Leg injuries are very common in the US population simply because we are largely a sitting society. A lot of time is being spent in a seated position - whether during work, in the car, or when relaxing and socializing - almost all activities are spent in a chair. Over time, muscles of the leg become atrophied from non-use and muscle strength will get gradually reduced.
When muscle strength in the leg diminishes, more emphasis of force and load is put on joints and ligaments of the knee for stability and motion. Over time, we start to develop arthritis and wear-and-tear on cartilage as we move around and perform daily or recreational activities. Ligaments and tendons are also heavily dependent upon for angular and joint stability when muscle strength is lacking, and this can cause pain and derail the patient’s ability to return to sport.
The following are some of the most common injuries that can benefit from our leg injury therapy here at Stride Strong's Portland physical therapy clinics.
Hamstring Injury Therapy
Hamstring injuries occur usually as a result of sports-related activities, but non-sports-related hamstring injuries can also happen. The hamstring muscle or tendon is usually strained when a load is given to it that cannot yet handle. This overloading can happen either via increased frequency or increased force on the muscle. For example, in the case of weekend warriors who sit for a majority of their week, only to play competitive games of basketball on the weekend, this transition from no-loading to full-loading ignores the body’s need for muscle tissue adaptation to exercise and tears can occur.
The duration of physical therapy after a hamstring tear will largely depend on the severity of the tear, and whether the tendon is involved. Because tendons receive less blood flow than the muscle belly, healing may be slow in a torn hamstring tendon.
Hamstring injuries also tend to re-occur either because of the muscle not completely healing prior to loading it with an activity, or the patient may be continuing to perpetuate bad habits of loading the muscle too hard and too fast without the appropriate muscle conditioning.
Leg physical therapy is very helpful with healing hamstring injuries so that adequate stimulation, progressive loading and tissue healing can occur. This comes by way of soft tissue mobilization, stiff and contracted areas of the muscle, along with progressive therapeutic exercise to strengthen the muscle system. In addition to this, Stride Strong Physical Therapists put our patients through a Video Gait Analysis to watch patients walk and run to detect any walking or running abnormalities that could be straining the hamstring system excessively. Usually, the biggest deficit that we detect in patients with hamstring injuries is glutenal and hip weakness.
IT Band Syndrome
IT Band Syndrome is a common complaint of runners and patients who perform sports with a largely running component to it. The IT Band is a thick band of fascia on the side of our thighs that afford us lateral stability when performing single-leg activities. Running is an activity where we shift body weights from one leg to the other, like a pogo stick. Through this repetitive activity and with longer distance running , the IT Band can be overstrained. The fascia also shares fiber connections with a hamstring muscle and also the lateral knee so pain can felt anywhere from the side of thigh, to the back of the thigh, to the side of the knee.
The typical home remedy for IT Band Syndrome is foam rolling to break up any restrictions, adhesions from inflammation, and to soothe irritation of the IT Band. Although this may temporarily solve the pain and tightness felt, this should be relied upon as the cure-all for IT Band pain. There are other lateral structures at play in running that could present themselves as weak. When these muscles are not able to stabilize the pelvis during single limb stance, the IT Band is recruited to take the load. Therefore, strengthening these structures, namely the gluteus medius muscle, can help tremendously in offloading the pressure on the IT Band.
Additionally, the runner’s gait need to assesses and analyzed to see how other joints are behaving that could provide some information for why the IT Band is getting continually strained. At times, an overly flexed hip while running can predispose the runner to IT Band Syndrome.
When seen by an expert physical therapist, IT Band issues can resolve as quickly as 2 weeks. If the patient waits too long to be treated, the pain and irritation in the tissues may last significantly longer.
Knee Pain Treatment
A large number of patients in the United States suffer from knee pain. There are many causes for it ranging from osteoarthritis to ligamentous injuries to the bad knee mechanics leading to mal-tracking of joints. The main reason why there is a large number of knee patients suffering from knee pain is largely because the knee does not possess much musculature. The muscles of the leg usually pass through the knee joint and attach to bone above and below the joint to allow for control of it, but there are no direct muscles or tendons that directly affects his movement other than a small muscle in the back of knee called the popliteus. Therefore, the knee joint is known more as a passive joint, one that is affected by the activation of muscles and joints above and below it. It is thus not surprising that wear and tear would easily happen to this middle connection.
The knee is largely controlled by the large muscle groups of the hip and thigh. Its stability and strength comes from them but when hip and quad muscles become weak from disuse or injured from overuse, the knee suffers through extra aberrant motion. Likened to the neck of a straw, then the forces tug on too much from all directions, the neck of the straw will start to tear (and in some cases snap!) and damage ensues. Physical therapy, therefore, is focused on strengthening the muscles and stability of the hip and foot.
Physical Therapy leg treatments should also strive for better biomechanics in all activities. Knee pain is usually aggravated with stair stepping down or up stairs and your physical therapist will need to watch you do these maneuvers - in addition to walking - to correct for poor mechanics that may be contributing to your knee pain.
