalities in the foot itself.

Muscles responsible for this movement = Big Toe extensor (EHL or Extensor Hallicus Longus) + EDL (Extensor Digitorum Longus) (located along the front part of your shin)

Opposing muscle groups = Muscles in the calf (gastroc, soleus) and on the small muscles on the bottom of your foot (restrictions here will prevent you from pulling the toes back all the way).

#2 Flexion: Curling the toes down under the foot.

Muscles responsible for this movement= Toe Flexors. These muscles are deep to the large muscles of your calf. Also consider working the larger muscles of your calf (gastroc, soleus).

Opposing muscle group= Toe Extensors along the shin.

The Ankle

Number of motions: Four (this gives you two pairs of muscles: 1) dorsiflexion + plantarflexion and 2) inversion + eversion)

#1 Dorsiflexion (this motion includes bending the foot/ankle back so that the top of the foot moves closer to the shin).

Key Take Away: Like the big toe, this motion plays a huge roll in gait and during athletic activities. Without full mobility in this direction, the shock of impact at heel strike is transmitted up the leg in larger amounts. This will result in a shortened push off and increased work load at the hip and knee.

Muscles responsible for this movement= Anterior Tibialis

Opposing muscle group = Gastroc/Soleus (calf muscles)

# 2 Plantarflexion (this motion refers to pointing the toes and ankle down towards the floor; away from the shin)

Muscles responsible for this movement= Gastroc/Soleus (calf muscles)

Opposing muscle group= Anterior Tibialis

# 3 Inversion (this motion refers to pulling the foot in towards the midline without moving the entire leg)

Key Take away: In the event of low arches/flat feet, the muscles that provide this motion can take a beating.

Muscles responsible for this movement = Posterior Tib

Opposing muscle group = Peroneals

#4 Eversion (this motion refers to pulling the foot out away from the body without moving the entire leg)

Key Take away: Like inversion, abnormal arches (either high or low) will alter how much movement there is at the foot. The result is increased strain on either side of the lower leg. The major purpose of orthotics is to help minimize this so that the foot can travel from heel to toe without excess side to side movement.

Muscles responsible for this movement = Peroneals

Opposing muscle group = Posterior Tib

The Knee

Number of motions: Two (this gives you one pair of muscles)

#1 Flexion (this motion refers to bending the knee so that the heel moves closer to the hip/butt)

Key Take Away: The quadricep/hamstring duo are one of the most powerful muscle pairings in the body. If one is bothering you, be sure to work on the other. Together, imbalances here are the leading cause of pain in and around the knee cap.

Muscles responsible for this movement = Hamstrings

Opposing muscle group = Quadriceps

#2 Extension (this motion refers to straightening the knee out. when sitting on the floor with the leg out in front, you should be able to flatten the back of your knee to the floor and lift your heel off the floor. this is known as hyperextension and a few degrees is considered normal).

Key Take Away: see above. These two muscle groups can cause LOTS of problems.

Muscles responsible for this movement = Quadriceps

Opposing muscle group = Hamstrings

The Hip

Number of Motions: Six (this gives you three pairs of muscles to work with: 1) Flexion + Extension, 2) abduction + adduction, and 3) internal + external rotation)

#1 Hip Flexion (this motion refers to bringing the knee up towards your chest)

Key Take Away: It is very common for the Hip Flexor/Glute duo to develop muscle imbalances in the event of prolonged sitting or a weak core.

Muscles responsible for this movement = Hip Flexors

Opposing Muscle Group = Glutes

# 2 Extension (This motion refers to the hip moving backwards away from the body)

Key Take Away: As stated above, the hip flexors or front of the hip is a common area for loss of mobility. If this area is tight, you will be limited in this motion.

Muscles responsible for this movement = Glutes

Opposing Muscle Group = Hip Flexors

#3 Abduction (this motion refers to the leg moving out away from the body)

Key Take Away: This muscle pairing is the primary cause of ITB pain. Even if only the outside hurts, be sure to work on the inside thigh!

Muscles responsible for this movement = Gluteus Medius + outer hip

Opposing muscle group = Adductors

#4 Adduction (this motion refers to the leg being pulled in across the midline of the body)

Key Take Away: In the event that work on this muscle pair does not relieve pain in the ITB, it’s time to look below the knee. Over/under pronation at the foot will also act to move the leg away from midline and place extra stress on this muscle pair.

Muscles responsible for this movement = Adductors

Opposing Muscle group = Glutues Medius + outer hip

#5 External Rotation (this motion refers to leg twisting at the hip so that the inside of the knee and foot move up towards the ceiling)

Key Take Away:  Of all the muscle pairs, this one is the most difficult as it also impacts the rest of the hip. Stay tuned for the upcoming hip ebook (will be available as a free download on the website) to better explain an approach to work on this area.

Primary muscles = External rotators (Piriformis)

Opposing muscles = Internal rotators (obturator +pectineus in the anterior hip/groin area)

#6 Internal Rotation (this motion refers to twisting the leg so that the outside of the knee and ankle move up towards the ceiling)

Key Take Away: see above :)

Primary muscles = Internal rotators (obturator + pectineus in the anterior hip/groin area)

Opposing muscles = external rotators (Piriformis)

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2 Responses to “Overuse Injuries- Lower Body”

  1. Fitz 10 March 2011 at 10:20 am Permalink

    This is incredibly valuable information, thanks for the in-depth analysis. One mistake I see a lot of runners making is attacking a fresh injury with a golf or tennis ball, which is way too aggressive. The sequence of treatments you listed is a great reminder that you need to progress in your treatment ( just like training )!

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