Popliteus tendinitis

 Popliteus tendinitis is characterized by inflammation andpain at the knee joint on the back part of the outer side of theknee and the outer side just above the knee at the popliteus

tendon.

Common Signs and Symptoms:

• Pain and tenderness over the popliteus tendon at the outerknee or back of the knee on the outer side

• Pain that is worse when standing on the leg with the kneebent slightly or when walking or running, just as the foot ofthe affected leg lifts off the ground

• Pain that is worse when rotating the leg

• Pain that starts or recurs after running a particular distance

• Crepitation (a crackling sound) when the tendon is movedor touched (uncommon, except when tested just after exercising)

  Causes :

Overuse of the popliteus muscle-tendon unit, usually in anathlete who runs or trains on hills or banked surfaces

Risk Increases With

 • Sports or activities that require a lot of downhill walkingor running, such as with backpacking, cross-country running, and distance running; also, running on a banked

track or next to the curb on the street (a banked surface)

• Poor physical conditioning (strength and flexibility)

• Inadequate warm-up before practice or play

• Flat feet

Diagnostic Test:

1. Garrick Test

Patient seated, hip and knee are both flexed to 90°. The patient actively externally rotates the lower leg and this is resisted by the examiner. A positive test is pain during the maneuver in the location of the popliteus muscle or tendon.

PHYSICAL THERAPY

1. Reverse heel tap

Attach a resistance band on to the forefoot of the non–weight-bearing leg (NWBL).The foot on the NWBL moves behind the stance leg via external rotation of the hip and knee flexion.

The foot of the NWBL continues to move behind the stance leg with increasing internal tibial rotation.Completion of the concentric exercise. The return to start position provides an eccentric muscle effort.

2. Step up and down

Place one foot on top of a small raised platform. Keeping the raised leg slightly bent at the knee, step forward with the opposite leg. Next, step backwards, then to the right and left of the foot planted on the step. Repeat this motion for 20 to 25 repetitions.

3. Leg curls

Attach one end of a resistance band to the base of a closed door or stable surface, such as a heavy table leg, at floor level. Place the other end of the band loop securely around one ankle. Lie on the floor, face down, with both feet toward the area where the band is initially attached. Lift the banded heel up and toward the glutes in a slow and steady motion. For more resistance, move farther away from the door or table. Slowly lower the foot to the starting position and repeat for 20 to 25 repetitions.

4. Gastrocnemius stretching , Standing

 Place hands on wall. Extend right / left leg, keeping the front knee somewhat bent.Slightly point your toes inward on your back foot.Keeping your right / left heel on the floor and your knee straight, shift your weight 

toward the wall, not allowing your back to arch.

You should feel a gentle stretch in the right / left calf. Hold this position for 7_ seconds.

Repeat 3-5 times. Complete this stretch 3 times per day. #behindthekneepain 

5. Stretching of Soleus, Standing

 Place hands on wall.Extend right / left leg, keeping the other knee somewhat bent.Slightly point your toes inward on your back foot. Keep your right / left heel on the floor, bend your back knee, and slightly shift your 

weight over the back leg so that you feel a gentle stretch deep in your back calf.

 Hold this position for 7 seconds.

Repeat 3-5 times. Complete this stretch 3times per day.

6. Stretching of Hamstrings, Standing

 Stand or sit and extend your right / left leg, placing your foot on a chair or foot stool. Keeping a slight arch in your low back and your hips straight forward.Lead with your chest and lean forward at the waist until you feel a gentle stretch in the back of your right / left knee or thigh. (When done correctly, this exercise requires leaning only a small distance.) Hold this position for 7 seconds.

Repeat 5times. 

7. Hip Flexor Stretch

This stretch focuses on the muscles running along the back and outside of your knee, according to the Sports Injury Clinic. Place one leg in front of your with your knee bent. Your foot should be planted on the ground and facing forward. The other leg should be bent with your knee on the floor. Slowly push 

your hips forward while keeping your back straight. You will feel a stretch in your upper leg. Hold this position for a count of 30 seconds. Repeat three sets of three repetitions daily.  

8. Half squat

Stand with your feet about hip distance apart. If you feel unstable, hold onto a wall or back of a chair for balance.Maintain a long spine and lifted chest as you bend gently through your hips and knees. Let the hips bend just about 10 inches as if you're sitting toward a chair. Keep your feet planted, weight in your heels.

