By Susan Hardin Rocchini, PT, DPT, OCS, MTC
If you have taken a break from exercise during the Chicago winter, you might be looking to return to a variety of exercises as summer nears. As physical therapists, we often see a surge in overuse, repetitive type of injuries in the upcoming season. We commonly see lower extremity overuse injuries and understanding common injuries may help you to discern the source of a pain you might be experiencing.
Achilles Tendonitis/Tendinopathy: This condition results in pain at the back of the ankle near the heel or at the lower part of the calf where the muscle blends into the tendon. Problems at the tendon can develop at the insertion of the tendon at the heel bone or about 2.5 inches from the heel towards the calf. Problems in the Achilles tendon are hte results of overloading due to repetitive microtrauma. The inflammation of the tendon and the sheath that surrounds the tendon can cause the pain, but much of the dysfunction is due to the microtears that develop in the tendon with overuse. This overuse injury accounts for up to 9% of injuries in elite and recreational runners. Achilles tendonitis/tendinopathy more often occurs in older runners, and males are three times more likely than females to experience the condition. (1) Overuse may occur when increasing running or walking distance too rapidly, wearing improper shoe wear, increasing time spent running or walking on an incline, or performing repetitive jumping activities. Certain risk factors also predispose one to the problem, such as decreased range of motion at the ankle, decreased strength around the ankle, and other health conditions such as diabetes, obesity, and hypertension, to name a few. Treatment is focused on modifying and minimizing tendon loading through activity modification, bracing, and education.
Posterior Tibial Tendonitis/Tendinopathy: Inflammation and breakdown of the posterior tibial tendon, which runs along the inner ankle and ankle bone and attaches to the bottom of the foot, results in posterior tibial tendonitis or tendinopathy. Pain is typically localized in the bottom of the foot or the inside part of the ankle or lower leg, and this problem is more common in women and those who are overweight. In addition to pain in the region, one may notice weakness of the foot and ankle, especially when rising up onto the toes. Overuse and irritation of the tendon may occur with any increase in weight bearing exercise and could be exacerbated by improper shoe wear combined with a flat foot. Treatments may include bracing and/or orthotics , education about proper shoe wear, improving muscle length and strength around the ankle and leg, and addressing any altered joint mechanics and gait mechanics.
Patellar Tendonitis/Tendinopathy: Inflammation of the tendon that is just below the kneecap can cause pain, swelling and inflammation at the front of the knee. This condition can be caused by a sport that involves impact, such as basketball, running, or any other activity that involves jumping. Even those who are not participating in a sport, but increase activity too quickly, may encounter this problem. Ultimately, the tendon pain is caused by excessive use and load on the tendon that cannot sustain the forces applied, resulting in inflammation and small microtears in the tendon.
Predisposing factors include muscle imbalances around the knee and hip, as well as shortening of any of the thigh muscles, especially the quadriceps muscle. Symptoms and pain can be exacerbated by running downhill and when descending stairs, as these activities place a significant load on the tendon. Treatment is directed towards gaining proper flexibility of the surrounding muscles, strengthening of the hip and thigh muscles, as well as modification of activity to decrease forces through the tendon, which may include bracing around the knee.
Iliotibial (IT) Band Syndrome: The iliotibial band is a fibrous band of connective tissue that originates at the outer hip and inserts into the outer part of the knee. Pain at the outer part of the knee may be a symptom of IT band syndrome and lateral knee pain in runners is often caused by this syndrome. People may be able to run a significant distance and not feel the pain after getting warmed up, but they will frequently have pain after the activity and this trend generally worsens as the condition worsens. This condition commonly afflicts runners, cyclists and participants in any sport or activity in which the knee is repetitively bending and straightening. The problem and pain is theorized to come from excessive friction between the band and the bone at the outer knee, especially if the IT band is shortened, creating a compression of the fat and connective tissue deep to the IT band, or an inflammation of the fluid filled sac (bursa) that lies between the bone and the tendon insertion on the bone. (2) Risk factors for development of IT band syndrome include increasing activity too quickly or increasing the intensity of an activity too quickly, such as increasing uphill running too aggressively. Other factors that may predispose one to the condition include altered alignment of the lower extremity, weakness of the outer hip musculature, and shortening of the muscles around the thigh and hip including tightness of the IT band. Treatment includes normalizing muscle length and strength around the thigh and hip, modifying activity, bracing to unload the tendon, and evaluation of lower extremity biomechanics statically and dynamically to assess any dysfunction.
Should you experience pain similar to these problems, you may be an excellent candidate for treatment by a physical therapist. Our complimentary injury screens can help you identify which of these factors might be causing your pain, identify a strategy to address them, and return you to your favorite spring and summer exercise activities!
- Satyendra, L. et al. Effectiveness of physical therapy for Achilles tendinopathy: An evidence based review of eccentric exercises. Isokinetics and Exercise Science . 14 (2006) 71–80.
- Strauss, E. et al. Iliotibial Band Syndrome: evaluation and management. Journal of the Academy of Orthopaedic Surgeons. 2011. Vol (19) 12, 728-29.