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-Three phased rehab
-Individualized and specific
-RTP anywhere from 2 - 6 weeks
-Pain during and after exercise
-Antalgic gait and impaired functional mobility
-Decreased ROM and flexibility of gastroc, soleus, and hamstring
-Weak foot intrinsic muscles
-Inadequate knowledge of condition and contributing factors
Goals: reduce pain, increase ROM, maintain CV fitness
Initial Steps: Reduce activity, weight bearing, and stress on area
Ensure: proper biomechanics
Modalities:
-Ice cup
-Soft tissue massage
Potential Exercises:
-Stretching (gastroc, soleus, hamstring)
-PROM of hip, knee, and ankle
-Short foot exercises
-Joint mobilizations of foot
-Toe box/alphabets
-Aquatic therapy
-Achieve normal gait and proper biomechanics
-Return to play in a pain free state
-Maintain CV fitness
-Strengthen foot intrinsics
-Patient Education
Progression:
-Pain free weight bearing
-Ability to perform light activity
-Proper biomechanics
Goals: Begin running progression, strengthen surrounding musculature, and maintain CV fitness
Goals: Full return to play, normal gait and biomechanics, normal strength
Running Progression: begin at 50% and bump up 10% per week as tolerated
Emphasize: ECCENTRICS
Exercises:
-Ankle manuals and strengthening
-Short foot exercises
-Plyometrics
-Calf raises and shuttle squats
-Heel/Toe walking
-Star drills
-Balancing exercises
-AROM of LL and hip with weight
Modalities: Cryotherapy
By the end of this phase athlete should have made a complete RTP!
Exercises:
-Stretching
-Ankle manuals
-Short foot exercises
-AROM activities of lower leg
-Plyometrics
-Calf raises and shuttle squats
Progression:
-Tolerate 75% intensity
-Full AROM of lower limb
-Stronger foot intrinsics
-Pain free
Weights should be increased as tolerated to build strength
Cross training should be done once per week
Once full RTP is made, athlete should continue to:
-Cross train weekly
-Strengthening and stretching (using eccentrics)
-Monitoring pain during and after activity
-Take time off if pain begins to present again
-More commonly known as shin splints
-Due to poor control of eccentric contractions and improper force absorption
-Presents as pain along the medial border of the tibia
-Can progress to stress fracture if not cared for
-Combination of muscle tightness and soreness, as well as of osteoclastic activity outpacing osteoblastic activity
MTSS is caused by improper force absorption and eccentric exercises should be practiced!
-Deals with muscles in compartments of lower leg and tibia
-Athlete will present with pain in lower leg
-Diffuse or pin point, worsens with activity
-History should be taken
-Training surface, volume, nutrition
-Biomechanics evaluated
-Special tests completed
-Percussion test
-Tuning fork
-Hop test
Found most commonly in:
-Runners
-Females
-High training volume
-Hard surfaces
-Improper footwear
-Poor biomechanics