Pause for three to five counts and straighten back up to a stand.Repeat 10 to 12 times.

9. Heel Cord Stretch

Stand facing a wall.Place your healthy leg forward and bend the knee slightly.Place the injured leg straight behind you with the heel flat and the toes pointed in a little bit.Keep your heels flat on the floor and press your hip complex forward, toward the wall.

Hold for 30 seconds.

10. Calf Raises

Stand and face the back of a chair; hold on for balance.Distribute your weight evenly over both feet.Bend your left knee behind you and place all your weight on your right foot.Raise your right heel as high as you can and then lower it slowly.Repeat 10 times

11. Isometrics exercise of quadriceps will help to maintain muscle power of quadriceps muscle, Isometrics: Initial isometrics with quadriceps contractions done with the knee fully extended and in different positions at 20-degree increments as knee flexion improves May discontinue isometrics when the patient can sit comfortably.

12. Straight leg raises: 

Sit flat on the floor with the legs straight out in front of you. Raise one leg off the floor keeping the knee straight. Hold for 3 to 5 seconds before lowering back to the ground. Repeat 10 to 20 times. This exercise can be done daily. Progress the exercise by increasing the length of hold and the number of reps.

 

13. Compression: 

This may help decrease blood flow and accompanied by elevation will serve to decrease both blood flow and excess interstitial fluid accumulation. The goal is to prevent hematoma formation and interstitial edema, thus decreasing tissue ischemia. However, if the immobilization phase is prolonged, it will be detrimental to muscle regeneration. Cryotherapy, accompanied by compression, should be applied for 15–20 min at a time with 30–60 min between applications. During this time period, the quadriceps should be kept relatively immobile to allow for appropriate healing and prevent further injury.

Electrotherapy

◾ULTRASOUND THERAPY: UltraSound is a therapeutic modality that generates ultrasound causes deep heat, provides micro-massage to soft tissue, increases flexibility, promotes healing of tissue as well improves localized blood supply to the area, and ultimately pain relief.

◾SHORT WAVE DIATHERMY: short wave diathermy is a deep heating modality that uses heat to provide pain relief, it improves the blood supply to targeted muscle, removal of waste products

◾TENS: transcutaneous electrical nerve stimulation is an electrical modality that provides pain relief by providing pain modulation.TENS closes the gate mechanism at the anterior grey horn in the spinal cord. also stimulates the endogenous opioid system which prevents the release of substance p at the anterior grey horn.

◾Cold therapy: used to relieve inflammation and reduce pain, Ice Massage- Ice on the area of inflammation for anti-inflammatory effects. Use ice in a paper or Styrofoam cup (peeled away) for 5-7 minutes, make sure to avoid frostbite.

◾Use Circulatory Boost TShellz Wraps®:

∆After swelling and inflammation have been reduced with cold compression.

∆Before exercise or workouts to warm up your injury to prevent re-injury.

∆Before and after surgery during rehabilitation to warm up your tissues before exercising or stretching.

∆Anytime you feel the tissue in your leg has stiffened up, is tight and your mobility is reduced causing you more pain.

∆Anytime you have sore or aching tissue around your injury.

∆Any other situation where you need to increase blood flow to your tendon to relax your soft tissue, relieve pain, prevent re-injury and enhance flexibility of your tissue.

Medication

NSAID

Corticosteroid

Muscle relaxer

Tarsal tunnel syndrome

 Tarsal tunnel syndrome:

 is the compression of an important nerve that runs through your ankle and into your foot. It’s possible to develop tarsal tunnel syndrome after spraining your ankle, overusing your feet, or developing arthritis or diabetes

Causes:-

Tarsal tunnel syndrome (TTS) is caused by compression of the posterior tibial nerve as it travels through the tarsal tunnel. Compression of the posterior tibial nerve can cause pain, tingling or numbness in the foot

Symptoms:

Burning sensations.

Numbness.

Tingling or “pins and needles” sensations.

Weakness in your foot muscles

Diagnosis:

🔹Tinel’s test:

 Physical therapist gently taps your tibial nerve. If you experience pain or tingling that reproduce your symptoms, it may point to TTS.

🔹Dorsiflexion – Eversion Test:  

Place the patient’s foot into full dorsiflexion and eversion and hold for 5-10 seconds

The results are that it elicits the patient’s symptoms

🔹Electromyogram (EMG): 

This two-part test uses an electrical impulse to measure your nerve and muscle function.

