The ankles and the lower legs have a casual relationship by allowing movement to the foot that causes an up-and-down motion. The lower leg has various muscles and tendons that surround the shin bone and allows the feet to take the body from one location to another. The peroneal muscles in the legs allow ankle stability to ensure that the weight from the host’s body doesn’t cause overload to the legs and ankles. However, factors like obesity, trauma, or overexerting can cause the peroneal muscles to be inflamed and develop issues like weak ankles or trigger points that can cause referred pain to the ankles and affect how a person walks. Today’s article examines the peroneal muscles, how weak ankles correlate with trigger points, and ways to strengthen the ankles while managing trigger points. We refer patients to certified providers that incorporate various techniques in the lower body extremities, like lower leg and ankle pain therapies correlating to trigger points, to aid many people dealing with pain symptoms along the peroneal muscles, causing weak ankles. We encourage and appreciate each patient by referring them to associated medical providers based on their diagnosis when it is appropriate. We understand that education is an excellent way when asking our providers intricated questions at the patient’s request and understanding. Dr. Alex Jimenez, D.C., only utilizes this information as an educational service. Disclaimer
The Peroneal Muscles On The Ankles
Have you been experiencing pain when walking around constantly? What about feeling a sharp or dull ache in the back or side of your legs? Or do you feel like falling when you are just standing around? Many people experiencing these issues on their legs and ankles could be dealing with trigger points along the peroneal muscles in the ankles. The peroneal muscles consist of two muscles in the lateral compartment of the lower legs: the peroneus longus and peroneus brevis. The peroneus longus is an important long muscle in the lower legs as it is at the top of the fibula and then runs down the outer leg while connecting to the foot. One of the primary functions of the peroneus longus is allowing plantarflex and evert the foot at the ankle. This means that the peroneus longus helps provide motor strength and range of motion to the ankles.
The peroneus brevis is one of the shorter peroneal muscles in the legs that go down to the ankles and provides assistance to allow eversion to the foot and plantarflexion to the ankles. This shorter muscle is important since the ankle joint is relatively mobile and needs stability from the surrounding ligaments and muscles. These two muscles work together for ankle stability when walking and positioning when the body is moving. Studies reveal that depending on a person’s environment, the peroneal muscles allow support and stability to the ankle in various positions. A good example is if the foot is placed in a sloped position, the peroneal muscles and the surrounding ligaments help stabilize the ankle so it won’t induce pain, causing the individual not to fall over.
Weak Ankles & Trigger Points
When factors like obesity, trauma, or injuries begin to affect the lower half of the body, it can cause instability in the legs and cause the surrounding muscles, tendons, and ligaments to be overstretched, take on more of an overload to the legs, or suffer from a muscle or tendon tear. These factors are associated with various issues that can invoke pain along with developing trigger points along the lower legs. When there are issues in the peroneal muscles, it can lead to muscle weakness in the ankles or “weak ankles,” which causes instability in the body and causes the individual to sprain their ankles. Studies reveal that when the peroneal tendons have a tear in the lower extremities, it can lead to lateral ankle pain that is often missed when examined. However, to that point, if the incision has been left untreated, it can lead to persistent ankle pain, instability, and ankle dysfunction. In “Myofascial Pain and Dysfunction,” written by Dr. Janet G. Travell, M.D., stated that when individuals suffer from weak ankles or have an ankle sprain, active trigger points can cause pain and tenderness to the ankles and cause the person to become unstable. If left untreated, it can cause them to lose balance and have foot drop and ankle fractures to their foot. The book also mentioned that any ruptures in the tendons and muscles might cause lateral compartment syndrome. When there is instability in the ankles, many people resort to using mobility aids like a cane or a walker to be mobile to compensate for the function lost in their feet.
