Sports Injury.pptx

Sports Injury basic knowledge is addressed here

1. Sports Injury Dr. Satyen Bhattacharyya Associate Professor: BIMLS, Bardhaman www.fitofine.in

2. DEFINITION A sports injury is any bodily damage sustained during participation in competitive or noncompetitive athletic activity. Sports injuries can affect bones or soft tissue ( i.e , muscles, ligaments, tendons).

3. DESCRIPTION Sports injuries are identified as either acute or chronic. Acute sports injuries are characterized by the sudden appearance of symptoms, usually associated with a single traumatic accident. Signs and symptoms of acute sports injuries include pain, swelling, and deformity in the affected area, and in the joint injuries, limited ability to move the joint. Common acute sports injuries include sprains and strains, contusions ( i.e , serious bruises), joint dislocations, bone fractures, and concussions.

4. CLASSIFICATION Among the various classifications proposed for sports injuries the one proposed by WILLIAMS (1971) is widely used and recommended.

5. TYPES OF SPORTS INJURY Acute :- An injury that occurs suddenly such as a sprained ankle caused by an awkward landing is known as an acute injury. E.g , Acute tenosynovitis of wrist extensors in canoists . Chronic :- Chronic injuries are caused by repeated overuse of muscle groups or joints. Poor technique and structural abnormalities can also contribute to the development of chronic injuries.E.g , March fracture in soldiers.

6. Overuse injury :- These are caused by excessive and repeated use of the same muscle, joint or bone.

7. Soft tissue injury Muscle sprains, Strains and Bruises Hard tissue Joints and Bones Dislocated joints Fractured bones

8. Most common sports injuries in upper limb. Shoulder complex : Rotator cuff injury Shoulder dislocation Fracture clavicle : Bicipital tendinitis or rupture Elbow : Tennis elbow Golfer's elbow

9. Wrist : Wrist pain Carpal tunnel syndrome HAND: Mallet injury Baseball finger Jersey thumb

10. Most common sports injuries in LOWER limb HIP Quadriceps strain Hip pain Groin pain due to adducter strain KNEE JOINT Jumpers knee Fracture patella Knee ligaments injuries Meniscal injuries.

11. LEGS Calf muscle strain Hamstrings sprain Ankle injuries Ankle sprain Injury to Achilles tendon

12. Foot March fracture Jones fracture

13. SHOULDER COMPLEX:

14. Rotator cuff injury The rotator cuff is made up of 4 group of muscles. The muscles include the supraspinatus , infraspinatus , teres minor and subscapularis . The scapula is responsible for stabilizing the glenohumeral joint, abducting, externally rotating and internally rotating the humerus .

15. Injury in sports Rotator calf injury is common in athletes and sports persons. Supraspinatus and Infraspinatus are the most commonly injured rotator cuff muscles particularly in sports which involve a lot of shoulder rotation for example bowling in cricket, pitching in baseball, swimming and kayaking. The injury is also more common in the older athlete, particularly where long term overuse or degeneration is present.

16. Supraspinatus tendon tear

17. MECHANISMS

18. CAUSES: Repetitive stress: Repetitive overhead movement of the arms can stress the rotator cuff muscles and tendons causing inflammation and eventually tearing. Impingement : Falls or incorrect throwing techniques or arm movements and weak shoulder muscles may cause the humerus to move up and trap the tendon.

19. Calcium deposits : Calcium may deposits in the tendons due to decrease oxygen and poor blood supply. This deposits may cause irritation and inflammation. Normal wear and tear : The rotator cuff tendons can degenerate due to ages ( starting around 40). This can cause a breakdown of fibrous protein ( collagen) in the cuff’s tendon and muscles.

20. Symptoms Pain in shoulder and radiate to arm. Difficulty in movement especially to abduction. Loss of range of motion.

21. I N VESTIGATION Arthography X RAY MRI Arthroscopy

22. TREATMENT Initial Care,Rest the shoulder,Ice pack Immobilize the shoulder by sling Medicine Anti inflammatory drug Surgery (If there is a large tear in rotator cuff, surgery may be needed to repair the rotator cuff. This is two type open repair through 6 to 10 cm incision or as an arthroscopic incision).