🔹MRI: 

MRIs use magnets and radio waves to take detailed images of soft tissue and bones inside of your body. Your healthcare provider may order an MRI to evaluate an injury or nerve damage or a mass putting pressure on your tibial nerve

  

◾Gait Analysis:

Assess for abnormalities (excessive pronation/supination, out-toeing, excessive inversion/eversion, antalgic gait, etc.)

◾Sensory Testing

Test light touch, 2-point discrimination, and pinprick in the lower extremity

Deficits will be in the distribution of the posterior tibial nerve

◾Palpation:

Tender to palpation in between the medial malleolus and Achilles tendon

Painful in 60-100% of those affected

◾Range of Motion (ROM):

Focus on ankle and toe ROM

 Physical therapy

⚫Heel-toe raises

Using the back of a chair or counter for support, lift the heels off the floor to stand on the toes.Hold for 5 seconds before slowly lowering back down to the floor.Repeat the exercise 15 times.Do two sets, with a 30-second rest between each set.

As the injured foot becomes stronger, try standing on the injured foot only.

⚫Balance exercise

Stand beside a chair, using it for support if needed, with the injured foot furthest from the chair.Stand on the injured foot and slightly bend the knee.Bend forward from the waist and reach forward with the hand furthest from the chair.Repeat 15 times for two sets.

Reach the hand furthest from the chair across the body, toward the chair.

Repeat 15 times for two sets.

⚫Calf stretch

Stand and face a wall with the hands placed on the wall at eye level.Take a lunge position by placing the injured foot slightly behind with the heel flat on the ground and the other leg slightly forwards with a bent knee.Turn the back foot inwards slightly.Gently lean towards the wall until there is a stretch in the back calf.

Hold in this position for 15–30 seconds.

Return to the start and repeat 3 times.

Repeat the entire exercise several times a day.

⚫Soleus muscle stretch

Lean forwards pressing the back heel into the ground until a stretch is felt

If it is not possible to feel a stretch, then place something underneath the toes to raise the front of the foot.Or put the ball of the foot up against the wall and push the knee forwards

Bending the knee takes the Gastrocnemius muscle, which attaches above the knee, out of the stretch

⚫ Ball Rolling 

Stretching the plantar fascia is by rolling it over a round or cylindrical shaped object such as a ball, rolling pin or can of soup. The can of soup can be placed in the freezer to include a cold therapy effect as well.

Roll the foot repeatedly over the ball applying downward pressure onto the plantar fascia. It acts like a deep tissue massage to help stretch the fascia.

⚫Resistance band ankle inversion

A resistance band is tied around the foot with the other end attached to a fixed point

The foot is turned inwards against the resistance of the band.Slowly return to the start position, rest and repeat 10-20 times

Begin with only 10 reps and gradually increase

This can be performed every day provided it is pain-free. To make it harder, start with the band under increased tension by shortening the section being used

⚫Ankle rotation – 

Just like all other parts of the body, exercising the ankles helps to keep them strong. For this exercise, sit on a chair and shake your ankles for a few seconds. After this, rotate the ankles gently clockwise about four to five times then repeat the same with counterclockwise motion.

⚫The pencil lift – 

The pencil lift is done by placing a pencil on the floor then picking it up with the toes and holding it for about ten seconds. You should repeat this exercise, relaxing after every round.

⚫TOE FLEXORS/PLANTAR FASCIA STRETCH

Sit on a chair or on the floor for this exercise.

Bring the foot you would like to stretch in towards you by bending your knee.Place the heel of one hand along the tips of all of your toes.Run your fingers around the ball of your feet and under your sole.Using your fingers and your hand, pull all of your toes back towards you.Be sure to not forget about your little toe.

Hold this position

Electrotherapy

TENS

Ultrasound therapy 

Acupuncture 

Shock wave diathermy 

K tapping 

Orthotic management:-

Braces, casts or splints:

 A cast or splint keeps your foot in place to encourage nerve healing. If you have flat feet or severe symptoms, your healthcare provider may recommend a brace to reduce pressure on your feet. Orthotics: You may use custom-made shoe inserts (orthotics).

Injection therapy: 

For very painful or disabling symptoms, a doctor may inject anti-inflammatory medication, such as corticosteroids and local anesthetics, directly into the nerve.