Trigger Point Therapy On The Peroneal Muscles- Video
Do you feel the pain from the bottom of your feet to your ankles? Does it hurt to walk around for a short period? Or have you sprained your ankle, and there is a dull ache when you try to rotate? Some ankle issues are associated with trigger points affecting the peroneal muscles. The peroneal muscles help the lower legs by allowing eversion to the foot and plantarflexion to the ankles. The two muscles that make up the peroneal muscles are the peroneus longus and the peroneus brevis, and they, along with the other tendons and ligaments, help with ankle stability. Since the ankle is a mobile joint, it can succumb to sprains, tears, and instability in the body, allowing trigger points to develop and causing even more issues. The great news is that there are ways to manage trigger points along the peroneal muscles and reduce ankle instability. The video above shows where the peroneal muscles are located on the leg, where the trigger points are, and how to use K-tape to help support the ankle and prevent more injuries on this moveable joint.
Strengthening The Ankles & Managing Trigger Points
Instability in the ankles can be a bummer to many individuals that are on the move, but when it comes to treatment, it can prevent future injuries from re-occurring. Studies reveal that when pain specialists incorporate joint mobilization techniques and dry needling therapy into their patients, it can allow them to reduce the pain and disability to the ankles, thus managing the trigger points along the peroneal muscles. Another way many people can reduce pain in their peroneal muscles is by incorporating stretches and exercises to strengthen their ankles. This allows the peroneal muscles to be loose and gently stretched while slowly strengthening the ankles in a semi-lock position. When people utilize these techniques on their legs and ankles, it can bring mobility and stability back to the body without fear of falling or causing more issues in the ankles.
Conclusion
As one of the most mobile skeletal joints in the lower body, the ankles work together with the legs to provide mobility and stability to the body. The lower legs have various muscles, tendons, and ligaments that travel down and help support the legs and ankles. One of the muscles that provide that support is the peroneal muscle. The peroneal muscles consist of two muscles known as the peroneus longus and peroneus brevis help with eversion to the foot and allow plantarflexion to the ankle. When a person has sprained their ankle, it causes the peroneal muscle to become overstretched and develop trigger points. The great news is that trigger points are treatable, and various treatments can reduce pain in the affected muscle. This allows stability and mobility back to the ankles and improves the body’s functionality.
References
Abd-Rasid, A F, and M Y Bajuri. “Isolated Peroneus Longus Tear – Commonly Missed Diagnosis of Lateral Ankle Pain: A Case Report.” Malaysian Orthopaedic Journal, U.S. National Library of Medicine, July 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7513650/.
Basit, Hajira, et al. “Anatomy, Bony Pelvis and Lower Limb, Foot Peroneus Brevis Muscle.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 8 Feb. 2022, https://www.ncbi.nlm.nih.gov/books/NBK535427/.
Lezak, Bradley, and Matthew Varacallo. “Anatomy, Bony Pelvis and Lower Limb, Calf Peroneus Longus Muscle.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 25 Aug. 2022, https://www.ncbi.nlm.nih.gov/books/NBK546650/.
Salom-Moreno, Jaime, et al. “Trigger Point Dry Needling and Proprioceptive Exercises for the Management of Chronic Ankle Instability: A Randomized Clinical Trial.” Evidence-Based Complementary and Alternative Medicine : ECAM, U.S. National Library of Medicine, 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4430654/.
Travell, J. G., et al. Myofascial Pain and Dysfunction: The Trigger Point Manual: Vol. 2:the Lower Extremities. Williams & Wilkins, 1999.
Several studies suggest that individuals with previous symptoms of neck pain were more likely to develop chronic symptoms after suffering a whiplash injury. But the true question was whether people who received medical attention for any neck or back injury or condition before being involved in an automobile accident reflected on their constant symptoms as compared to people who never received
Whiplash-associated disorders, or WAD, describe injuries sustained from sudden acceleration/deceleration movements. It is a common outcome after a motor vehicle collision but can also be caused by sports injuries, falls, or assaults. Whiplash refers to the mechanism of the injury, while WAD refers to the presence of symptoms like pain, stiffness, muscle spasm, and headaches. A WAD prognosis is unpredictable, with some cases remaining acute with a full recovery, while others progress to chronic conditions with long-term symptoms and disability. Early intervention recommendations include rest, chiropractic care and physical rehabilitation, massaging and stretching exercises, and an anti-inflammatory diet.