23. PHYSIOTHERAPY MANAGEMENT During the initial acute stage rest in the sling. Cryotherapy , UST, TENS, SWD During the later stages Isometric exercises for shoulder joint muscles, Mobilization of shoulder joint. Exercise- Gravity eliminated abduction, Flexion extension exercises, pendulum swing. UST, TENS, SWD.

24. TREATMENTS

25. PREVENTION Warm up stretching and strengthening of the shoulder muscles. Avoiding certain sports which constantly cause friction to the shoulder. Avoiding sudden jerky movements and abrupt lifting of heavy weights.

26. shoulder DISLOCATION Shoulder dislocations occur when the head of the humerus pops out of the shoulder joint. It occurs more commonly in adults, and is rare in children.

27. TYPES OF DISLOCATION Anterior Dislocation In this injury, the head of the humerus comes out of the glenoid cavity and lies anteriorly. This dislocation is more common the other dislocations. Subtypes depending on the position of the dislocated head,Preglenoid Head lies in front of the glenoid. Subcoracoid Head lies below the coracoid process. Subclavicular Head lies below the clavicle.

28. Posterior Dislocation In this injury, the head of the humerus comes to lie posteriorly behind the glenoid. Inferior dislocation (Luxatio erecta) This is the rare type where the head comes to lie in the subglenoid position.

29. Causes Shoulder joint is the commonest joint in the body to dislocate. Shoulder joint is more mobile than stable. The glenoid cavity is small than the head of the humerus.

30. Injury in sports Shoulder dislocation common in Football, Hockey, Gymnastic, downhill skiing, Volleyball.

31. SYMpTOMS The patient enters the casualty with his shoulder abducted and the elbow is supported with opposite hand. Pain Inability to move the shoulder.

32. INVESTIGATION X-ray CT Scan

33. TREATMENT For acute dislocation reduction under sedation or general anaesthesia followed by immobilisation of the shoulder in a chest arm bandage for three weeks. Techniques of reduction Kocher’s manoeuvre- Most commonly used method. The steps are as follows- i)Traction ii)External rotation iii)Adduction iv)Internal rotation

34. PHYSIOTHERAPY MANAGEMENT

35. 3 weeks later Strapping are removed and the limb is supported in a sling Shoulder Mobilization is done Flexion extension then abduction and ext. rotation Strengthening exercises

36. FRACTURE CLAVICLE The clavicle is a S shaped bone that act as a structure between the sternum and the glenohumeral joint. It gives power and stability of the arm, motion of the shoulder gridle, protects neuro vascular structures.

37. MECHANISM OF INJURY Direct Due to fall on the point of the shoulder. This is the most common mode of injury. Direct trauma Over the clavicle due to assault RTA. Indirect Fall on the outstretched hands.

38. INJURY IN SPORTS Fracture in clavicle common in football, Biking, skating, ice hockey etc.

39. SYMPTOMS

40. DIAGNOSIS X-ray CT scan

41. TREATMENT It may be conservative or surgical. Conservative Treatment Supports the arm in a sling Until the pain subside, usually 1 to 3 weeks. Figure of 8 bandage. Clavicle ring, Analgesics. Rehabilitation The patient should be instructed regarding hand, wrist and elbow exercises during immobilization. And regarding shoulder exercises once fracture healed.

42. Surgical Treatment Closed reduction and percutaneous fixation with K-wires Open reduction and internal fixation with plate screws.

43. COMPLICATION

44. BICIPITAL TENDINITIS Bicep tendinitis is an inflammation of the upper biceps tendon. Also called the long head of the biceps tendon, this strong, cord like structure connects the biceps muscle to the bones in the shoulder. Pain in the front of the shoulder and weekness are common symptoms of biceps tendinitis.

45. Causes Damage to the biceps tendon is due to a lifetime of normal activities or overuse repeating the same shoulder motions again and again. Overhead motion such as swimming,tennis & baseball.

