Abstract
The proper rehabilitation of posterior lower leg injuries is critical in achieving optimal clinical outcomes. Successful rehabilitation requires collaboration between all parties involved in the care of the patient and an injury-specific program that is tailored to patient goals. Although each case is unique, following fundamental principles of rehabilitation and evidence-based approaches should be the basis for development of the rehabilitation program. This chapter reviews the literature and provides recommendations for the rehabilitation of the following structures and injuries: distal hamstring tendon, proximal gastrocnemius and soleus, musculotendinous junction of gastrocnemius and soleus, popliteus, neurovascular entrapment, tibialis posterior, flexor hallucis longus, chronic exertional compartment syndrome (CECS), Achilles tendon, retrocalcaneal bursa, posterior impingement, and Sever’s apophysitis.
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References
Armfield DR, Kim DH-M, et al. Sports-related muscle injury in the lower extremity. Clin Sports Med. 2006;25(4):803–42.
Lempainen L, Sarimo J, Mattila K, et al. Distal tears of the hamstring muscles: review of the literature and our results of surgical treatment. Br J Sports Med. 2007;41(2):80–3.
Bylund WE, de Weber K. Semimembranosus tendinopathy: one cause of chronic posteromedial knee pain. Sports. 2010;2(5):380–4.
Ropiak CR, Bosco JA. Hamstring injuries. Bull NYU Hosp Jt Dis. 2012;70(1):41–8.
Heiderscheidt BC, Sherry MA, Silder A, et al. Hamstring strain injuries: recommendations for diagnosis, rehabilitation and injury prevention. J Orthop Sports Phys Ther. 2010;40(2):67–81.
Scott A, Docking S, Vicenzino B, et al. Sports and exercise-related tendinopathies: a review of selected topical issues by participants of the second International Scientific Tendinopathy Symposium (ISTS) Vancouver 2012. Br J Sports Med. 2013;47:536–44.
Copeland ST, Tipton JS, Fields KB. Evidence-based treatment of hamstring tears. Curr Sports Med Rep. 2009;8(6):308–14.
Wilson JJ, Best TM. Common overuse tendon problems: a review and recommendations for treatment. Am Fam Phys. 2005;72:811–8. (Internet) (Cited 2013 Jul 6). www.aafp.org/afp.
Carlson C. The natural history and management of hamstring injuries. Curr Rev Musculoskelet Med. 2008;1:120–3.
Sherry MA, Best TM. A comparison of 2 rehabilitation programs in the treatment of acute hamstring strains. J Orthop Sports Phys Ther. 2004;34(3):116–25.
Zebis MK, Skotte J, Andersen CH, et al. Kettlebell swing targets semitendinosus and supine leg curl targets biceps femoris: an EMG study with rehabilitation implications. Br J Sports Med. 2012. doi:10.1136/bjsports-2011-090281. (Published Online First).
Brukner P, Nealon A, Morgan C, et al. Recurrent hamstring muscle injury: applying the limited evidence in the professional football setting with a seven-point programme. Br J Sports Med. 2013. doi:10.1136/bjsports-2012-091400. (Published Online First).
Ahmad CS, Redler LH, Ciccotti MG, et al. Evaluation and management of hamstring injuries. Am J Sports Med. 2013;20(10):1–15. (Internet) (Cited 2013 Jul 6). http://www.sagepub.com/journalsPermissions.nav.
Cavalier R, Gabos PG, Bowen JR. Isolated rupture of the soleus muscle: a case report. Am J Orthop. 1998;27:755–7.
McClure JG. Gastrocnemius musculotendinous rupture: a condition confused with thrombophlebitis. South Med J. 1984;77:1143–5.
Dixon B. Gastrocnemius vs. soleus strain: how to differentiate and deal with calf muscle injuries. Curr Rev Musculoskelet Med. 2009;2:74–7.
Cardinal É, Rethy K. et al. Ultrasound-guided interventional procedures in the musculoskeletal system. Radiol Clin North Am. 1998;36(3):597–604.
Shields CL, Redix L, Brewster CE. Acute tears of the medial head of the gastrocnemius. Foot Ankle. 1985;5(4):186–90.
Kwak H-S, Han Y-M, Lee S-Y, et al. Diagnosis and follow-up US evaluation of ruptures of the medial head of the gastrocnemius (“tennis leg”). Korean J Radiol. 2006;7(3):193–8.