Whiplash Associated Disorders
Cervical hyperextension injuries happen to drivers and passengers of moving, slow-moving (less than 14 miles per hour), and stationary vehicles when struck from behind.
The individual’s body is thrown forward, but the head does not follow the body and instead whips forward, resulting in hyperflexion or extreme forward movement of the neck.
The chin limits forward flexion, but the momentum can be sufficient to cause cervical distraction and neurological injuries.
When the head and neck have reached maximum flexion, the neck snaps back, resulting in hyperextension or extreme backward movement of the neck.
Pathology
Most WADs are considered soft tissue-based injuries with no fractures.
Stages
The injury goes through stages:
Stage 1
The upper and lower spine experiences flexion in stage one.
Stage 2
The spine takes on an S-shape while extending and eventually straightens, causing lordosis.
Stage 3
The entire spine is hyperextending with an intense force that causes the facet joint capsules to compress.
Symptoms
Whiplash-associated disorders can be classified through grades by the severity of symptoms, including neck pain, stiffness, occipital headache, cervical, thoracic, and lumbar back pain, upper-limb pain, and paraesthesia.
Grade 0
No complaints or physical symptoms.
Grade 1
Neck complaints but no physical symptoms.
Grade 2
Neck complaints and musculoskeletal symptoms.
Grade 3
Neck complaints and neurological symptoms.
Grade 4
Neck complaints and fracture and/or dislocation.
Most cervical fractures occur predominantly at C2 or C6, or C7.
A chiropractor will identify areas of restricted joint motion, muscle tension, muscle spasm, intervertebral disc injury, and ligament injury.
They will analyze posture, and spinal alignment, check for tenderness, tightness, and how well the spinal joints move.
This will allow the chiropractic physical therapy team to understand the injured body mechanics and how the spine is operating to make a thorough diagnosis.
The doctor will order imaging tests like an x-ray or an MRI to evaluate any degenerative changes that may have existed before the whiplash injury.
Once the injury has been accurately diagnosed, the chiropractor will design a personalized treatment plan.
Spinal Adjustments
Spinal manipulation is applied to areas of the spine that are out of alignment to realign the spine and activate the healing process.
Flexion-distraction technique is a gentle technique that uses slower, less intense pushing motions on the discs used to treat disc herniations that often occur after a whiplash injury.
Instrument-assisted manipulation utilizes special instruments to apply various forces or massage settings to the area.
Targeted spinal manipulation targets specific areas to rework, release, and rebuild the structures.
Massage Therapy stimulates the affected muscles to relax them from their tense state.
A treatment plan may utilize:
Instrument-assisted therapy
Trigger point therapy
Resistance-based stretches to rehabilitate soft tissue damage.
Our chiropractic team is ready to help you feel your best so you can return to normal activities and get on with your life.