46. Symptoms Pain or tenderness in front of the shoulder. Radiating pain towardas wrist. Pain in movement. Pain in overhead activity.

47. INVESTIGATIONS X RAY MRI CT SCAN

48. SPECIAL TESTS Speeds test Yergason test

49. TREATMENT Ice packs on shoulder for 20 to 30 minutes every 3 to 4 hours for 2 or 3 days. Anti inflammatory oral steroid. Corticosteroids. Arthroscopic surgery Open surgical repair.

50. PHYSIOTHERAPHY MANAGEMENT

51. EXERCISES

52. PREVENTION

53. ELBOW

54. TENNIS ELBOW This is a condition characterised by pain and tenderness at the later epicondyle of the humerus due to non specific inflammation at the origin of the extensor muscles of the forearm. It was first described from the writer’s cramps by range in 1873. it was Madris who called it as “tennis elbow” shortly thereafter.

55. CAUSES Repeating the same motion over and over again like making roll for chapatis . Playing a racquet sports such as tennis or badminton Carrying heavy loads Constant more use computer keyboard and mouse.

56. Famous sports man who had Tennis Elbow

57. SYMPTOMS Pain may slowly increase around the outside of the elbow. Pain is worse when shaking hands or squeezing objects. Pain is made worse by stabilizing or moving the wrist with force. Example including lifting, opening jars, etc.

58. INVESTIGATION X-ray MRI Special Test Cozen’s test

59. TREATMENT Conservative Treatment Rest Medicine Anti inflammatory drugs for a weeks. Hydrocortison injection Elbow strap

60. PHYSIOTHERAPY MANAGEMENT Acute phase Rest with POP splint Ultrasound, SWD Cryotherapy Electrical Stimulation Massaging Active exercises ( Isometrics) Progressive resisted exercises Manipulation

61. Post acute phase Patient is instructed to avoid repeated wrist extension and supination movement. Exercises passive exercises resistive exercises strengthening exercises Surgical treatment also occur to relive severe pain for 6 weeks at least, Failure to respond in any management. After surgery physiotherapy is also done.

62. EXERCISES

63. GOLFER’S ELBOW It is a tendinopathy of the insertion of the epitrochlear muscles (Flexors of the fingers of the hands and pronators). The inflammation is at the origin of the flexor tendons at the medial epicondyle of the humerus.

64. CAUSES

65. In sports mainly seen in Golf,cricket,swimming, tennis players are affected most. Due to repeted movements and overload of flexor muscles inflammation occurred at medial epicondyle.

66. SYMPTOMS

67. INVESTIGATION X-ray MRI Special Test - Medial epicondylitis test Elbow flexed, forearm pronated -pain passivly flexed pt. wrist & asked the pt. to extend the elbow, pt. forearm passivly supinated . Pain in the medial side.

68. Special test

69. TREATMENT Rest Anti inflammatory medicine Cortisone injection ICE packs Elbow strap

70. PHYSIOTHERAPY MANAGEMENT Acute phase Rest with POP splint Ultrasound, SWD Cryotherapy Electrical Stimulation Massaging Active exercises ( Isometrics) Progressive resisted exercises Manipulation

71. Post acute phase Patient is instructed to avoid repeated wrist flexion and pronation movement. Exercises passive exercises resistive exercises strengthening exercises Surgical treatment also occur to relive severe pain for 6 weeks at least, Failure to respond in any management. After surgery physiotherapy is also done

72. CARPAL TUNNEL SYNDROME The carpal tunnel is bounded by bones on three sides and a ligament on one side. The floor is an osseous arch formed by the carpal bones and the roof is formed by the transverse carpal ligament. Carpal tunnl syndrome was first described by Sir James Paget in 1854, but the term was coined by Moerisch.

73. It caused by compression of the median nerve in the carpal tunnel along with the tendon of the flexor digitorum superficialis and flexor pollicis longus muscles. The tunnel can narrow creating pressure on the nurve for a number of reasons: Traumatic wrist injury such as wrist sprain or broken wrist Repetitive strain injury caused by the over used of the wrist.

