Sharp pain over the heel and aching pain along the underside of the foot are signs of plantar fasciitis. Pain often increases when more time is spent in standing or walking.
This condition is caused by excessive stretching of the plantar fascia, which is the strong “spring-like” ligament that runs along the arch of the foot. Typically this is more prevalent when people have either flat feet or very high arches. A long history of wearing high-heeled shoes can be a contributing factor in females.
Hands-on joint mobilization can relieve ankle stiffness, and stretching tight calf muscles can improve ankle movement. Myofascial release of the plantarfascia helps prevents scar formation, and strapping techniques decrease stress on the plantarfascia. If an orthotic shoe insert is needed, the therapist will either suggest an “over-the-counter” orthotic or refer the patient to a podiatrist for a more specialized orthotic.
Pain and swelling of the Achilles tendon where it attaches to the heel bone and slightly above indicates Achilles tendonitis. Symptoms get worse with weight-bearing activities and may develop suddenly or gradually.
Achilles tendonitis accounts for over 10% of all running injuries and is also common in jumping activities such as basketball. Beginning or increasing an activity or even simple walking can lead to the onset of this condition. It occurs when calf weakness or tightness or poor foot biomechanics make the tendon vulnerable to stress.
Hands-on myofascial release of the calf muscle and Achilles tendon help prevent scar formation. “Eccentric” exercises, which develop tension while the muscle is lengthened, help restore pain-free flexibility of the calf. Ultrasound, ice and electrical stimulation relieve soreness while the exercise promotes healing. Taping, orthotics and footwear changes may also be needed.
Pain and tenderness along the inside of the shin bones may indicate shin splits. Often symptoms come on with activity, then ease as activity continues, but return after activity ends. Occasionally bumps, swelling or warmth can be felt along the shin bone.
This is often a sports-related injury caused by stretching of muscle attachments along the shin bone during weight-bearing activities. A very flat foot can increase this traction force. Over-striding or forcible striking of the heel during walking, running or marching are also frequent causes. This explains why shin splints are common in the military.
Rest from the aggravating activity is the first priority. If this problem is not appropriately managed, it may develop into a stress fracture. Localized massage can release muscle tightness. Exercises include calf stretching to reduce resistance and strengthening of the stressed muscle groups to help absorb force. Ultrasound and ice can ease inflammation. For those people with a very flat foot, taping and orthotic inserts may help. A graduated return to sport needs to be supervised by the therapist.
Sprains may result in swelling and pain on the outside of the ankle near the ankle bone, limited movement, and sometimes inability to bear weight.
“Turning” or “rolling” of the ankle in an accident may over-stretch the ankle ligaments. The severity can vary significantly. A simple Grade 1 may limit activity for one to two weeks while a Grade 3 may hobble you for up to two months. This is the most common injury physicians treat, and it has the highest rate of recurrence. Hence the need to ensure complete rehabilitation.
Treatment begins with simple range of movement exercises and manual therapy to restore ankle joint mobility. Of more importance is the late stage of rehabilitation where exercises retrain the surrounding muscles to protect the ligaments from re-injury. This “proprioceptive” re-training is often overlooked by therapists and physicians, which explains the high rate of recurrence.
Pain around or under the kneecap may sometimes include “grinding” or “popping” of the kneecap. Pain gets worse when going up or down stairs, squatting and after getting up from sitting for an extended period.
A variety of factors may cause poor tracking of the kneecap on the femur. This may be due to imbalance in the thigh muscles, poor foot biomechanics, or weakness of the gluteal muscles.
Physical Therapy treatment involves identifying contributing factors and addressing these through corrective exercises and manual therapy. Taping of the patella may help re-educate an improved tracking mechanism. Appropriate footwear or supportive orthotics may improve poor foot biomechanics. Rest from aggravating activities and sports may relieve inflammation to allow corrective therapy treatment.
Immediate pain and swelling in the knee may follow an injury, and depending on severity, the knee may not be able to move normally or bear weight.
Four ligaments in the knee are subject to injury from falls or direct trauma. Although the knee functions well with normal activity, it is the most frequently injured joint in the body when exposed to trauma. Excessive twisting or stretching forces will overcome ligament structures, resulting in either sprain or tear. The direction of force will determine which ligament(s) are injured.
For a complete (grade 3) tear of the ligament, knee surgery will be indicated in most cases. Recovery after surgery will vary according to the surgeon’s protocol and the type and severity of the injury. For most partial tears (grades 1 or 2), surgery is not needed and a full recovery can be gained through personalized physical therapy. Treatment focuses on strengthening of the quadriceps, hamstring and gluteal muscles, while restoring normal mobility as the ligament heals. End-stage coordination exercises (also known as proprioceptive exercises) are needed to ensure an athlete or worker is ready to return to full activity. This will ensure the muscles react quickly in a coordinated manner to protect the knee from future trauma.
A “pop” is often felt or heard when a meniscal tear is sustained. Swelling increases gradually over the next 24 to 72 hours, and the knee stiffens. Initially, weight-bearing may be possible. The knee may “lock” or be unable to fully bend or straighten. A “giving-way” sensation is common with knee meniscal injuries.
Meniscal injuries may be either traumatic or degenerative in nature. Traumatic tears are due to high impact activity like tackling in sport, or sudden twisting and bending movements. Degenerative Injuries are due to a gradual thinning of the meniscus, often followed by a relatively small force causing a tear.
For large tears, a surgeon may repair or remove the meniscal. The downside to surgical intervention is that it often speeds up degenerative changes in the knee and increases the likelihood of needing a total knee replacement later in life. Physical therapy intervention focuses on joint mobilization techniques aimed at restoring normal movement. Once this is achieved, further treatment strengthens the quadriceps, calf, hamstring and gluteal muscles to prevent recurrence and decrease further stress on the meniscal structures. Ultrasound, ice, and electrical-stimulation help decrease inflammation in the initial stages of treatment. A knee brace may provide additional support.
Knee osteoarthritis (OA) symptoms include a deep ache, stiffness, and loss of ability to climb stairs, squat and walk or stand for prolonged periods. Swelling and warmth are associated with this condition, as well as weakness in the muscles surrounding the knee and occasionally stiffness in the hip joint.
This condition may be caused by a prior trauma, surgery, or simple “wear and tear”. Over time, the cartilage in the knee becomes thin and worn, leading to wear on the bone beneath the cartilage.
Common non-surgical treatment includes joint mobilization of the knee to unload the cartilage surfaces and to decrease stiffness. Strengthening of the hip and knee muscles help to decrease the stress on the knee joint and improve overall function. There is good evidence to support manual mobilization of the hip joint to decrease knee pain and improve function. Use of ice and electrical stimulation are useful in pain management. In more severe cases, a knee replacement is indicated. Many surgical advances have been made, and physical therapy following surgery is shown to significantly improve function and outcomes. Your therapist will coordinate with your physician to ensure a proper treatment plan.
Other knee conditions include Osgodd-Schlatters, Bakers Cyst, Patella Tendonitis, Hamstring Strains, Patella Dislocation/Subluxation. Physical therapy is helpful in all these conditions.