Ritchie, C., Ehrlich, C. & Sterling, M. Living with ongoing whiplash-associated disorders: a qualitative study of individual perceptions and experiences. BMC Musculoskelet Disord 18, 531 (2017). https://doi.org/10.1186/s12891-017-1882-9
Sterling, Michele. “Whiplash-associated disorder: musculoskeletal pain and related clinical findings.” The Journal of manual & manipulative therapy vol. 19,4 (2011): 194-200. doi:10.1179/106698111X13129729551949
Wong, Jessica J et al. “Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration.” The spine journal: official Journal of the North American Spine Society vol. 16,12 (2016): 1598-1630. doi:10.1016/j.spinee.2015.08.024
Woodward, M N et al. “Chiropractic treatment of chronic ‘whiplash’ injuries.” Injury vol. 27,9 (1996): 643-5. doi:10.1016/s0020-1383(96)00096-4
The legs are crucial for many individuals to move, jump, run, walk, and stand in various locations. The legs involve the thighs, hips, and knees as they work together to provide support and a range of movements for the body. For athletes, the legs allow them to run from one obstacle to another and kick the object to finish the game they are participating. Many individuals require strong leg muscles to keep the body balanced and stabilized from the upper body’s weight. One leg muscle that allows the body to be stabilized is the anterior tibialis muscle. When the legs suffer from various sports injuries or injuries in general, it can lead to issues like shin splints correlated with trigger points that can cause pain to the lower portion of the legs and can affect the body’s stability. Today’s article examines the anterior tibialis muscles, how shin splints are associated with myofascial trigger points, and various methods to treat shin splints. We refer patients to certified providers that incorporate various techniques in the lower body extremities, like lower leg pain therapies correlating to myofascial trigger point pain, to aid many people dealing with pain symptoms along the anterior tibialis muscles, causing shin splints. We encourage and appreciate each patient by referring them to associated medical providers based on their diagnosis, especially when appropriate. We understand that education is an excellent source to asking our providers intricated questions at the patient’s request. Dr. Alex Jimenez, D.C., only utilizes this information as an educational service. Disclaimer
What Is The Tibialis Anterior Muscles?
Have you been dealing with leg pain affecting your ability to move? Do you feel radiating pain going down to your feet? Or does even the smallest amount of pressure sends shooting pain from your knees to your feet? Many of these leg pain issues correlate to myofascial trigger points along the anterior tibialis muscles, mimicking shin splints. Studies reveal that the leg is divided into anterior, lateral, and posterior crural compartments. As one of the largest four muscles in the anterior compartment of the legs, the tibialis anterior is a thick muscle located in the front of the lateral tibia of the legs. The tibialis anterior has the muscle that allows the function to the lower leg and tendons that travel down to the ankle and foot. The anterior tibial muscle plays an important role in the lower leg through dorsiflexion and inversion of the foot. To that point, the anterior tibial muscle plays a key role in energy absorption when walking and maintaining balance.
Shin Splints Associated With Myofascial Trigger Points
Since the anterior tibial muscle plays a key role in energy absorption when it comes to walking and maintaining balance in the body, when the lower leg extremity muscles have been overused, it causes stress on the tibial anterior. It can lead to medial tibial stress syndrome or shin splints. Studies reveal that shin splints affect many athletes, especially runners, by causing pain and discomfort to the tibial anterior. This can cause mobility and balancing issues in the legs and lead to the development of myofascial trigger points in the anterior tibial muscle. Now, how do shin splints and myofascial trigger points correlate with each other?
Dr. Janet G. Travell, M.D., author of “Myofascial Pain and Discomfort: The Trigger Point Manual,” mentioned that one of the chief complaints many people have when experiencing myofascial trigger points would feel muscle weakness of dorsiflexion to the foot when walking. Other complaints include:
Falling
Dragging their feet
Ankle weakness
The book also mentioned that myofascial pain causes referred pain to the anterior tibial muscle, thus mimicking shin splints. The activation from myofascial trigger points causes an overload of the anterior tibial muscle, thus causing various pain issues in the legs and restricting mobility to the muscle itself.
An Overview Of Tibialis Anterior Trigger Points- Video
Have you been dealing with radiating pain from your knees to your feet? Do your legs feel heavy from walking a short distance? Or do your leg muscles feel cramps that hinder your ability to move? These pain-like issues are associated with the anterior tibialis muscle being affected by trigger points. Trigger points or myofascial pain syndrome can affect the worldwide population by affecting a muscle or muscle group in the body that can impair mobility, cause pain-like symptoms, and reduces a person’s overall sense of well-being. Trigger points along the tibialis anterior muscle cause mobility issues and mimic shin splint issues in the legs. All is not lost, however, as there are ways to reduce pain-like symptoms and help manage myofascial trigger points in the anterior tibialis muscle. The video above explains where the trigger points are located in the tibialis anterior through palpitation. By finding the trigger points in the affected muscle, doctors can refer patients to pain specialists who target trigger points and provide treatment to reduce the pain.