74. SYMPTOMS Tingling Numbness Pain Weakness Clumsiness Symptoms are more at night

75. Some tests Phalen’s test The patient is asked to actively place the wrist in complete but unforced flexion. If tingling and numbness are produced in the median nerve distribution of the hand within 60 secs , the test is positive. Median nerve percussion test The examiner gentaly taps the median nerve at the wrist. The test is positive if there is tingling sensation present.

76. PHALENS TEST

77. TREATMENT Non operative methods Non steroidal anti inflammatory drugs Steroids like prednisolone , tapering Carpal tunnel splint Physiotherapy Management UST, SWD Exercises Gentle relaxed passive movements, active assisted and active movement of the wrist and fingers area.

78. HAND

79. MALLET INJURY This is a flexion deformity of the DIP joint. It is an injury of the extensor digitorum tendon of the finger at the distal inter phalengeal joints. It results from hyperflexion of the tendon usually occur catching a cricket ball, basket ball volley ball, in the bed tucking etc.

80. SYMPTOMS Pain Swelling Deformity Tingling Unable to extend the finger

81. INVESTIGATION Xray

82. TREATMENT Closed splinting of the DIP joint in hyper extension for 6- 8 weeks Night splinting for 4- 6 weeks. In avulsion fracture open reduction and internal fixation. Ice packs.

83. Rehabilitation Exercises

84. HIP HIP:

85. QUADRICEPS STRAIN A strain is a tear in a muscle or the tendon that attaches the muscle to bone. A quadriceps strain is a tear in the muscles on the front of the thigh or their tendons. The quadriceps muscles are important for straightening the knee and bending the hip.

86. STRAIN Classified into three categories- Grade -1 Cause pain but the tendon is not lengthened. Grade-2 lengthened ligamint due to being stretched,function is maintained. Grade-3 complete tear of tendon,function impaired.

87. Grades of STRAIN

88. CAUSES Muscle tightness Muscle fatigue Muscle imbalances Incorrect exercise technique Inadequate warm up period Direct trauma

89. INJURY IN SPORTS Mainly seen in Football Tennis Cycling Rugby Running Hockey

90. SYMPTOMS Pain, tenderness, inflammation. Pain worsens witrh use of the quadriceps muscles. Muscle spasm Difficulty in walking, running. A crackling sound. Loss of fullness.

91. INVESTIGATIONS MRI USG

92. TREATMENT

93. PHYSIOTHERAPHY TREATMENT Reduce pain and inflammation. Protect the injury. Normalise the joint ROM Quadriceps and Hamstrings strengthen. Knee cap Use of crutces Improve running, walking techniques. Ice packs UST.

94. PREVENTION Warm up and stetch properly Allow for adequate recovery between workouts. Maintain physical fitness. Strength, flexibility, endurance Wear properly fitted and padded protective equipment.

95. HIP PAIN Defination Hip pain is a common complaint that can be caused by a wide variety problems. Problems within the hip joint tend to result in pain on inside of hip or groin. Hip pain on the outside hip, upper thigh, or buttock caused by problems with muscles, ligaments, tendons or other soft tissues around hip.

96. CAUSES ARTHRITIS Osteoarthritis Rheumatoid arthritis Septic arthritis INJURIES Bursitis Dislocation Hip fracture Sprains & strains Tendinitis

97. SYMPTOMS Joint pain Groin pain Loss of motion of the hip Swelling over the hip Tenderness Difficulty sleeping on the hip Problems in movement Muscle weekness

98. INVESTIGATIONS X-RAY MRI CT SCAN ULTASOUND

99. TREATMENT Rest Ice packs Compression Elevation Anti inflammatory dugs Steroids Surgery rarely needed

100. PHYSIOTHERAPHY TREATMENT Muscle stretching Core exercises Poor posture correction Gait analysis Dry needling Balance exercises Heat packs TENS Supportive taping and strapping Isometric exercises.

101. Rehabe Exercises

102. Knee

103. Jumpers Knee Jumpers knee is also known as patellar tendinitis is a relatively common cause of pain in the inferior patellar region in athletes. It is common with frequent jumping and studies have shown it may be associated with stiff ankle movement and ankle sprains. The term jumper’s knee was first used in 1973 to describe an insertional tendinopathy.