Elias DA, White LM, Rubenstein JD, et al. Clinical evaluation and MR imaging features of popliteal artery entrapment and cystic adventitial disease. Am J Roentgenol. 2003;180:627–32.
Tercan F, Oğuzkurt L, Kızılkılıç O, et al. Popliteal artery entrapment syndrome. Diagn Interv Radiol. 2005;11(4):222–4.
Nunes GS. Effect of Kinesio taping on jumping and balance in athletes: a cross-over randomized controlled trial. J Strength Cond Res. 2013;27:3183–9.
Stedge HL, Kroskie RM, Docherty CL. Kinesio taping and the circulation and endurance ratio of the gastrocnemius muscle. J Athl Train. 2012;47:635.
Perkins RH, Davis D. Musculoskeletal injuries in tennis. Phys Med Rehabil Clin N Am. 2006;17(3):609–631.
Touliopolous S, Hershman EB. Lower leg pain. Sports Med. 1999;27(3):193–204.
Campbell JT. Posterior calf injury. Foot Ankle Clin N Am. 2009;14(4):761–71.
Kwak HS, Lee KB, Han YM. Ruptures of the medial head of the gastrocnemius (“tennis leg”): clinical outcome and compression effect. Clin Imaging. 2006;30(1):48–53.
Nyland J, Lachman N, Kocabey Y, et al. Anatomy, function and rehabilitation of the popliteus musculotendinous complex. J Orthop Sports Phys Ther. 2005;35(3):165–179.
Blake SM, Treble NJ. Popliteus tendon tenosynovitis. Br J Sports Med. 2005;39:e42.
HwangK, Lee KM, Han SH, Kim SG. Shape and innervation of popliteus muscle. Anat Cell Biol. 2012;43(2):165.
Hall CM, Brody LT. Therapeutic exercise moving toward function. 2nd ed. Philadelphia: Lippincott Williams and Wilkins; 2005. p. 283–308. Chapter 15, Closed kinetic chain training.
Fu SC, Hung LK, Shum WT, et al. In vivo low-intensity ultrasound following tendon injury promotes repair during granulation but suppresses dcorin and biglycan expression during remodeling. J Orthop Sports Phys Ther. 2010;40(7):422–9.
Pescasio M, Browning BB, Pedowitz RA. Clinical management of muscle strains and tears. J Musculoskelet Med. 2008;25(11):1–9.
Brown CL, Gilbert KK, Brismee JM, SizerPS, James CR, Smith MP. The effects of neurodynamic mobilization on fluid dispersion within the tibial nerve at the ankle: an unembalmed cadaveric study. J Man Manip Ther. 2011;19(1):26–34.
Ellis RF, Hing WA, McNair PJ. Comparison of longitudinal sciatic nerve movement with different mobilization exercises: an in vivo study utilizing ultrasound imaging. J Orthop Sports Phys Ther. 2010;42(80):667–75.
Boyd BS, Topp KS, Coppieter MW. Impact of movement sequencing on sciatic and tibial nerve strain and excursion during the straight leg raise test in embalmed cadavers. J Orthop Sports Phys Ther. 2013;43(6):398–403.
Settergren R. Conservative management of a saphenous nerve entrapment in a female ultra-marathon runner. J Bodyw Mov Ther. 2013;17:297–301.
Howitt S, Jung S, Hammonds N. Conservative treatment of a tibialis posterior strain in a novice triathlete: a case report. J Can Chiropr Assoc. 2009;53(1):23–31.
Galbraith R, Lavallee ME. Medial tibial stress syndrome: conservative treatment options. Curr Rev Musculoskelet Med. 2009;2:127–33.
Kohls-Gatzoulis J, Angel JC, Singh D, Haddad F, Livingstone J, Berry G. Tibialis posterior dysfunction: a common and treatable cause of adult acquired flatfoot. Br Med J. 2004;329:1328–33.
Schon LC, DiStefano AF. Ecaluation and treatment of posterior tibialis tendinitis a case report and treatment protocol. J Dance Med Sci. 1999;3(1):24–7.
Wilson JJ, Best TM. Common overuse tendon problems: a review and recommendations for treatment. Am Fam Physician. 2005;72(5):811–8. (Review).
Jarvinen TA, Jarvinen TL, Kaariainen M, et al. Muscle injuries: optimizing recovery. Best Pract Res Clin Rheumatol. 2007;21:317–31. doi:10.1016/j.berh.2006.12.004.