Meanwhile, home remedies outside of leg injury therapy include cold therapy and electric stimulation via a TENS unit. Regular cardiovascular activities that promote bending and straightening the knee, but not excessive weight bearing and loading (i.e., biking and swimming) can help with swelling reduction and muscle activation to bridge the therapy gap between PT visits.
Total Knee Replacement Physical Therapy
With the baby boomers entering the age range for osteoarthritis, total knee replacements are on the rise. Total knee replacement surgery is warranted when arthritis and cartilage wear in the knee is so severe that it starts affecting quality of life dramatically. The patient may not be able to ascend or descend stairs at all, and any amount of weight bearing at this stage is intolerable.
Total knee replacements offer the patient the option of increased quality of life with the prosthetic joint. Usually, this involves a prosthetic titanium femur and prosthetic tibia component that smoothes out the articulation between these bones. Total knee replacements allow patients to return to full community ambulation after physical therapy is finished.
However, it must be mentioned that leg therapy and rehabilitation after a total knee replacement can be a long and arduous process because of the amount of scar tissue and trauma that the knee has endured. A total knee replacement is a very involved surgery and patient will need to recover from the pain from surgery trauma. Outcomes fare the best with patients who begin their physical therapy treatments BEFORE their total knee replacement is to happen. This allows the physical therapist to help with swelling control before the surgery. Your PT will also start work on strengthening the essential muscles that help knee rehabilitation: mainly the gluteal muscles, core muscles and balance muscles. There is a lot of planning and preparation for surgery and rehab that would assist in fast healing after surgery so your therapist will go over scar and wound care, exercise frequency, bed mobility and toileting/bathing tips.
After surgery, the focus will be on gaining range of motion, and further working on strength. It is important to not underload or overload the knee after surgery. Too little exercise, and muscle strength would be hard to gain - the result is sometimes prolonged disability and pain. Too much exercise, and that could cause the knee the swell and derail the physical therapy schedule a bit. Close communication with your trusted physical therapist is needed to calibrate exercise dosage so healing is maximized.
Meniscus tears can feel like sharp pain in the knee joint. Loading and weight bearing - especially during squatting and lunging - are typical aggravating factors. Tears can vary from small nicks to severe “bucket-handle tears” (describing crescent-shaped tears that look like bucket handles). Typical causes for meniscus tears tend to be traumatic - sudden pivoting motions of the knee, falling at an awkward angle, etc.
It used to be that the immediate intervention for knee meniscus tears would be orthopedic arthroscopic surgery regardless of the severity of the tear. But recent evidence in the past few years have shown that arthroscopic surgery may not be as effective as physical therapy for knees with minimal to moderate tears. It is therefore suggested that patients try conservative leg treatment with physical therapy first before considering surgery.
Physical Therapy for knee meniscus tears involves swelling control with manual therapy, cold therapy, and kineseotaping. Therapeutic exercise is a must when it comes to normalizing gait and strength. Biomechanics corrections will likely be needed to make sure that the knee joint tracks correctly when performing daily and sports activities. If 6 weeks of therapy does not provide significant gains in function and pain levels, the patient should be referred out to an orthopedist for further imaging and possibly surgery.
Shin splints are another common complaint from long distance runners and walkers. Shin splint pain feels very much like a soreness along the shin, usually on the inside of the shaft but can present on the top side of the shaft. The name “shin splints” is a misnomer because it does not necessarily mean that the shin is splinting, but rather it describes the pain that the runner is feeling.
Shin splints usually occur because of inadequate tissue adaptation when starting an exercise regime. Muscles along the lower leg control for the foot and when walking or running distances increase, these muscles are strained more and more.
Physical Therapy is very effective in helping with shin splints. Manual therapy is given to the affected muscles to help with tissue strain and taping/orthotics may be prescribed to help offload the muscles during activity. Your physical therapist may also recommend activity modification so the strain is not repetitively damaging the tissues. Strengthening the tibial muscles later on in the leg injury treatment progression would also help the runner/walker acclimate to stresses of long distance running and walking.
Although the fix for shin splints may be simple and effective, simple shin splints may be masking something more severe. Only a trained Doctor of Physical Therapy can discern posterior compartment syndrome, actual stress fractures in the lower leg and shin splints. When the therapist has doubts about the diagnosis of shin splints, further insights by a podiatrist or an orthopedist may be necessary. If the limb is swollen, red and has unrelenting pain, this may signal something more severe.
Stride Strong Physical Therapy aims its largest emphasis on disorders of the lower extremity. This is why we have Video Gait Analysis equipment at each of our locations, and why we have a dedicated walking track so we can properly view and analyze our patients’ walking and running biomechanics. We believe strongly in leg injury therapy, the healing power of strengthening and exercise, which is the crux for majority of leg injuries. Call today, schedule an appointment at our physical therapy clinics in the Beaverton and Hillsboro areas, so you can start Striding Stronger.