104. Injury happened particularly those participating in jumping sports such as basketball, volleyball,football, high or long jumping. Tenderness is present over the inferior pole.

105. Signs and Symptoms Anterior knee pain often with aching quality.Onset is insidious. Involvment of infrapatellar area may be surpapatellar. Pain during athletic motion Swelling Bruising or redness Discomfort during daily activites.

106. CAUSES

107. DIAGNOSIS X-RAY MRI Physical examination. Consideration of patient medical history.

108. TREATMENT NSAIDS include ibuprofen Rest, Ice, Compression and Elevation. Steroids injections Patellar tendon strap. Surgery (STAGE 4 INJURY )

109. PHYSIOTHERAPHY TREATMENT Decrease activities that increase patellofemoral pressure (eg, jumping, squatting) Joint full ROM exercises Stretching- Hamstrings, rectus femoris, adductors, quadriceps, gluteals, iliopsoas. Srengthening exercises. Cryotheraphy. Dry Needling. Sports specific proprioceptive training. UST.

110. REHABE EXERCISES

111. KNEE LIGAMENTS INJURY

112. MAJOR KNEE LIGAMENTS

113. ACL INJURY Anatomy: origin: Medial and anterior aspect of the tibial plateau. Insertion:Lateral femoral condyle. Function: Prevents excessive tibial medial & lateral rotation. Provides restraining force of anterior translation.

114. One of the most common knee injuries is an anterior cruciate ligament sprain or tear. MECHANISM: Hyperextension force Twisting force on a semiflexed knee.

115. CLINICAL FEATURES: Immediately collapse and is painful. Popping sensation felt or heard. Swelling. Giving away.

116. CLASSIFICATION: Ligaments sprain are classified in three degrees: 1 st Degree: Tear of only a few fibres of the ligament.Minimal swelling, localised tenderness but little functional disability. 2 nd Degree: Almost all the fibres of a ligament are disrupted. Pain, swelling and inability to use the limb.Normal joint movements. 3 rd Degree: Complete tear of the ligament.

117. DIAGNOSIS: Clinical Examinations. X-RAY MRI Arthroscopy (where doubt persists).

118. SPECIAL TESTS Lachmans test Anterior drawer test Pivot shift test. McMurrey test

119. TREATMENT

120. OTHERS METHOD: Rest, Ice, Compression and Elevation. NSAIDS Corticosteroids. Knee Band.

121. PHYSIOTHERAPHY TREATMENT Mobility exercises: Static quads/SLR Ankle DF/PF/CIRCUMDUCTION Knee flexion/extension in sitting Patellar mobilisations Glute exercises in prone Knee flexion in prone. Strenghtening ex. Of knee

122. Neuromuscular electrical stimulatuin UST ICE packs Full ROM EX. VMO EX.

123. PT MANAGEMENT

124. REHABE EXERCISES

125. PCL INJURY ANATOMY: ORIGIN: The posterior intercondyler area of the tibia. INSERTION: Medial condyle of the femur. FUNCTION: Keeps the tibia from moving backwarda too far.

126. DEFINATION: It is less common than ACL tears. MECHANISMS: Backward force on tibia.

127. CLINICAL FEATURES: Pain and swelling that occurs steadily and quickly after the injury. Swelling that makes the knee stiff. Difficulty in walking. The knee feels unstable like it may give out.

128. Sports are a common cause of PCL injury. Football Soccer Baseball Skiing

129. CLASSIFICATION OF INJURY According to the severity: Grade 1- PCL has a partial tear . Grade 2- Ligament is partially torn and is looser than grade 1. Grade 3- Ligament is completely torn and the knee becomes unstable. Grade 4- PCL is damaged along with another ligament of knee.

130. DIAGNOSIS: X-RAY MRI BONE SCAN. ARTHROSCOPY

131. SPECIAL TEST: Posterior Drawer test:

132. TREATMENT: Protect, Rest, Icing, Compression, Elevation are performed. NSAIDS. Corticosteroids Surgery (grade 3 injury).