Ferber R, a H, Kendall KD. Suspected mechanisms in the cause of overuse running injuries: a clinical review. Sports. 2009;1(3):242–6.
Beiner JM, Jokl P, Cholewicki J, et al. The effect of anabolic steroids and corcitosteroids on healing of muscle contussion injury. Am J Sports Med. 1999;27(1):2–9.
Markert CD, Merrick MA, Kirby TE, et al. Nonthermal ultrasound and exercise in skeletal muscle regeneration. Arch Phys Med Rehabil. 2005;86(7):1304–10.
Proske U, Morgan DL. Muscle damage from eccentric exercise: mechanism, mechanical signs, adaptation and clinical applications. J Physiol. 2001;537(Pt 2):333–45. (Review).
Michael R, Simpson, DO, MS, Thomas M, Howard, MD. Tendinopathies of the foot and ankle. Am Fam Physician. 2009;80(10):1107–14.
Doan-Johnson S. Flexor hallucis longus tenosynovitis. OrthopOne. 2012. http://www.orthopaedicsone.com/display/Main/Flexor+hallicus+longus+tenosynovitis.
George J, Kolettis MD, Lyle J, et al. Release of the Flexor hallucis longus tendon in ballet dancers. J Bone Joint Surg. 1996;78-A(9):1386–90.
Itzhak Siev-Ner MD. Common overuse Injuries of the foot and ankle in Dancers. J Dance Med Sci. 2000;4(2):49–53.
Christine L, Berglung SPT, Laura E, Philipps SPT, Sheyi Ojofeitimi MPT. Flexor hallucis longus tendinitis among dancers. Orthop Pract. 2006;18(3):26–31.
Conti SF, Wong YS. Foot and ankle injuries in the dancer. J Dance Med Sci. 2001;5(2):48.
Rowdon GA. Chronic exertional compartment syndrome. Updated Mar 7, 2013. http://emedicine.medscape.com/article/88014-overview.
American Academy of Orthopaedic Surgeons. Compartment syndrome. Last reviewed Oct. 2009. http://orthoinfo.aaos.org/topic.cfm?topic=A00204.
Varelas FL, Wessel J, Clement DB, Doyle DL, Wiley JP. Muscle function in chronic compartment syndrome of the leg. J Orthop Sports Phys Ther. 1993;18(5):586–589.
Forefoot Running for Chronic Exertional Compartment Syndrome. Posted on 30 May, 2012 by the sports physiotherapist in article review, blog, exercise prescription, foot and ankle, rehabilitation, sports physiotherapy, treatment. http://www.thesportsphysiotherapist.com/forefoot-running-for-chronic-exertional-compartment-syndrome/.
Knobloch, Karsten JM, et al. Eccentric training decreases paratendon capillary blood flow and preserves paratendon oxygen saturation in chronic Achilles tendinopathy. J Orthop Sports Phys Ther. 2007;37(5):269.
Sandmeier R, Renström PA. Diagnosis and treatment of chronic tendon disorders in sports. Scand J Med Sci Sports. 1997;7(2):96–106.
Neeter C, et al. Iontophoresis with or without dexamethazone in the treatment of acute Achilles tendon pain. Scand J Med Sci Sports. 2003;13(6):376–82.
Stanish WD, Mitchell Rubinovich R, Curwin S. Eccentric exercise in chronic tendinitis. Clin Orthop Relat Res. 1986;208:65–8.
Alfredson H, et al. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med. 1998;26(3 ):360–6.
Miners AL, Bougie TL. Chronic Achilles tendinopathy: a case study of treatment incorporating active and passive tissue warm-up, Graston Technique®, ART®, eccentric exercise, and cryotherapy. J Can Chiropr Assoc. 2011;55(4 ):269.
Norregaard J, et al. Eccentric exercise in treatment of Achilles tendinopathy. Scand J Med Sci Sports. 2007;17(2):133–8.
Roos EM, et al. Clinical improvement after 6 weeks of eccentric exercise in patients with mid‐portion Achilles tendinopathy–a randomized trial with 1‐year follow‐up. Scand J Med Sci Sports. 2004;14(5 ):286–95.
Wasielewski NJ, Kotsko KM. Does eccentric exercise reduce pain and improve strength in physically active adults with symptomatic lower extremity tendinosis? A systematic review. J Athl Train. 2007;42(3):409.
