Overuse Injuries of the Lower Extremity

Posted on by Dr.Mike
Overuse Injuries of the Lower Extremity
For Healthcare Professionals
August 2018
Research Studies
Practical
Daily activities, including work and exercise, expose the joints, muscles and connective tissues to high levels of stress, leading
to lower extremity overuse injuries. Many short-hand terms have been used to describe these conditions, but they’re all
caused by the same thing: repetitive stress. As a Chiropractor, you can examine your patient’s feet for evidence of abnormal
biomechanics and an altered gait and offer them long-term support with custom-made, flexible Stabilizing Orthotics, like
those offered by Foot Levelers.
To categorize overuse injuries, look over Table 1, a compendium of potentially affected tissues and the causes and conditions
that encompass the large domain of overload injuries. Note that virtually all of the conditions listed in the table have been
directly correlated with abnormal foot biomechanics.
1
Bodily Tissue Affected
Tissues/Joints
Causes
Conditions
Muscles
Repetitive/excessive strain strengthens or breaks
down muscles.
Shin splints, groin strains, piriformis strains, pulled hamstrings,
fascia lata tightness, compartment syndromes, tibialis (post &
ant.) strains, calf strains, patellar tracking problems
Tendons
Frequent movement can lead to an inflammatory
response (tendinitis or “tendinosis”).
2
Achilles tendinitis, peroneal tendinitis, patellar tendinitis
(“jumper’s knee”), iliotibial band syndrome
Ligaments/Fascia
Frequent overloading tightens ligaments, causing
them to eventually fail.
Plantar fasciitis, spring ligament sprains, hip joint capsulitis,
compartment syndromes, trochanteric bursitis, anterior
cruciate ligment injuries
Bones
Repetitive/excessive strain can cause a stress
reaction and, eventually, stress fracture in as little as
two weeks in the hip and upper leg.
Stress reaction, bone marrow edema, stress fractures of the
calcaneus, metatarsals, tarsals, tibia, femur, sesamoiditis, tibial
periostitis, calcaneal periostitis (heel spurs)
Joints
Repetitive loading with poor shock absorption can
affect the weight-bearing and patellofemoral joints.
3,4
Chondromalacia patellae, degenerative joint disease of the
ankle, knee and/or hip joint, osteoarthritis
Nerves
Repetitive irritation can lead to an overgrowth of
protective connective tissue.
Morton’s (interdigital) neuromas, tarsal tunnel syndromes,
nerve entrapments of lateral plantar or medial calcaneal nerves
Table 1. Overuse injuries of the lower extremity
Overuse/Microtrauma
The conditions listed in Table 1 are all due to excessive
and/or repetitive motion and result in microtrauma injuries,
in which tissues fail because the body is unable to repair
quickly enough. The various causes of overuse injuries
are best categorized into intrinsic and extrinsic factors
(Table 2) and should be addressed immediately.
5
Extrinsic Factors
Intrinsic Factors
Exercise program (intensity)
Muscle imbalance
Exercise/work environment (surfaces)
Structural misalignment
Equipment (shoes)
Joint dysfunction
Table 2. Factors that cause overuse injuries
Research Studies
Practical
Analysis of Extrinsic and Intrinsic Factors
Extrinsic and intrinsic factors are closely intertwined and contribute to
most lower extremity overuse injuries.
For example, scientists found that walking at a normal pace produces
around 5 Gs of force on the foot and ankle and sends a ve ry rapid shock
wave (a “transient”) up through the spine with each step (Fig. 2). Within 10
milliseconds of the heel striking the ground (faster than we can consciously
respond), the scientists recorded a .5 G impact at the skull,  which is the
equivalent of a 160-pound man being hit in the head by 80 pounds with
each step. Running multiplies this effect by about 3 times (the Rule of
Three).   Also, if the foot goes too far into pronation, or stays too supinated,
the effects are amplified: “A high-arched [cavus] foot with limited range
of motion . . . and [a] hypermobile flat foot . . . [attenuate shock poorly]
because of its function near the end of the range of motion.”
Orthotic Support
Chiropractic adjustments and exercising can be helpful when it comes to
treating overuse injuries, but Stabilizing Orthotics are often necessary for long-
term support. Orthotics utilize a pronation wedge, viscoelastic materials and
the 3 Arch Advantage
to provide unmatched support:
Absorb heel strike impact and reduces the force on the joints
Reduce pronation by decreasing medial rotation to the knees and spine
Improve alignment and mobility of the arches to reduce muscle stretching
Provide accurate proprioception for better balance and alignment
Support the medial arch and reduces calcaneal eversion
References
1.
Hartley A.
Practical Joint Assessment: A Sports Medicine Manual
. St. Louis: Mosby YearBook; 1991:571.
2.
Khan KM et al. Overuse tendinosis, not tendinitis, part 1: a new paradigm for a difficult clinical problem.
Phys & Sportsmed
2000; 28:38-48.
3.
Radin EL et al. Mechanical determinants of osteoarthrosis.
Sem Arth Rheum
1991; 21:12-21.
4.
Seedhom B et al. Mechanical factors and patellofemoral osteoarthritis.
Ann Rheum Dis
1979; 38:307-316.
5.
Lysholm J, Wiklander J. Injuries in runners.
Am J Sports Med
1987; 15:168-171.
6.
Subotnick SI, ed.
Sports Medicine of the Lower Extremity
. New York: Churchill Livingstone; 1989:193.
7.
Light LH, McLellan GE, Klenerman L. Skeletal transients on heel strike in normal walking with different footwear.
J Biomech
1980; 13:477-480.
8.
Subotnick SI, ed.
Sports Medicine of the Lower Extremity
. New York: Churchill Livingston; 1989:67.
9.
Subotnick SI. Forces acting on the lower extremity. In:
Sports Medicin of the Lower Extremity
. New York: Churchill Livingston;
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