133. PHYSIOTHERAPHY TREATMENT: Using crutches at first, then gradually walking with more weight on the knee. Full ROM exercises. Use a knee brace. Strengthening ex. of thigh muscles. Treadmill ex or walking or running in a pool. Specific training needed for a sports. Neuromuscular electrical stimulation. UST.

134. Rehabe exercises:

135. Meniscal Injury The semilunar cartilages are two crescent shaped plates of fibrocartilage placed on condyler surface of the tibia. FUNCTIONS- Increase the stability of knee. Controlling the complex rolling and the gliding actions of the joint. Distributing load during movement.

136. Definition Medial meniscus is more commonly injured than the lateral and is usually associated with other ligament injuries of the knee. Mainly seen in football, basketball, cricket, rugby etc.

137. CLASSIFICATION OF INJURY

138. CAUSES In young- twisting force with the knee bent and taking weight. In Middile - fibrosis has decreased the mobility of meniscus and hence tear occurs with less force. Over activity in sports.

139. Clinical Features Usually a young person Pain usually on the middle side Knee is locked in partial flexion Swelling

140. DIAGNOSIS McMurray s test Apley compression test

141. X-RAY MRI Artroscopy (where doubt persits).

142. Treatment Rest, ICE, compression, elevation. NSAIDS Corticosteroids Endurance and strength Surgery – arthroscopy technique

143. Physiotheraphy treatment Muscle strengthening around knee mainly quadriceps. Full active ROM exercises. Muscle stimulation. UST Weight bearing activities.

144. Rehabe exercises

145. Leg

146. CALF MUSCLE STRAIN: CALF MUSCLES : Gastrocnemius. Soleus. Plantaris. A calf strain occurs as a result of these muscles being torn or pulled. When a muscle is stretched muscle fibers. The severity of these tears depends on the depth & suddenness of the stretch.

147. CAUSES: A calf strain occurs when the calf muscles are over stretched.This can be caused by a sudden abrupt movement or as a result of over use. Insufficient warm up or cool down is a common cause. Climbing or running up hills. Wearing inappropriate footwear. A sudden change of direction explosive movement or increase in speed can result in the calf muscles become torn or strained.

148. SYMPTOMS: Sharp pain in the lower leg. Pain or resisted plantar flexion or when standing on pointed toes. Swealing. Inflammation of the leg. Internal bleeding due to bruising Tightness Difficulty in weight bearing. A lump can be felt.

149. DIAGNOSIS: Strength testing: pain will be illiciated with resisted plantar flexion against resistance. MRI X-RAY USG

150. SPECIAL TEST: THOMPSON`s test

151. TREATMENT: Rest-Ice-compression-elevation Strapping NSAIDS Orthotics-prevent overpronation . Kinesiology taping.

152. PHYSIOTHERAPHY TREATMENT: Massage not in acute condition Strengthening ex. Flexibility and proprioceptive ex. Muscle of stretching. Weight calf ex. UST TENS MFR.

153. REHABE EX:

154. HAMSTRING STRAIN: A hamstring strain is a common leg injury involving a tear in one or more of the hamstring muscles. A hamstring strain can range from mild to very severe involving a complete tear of the hamstring muscle. Mainly seen in soccer, basketball, tennis, football.

155. HAMSTRING MUSCLES : SEMIMEMBRANOSUS. SEMITENDINOSUS. BICEPS FEMORIS – short & long head.

156. CAUSES: Muscle stiffness Poor running mechanics Improper warm up. Inappropriate training loads. Fatigue Abnormalities of the lumber spine or poor pelvic control. Playing surface: wet slippery surface.

157. SYMPTOMS:

158. Diagnosis: Ultrasound scan. MRI. Grade 1: Tightness of the back of thigh but able to walk normnally . Mild swealling and spasm may present. Grade 2: Walking pattern will be affected. pain, swelling, tenderness present. Grade 3: A severe injury involving a tear to half or all the hamstring muscle. Need crutches to walk. Pain & weakness in the muscle.