Sharma P, Maffulli N. Biology of tendon injury: healing, modeling and remodeling. J Musculoskelet Neuronal Interact. 2006;6(2):181.
Melham TJ, et al. Chronic ankle pain and fibrosis successfully treated with a new noninvasive augmented soft tissue mobilization technique (ASTM): a case report. Med Sci Sports Exerc. 1998;30:801–4.
McCormack JR. The management of mid-portion achilles tendinopathy with Astym® and eccentric exercise: a case report. Int J Sports Phys Ther. 2012;7(6):672.
Van Dijk CN, et al. Terminology for achilles tendon related disorders. Knee Surg Sports Traumatol Arthrosc. 2011;19(5):835–41.
Thomas JL, et al. The diagnosis and treatment of heel pain: a clinical practice guideline—revision 2010. J Foot Ankle Surg. 2010;49(3):S1–S19.
McBryde J, Angus M, Fred W, Ortmann IV. Retrocalcaneal bursoscopy. Tech Foot Ankle Surg. 2005;4(3):174–9.
Solan M, Davies M. Management of insertional tendinopathy of the Achilles tendon. Foot Ankle Clin N Am. 2007;12(4):597–615.
Yeung EW, Yeung SS. A systematic review of interventions to prevent lower limb soft tissue running injuries. Br J Sports Med. 2001;35(6 ):383–9.
Schepsis AA, Jones H, Haas AL. Achilles tendon disorders in athletes. Am J Sports Med. 2002;30(2):287–305.
Luk P, Thordarson D, Charlton T. Evaluation and management of posterior ankle pain in dancers. J Dance Med Sci. 2013;17(2):79–83.
Sofka CM. Posterior ankle Impingement: clarification and confirmation of the pathoanatomy. HSSJ. 2010;6:99–101.
Gasparetto F, Collo G, Pisanu G, Villella D, Drocco L, Cerlon R, Bonasia E. Posterior ankle and subtalar arthroscopy: indications, technique, and results. Curr Rev Musculoskelet Med. 2012;5:164–70.
Kadel NJ. Foot and ankle injuries in dance. Phys Med Rehabil Clin N Am. 2006;17:813–26.
DeLee JC, Drez’s DD. Orthopaedic sports medicine. 3rd ed. Philadelphia: Saunders; 2009.
Howard PD. Differential diagnosis of calf pain and weakness: flexor hallucis longus strain. J Orthop Sports Phys Ther. 2000;30(2):78–84.
Cipriani DJ, Swartz JD, Hodgson CM. Triathlon and the multisport athlete. J Orthop Sports Phys Ther. 1998;27(2):42–50.
Albisetti W, Ometti M, Pascale V, De Bartolomeo O. Clinical evaluation and treatment of posterior impingement in dancers. Am J Phys Med Rehabil. 2009;88(5):349–54.
Smith TR. Management of dancers with symptomatic accessory navicular: 2 case reports. J Orthop Sports Phys Ther. 2012;42(5):465–73.
Vasukutty NV, Akrawi H, Theruvil B, Uglow M. Ankle arthroscopy in children. Ann R Coll Surg Engl. 2011;93:232–5.
Kolettis GJ, Micheli LJ, Klein JD. Release of the flexor hallucis longus tendon in ballet dancers. J Bone Joint Surg. 1996;78-A(9):1386–90.
Pommering TL, Kluchurosky L, Hall S. Ankle and foot injuries in pediatric and adult athletes. Prim Care Clin Office Pract. 2005;32:133–1.
Gillespie H. Osteochondroses and apophyseal injuries of the foot in the young athlete. Curr Sports Med Rep. 2010;9(5):265–68.
Cassas KJ, Cassettari-Wayhs A. Childhood and adolescent sport-related overuse injuries. Am Fam Physician. 2006;73:1014–22.
Cipriani DJ, Swartz JD, Hodgson CM. Triathlon and the multisport athlete. J Orthop Sports Phys Ther. 1998;27(1):42–50.
Howard PD. Differential diagnosis of calf pain and weakness: flexor hallucis longus strain. J Orthop Sports Phys Ther. 2000;30(2):78–84.
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Baldea, J. et al. (2016). Rehabilitation of Injuries in the Posterior Leg. In: Dixon, J. (eds) Muscular Injuries in the Posterior Leg. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-7651-2_11
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