159. Treatment: Rest, Ice, Elevation, Compretion. NSAIDS. Corcitosteroids. Avoid repeated injury. Hamstring caps

160. Physiotheraphy Treatment: Normalise ROM. Muscle strength. Muscle stretcing. Improve technique and function of running, jumping, landing. Improve game speed, balance. Core ex, gait analysis, soft tissue massage. Tapping, support, HOT PACKS. Sports specific ex. TENS Dry needling.

161. Exercises

162. Ankle

163. Ankle Sprain : Anatomy: Ligaments of the ankle: Anterior talofibular ligament Calcanofibular ligament Post talofibular ligament.

164. Ankle sprain is a common injury in sports. If improperly treated it may result in chronic laxity, pain or delayed recovery. Mechanisms: Inversion of supinated planter flexed foot.

165. Clinical Features: Ant talofibular ligament commonly injured followed by calcaneofibular ligament. The post talofibular ligament is rarely sprained. Pain, swelling and tenderness over the affected ligament.

166. Diagnosis: X-RAY. MRI. Ant Drawer Test: If the displacement of talus is more than 8 mm ant, it suggests laxity of the ant talofibular ligament. Talar tilt test- If the tilt is more than 5 DEGREE it suggests laxity of ant talofibular and calcaneofibular ligaments.

167. A: Ant Drawer test. B: Talar Tilt test.

168. Management: Grade 1 : ICE, Compression bandage, foot elevation, NSAIDS. Grade 2: Long leg cast, ROM EX, strengthening ex. Grade 3: Same as grade 2 sometimes requir surgical care.

169. TREATMENT:

170. Achilles Tendon The achilles tendon or heel cord also known as the calcaneal tendon is a tendon of the back of the leg, and the thickest in human body. It serves to attach the calf muscles to the calcaneus (heel) bone. These muscles acting via the tendon, cause plantar flexion of the foot at the ankle and knee flexion.

171. Achilles Tendinities Achilles tendinitis is the tendinitis of the achilles tendon caused by overuse of the affected limb and is more common among athletes training under less than ideal conditions.

172. Signs & Symptoms Symptoms can vary from an ache or pain and swelling to the local area of the ankles or a burning that surrounds the whole joint. With this condition the pain is usually worse during and after activity and the tendon and joint area can become stiffer the following day as swelling impings on the movement of the tendon.

173. CAUSES Achilles tendon injuries are common in people who do things where they quickly speed up, slow down, or pivot such as; Running Gymnastics Football Baseball Tennis Basketball Tight leg muscle.

174. Diagnosis: X-RAY MRI USG Physical Examination.

175. Treatment: Rest: avoid putting weight on legs. Need crutches Ice: icing for 20 minutes Compress leg: use an elastic bandage around ankle to keep down swelling. Raise leg NSAIDS: Ibuprofen, Naproxen. Use a heel lift. Surgery

176. PT Management: Calf muscle stretching Strenghtening ex. ROM ex. Active daily ex. Extracorporeal shock wave theraphy UST Tapping Night splints. Laser

177. Rehabe exercises:

178. Foot

179. March Fracture: Also known as fatigue fracture or stress fracture of metatarsal bone, is the fracture of the distal third of one of the metatarsals occuring because of recurrent stress. Its one of the most common sports injuries. Mainly seen in running, football, basketball due to heavy stress in lower bones.

180. Stages in development:

181. Clinical features: History of unaccustomed & repeated activity. Pain after ex. Pain during ex. Pain without ex. Load related pain. Swealling . Tenderness. Leg lenth discrepancy, muscle imbalance excessive subtalar pronation .

182. Diagnosis: X-RAY CT SCAN MRI - for more specific.

183. Treatment: Rest to allow the bone remodeling process. Identify and correct any predisposing factor. Training errors- identified and corrected. Non wt bearing cast immobilisation. ice., compression . NSAIDS CORTICOSTEROIDS.

184. PT Management. Mobilisation Active rom ex. Strengtening ex UST LASER.

185. THANK YOU.