Various Methods Of Treating Shin Splints
There are various methods to treat the tibialis anterior when treating shin splints associated with trigger points. Studies reveal that one of the multiple ways to reduce shin splints is to strengthen the core hip muscles, improve running mechanics, and prevent lower-extremity overuse injuries. Muscle strength training allows the other muscles from the abdominals, gluteal, and hips to be stronger and reduce strain on the anterior tibialis muscles. Another method that many individuals should consider is to wear the appropriate footwear. Wearing the proper footwear can reduce the shock absorption to the feet and reduce the overloading forces on the anterior tibialis. These are two methods to manage trigger points and prevent shin splints from re-occurring in the legs.
Conclusion
As one of the four leg muscles, the anterior tibialis is a large muscle located in front of the lateral tibia and travels down to the ankles and foot. This muscle plays an important role in the legs as it allows dorsiflexion and inversion of the foot while also playing a key role in energy absorption when walking and maintaining balance. When the anterior tibialis becomes overused, it can develop trigger points, which invoke shin splints in the legs. When the legs suffer from shin splints associated with trigger points, it can cause pain in the lower leg extremities and cause the body to become unstable. However, various methods can take the load off the tibialis anterior and help improve the body’s stability, allowing the individual to walk without feeling pain traveling up from their feet.
References
Deshmukh, Nikita S, and Pratik Phansopkar. “Medial Tibial Stress Syndrome: A Review Article.” Cureus, U.S. National Library of Medicine, 7 July 2022, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9356648/.
Galbraith, R Michael, and Mark E Lavallee. “Medial Tibial Stress Syndrome: Conservative Treatment Options.” Current Reviews in Musculoskeletal Medicine, U.S. National Library of Medicine, 7 Oct. 2009, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848339/.
Juneja, Pallavi, and John B Hubbard. “Anatomy, Bony Pelvis and Lower Limb, Tibialis Anterior Muscles.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 29 Aug. 2022, https://www.ncbi.nlm.nih.gov/books/NBK513304/.
Travell, J. G., et al. Myofascial Pain and Dysfunction: The Trigger Point Manual: Vol. 2:the Lower Extremities. Williams & Wilkins, 1999.
Zielinska, Nicol, et al. “Anatomical Variations of the Tibialis Anterior Tendon Insertion: An Updated and Comprehensive Review.” Journal of Clinical Medicine, U.S. National Library of Medicine, 19 Aug. 2021, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8396864/.
The spine is the body’s central highway, with the spinal canal as the main lane that handles all the traffic. There are entrances and exits, or spinal cavities, that allow the nerves to branch off the spinal cord and run throughout the body. A traffic jam develops during lane closures, accidents, or construction at an entrance or exit. Lateral recess stenosis causes the narrowing of the spine’s lateral recess/Lee’s entrance, which can compress nerves, impede nerve circulation, and cause painful symptoms.
Lateral Recess Stenosis
The spinal column provides a strong and flexible structure for the spinal cord. The nerves travel from the spinal cord through various openings and passageways to the rest of the body. One of the openings is known as the lateral recess. Stenosis means narrowing. When a lateral recess in a vertebra develops stenosis, the nerve in that area can get jammed/pinched with no room to move, causing varying symptoms and sensations.
Symptoms
Depending on where the stenosis is taking place (neck, middle or low back), common symptoms of lateral recess stenosis can include:
Back pain that can spread out to other areas.
Cramping that can spread out to other sites.
Radiating pain that worsens with movement and eases with rest.
Numbness or weakness of the legs or arms.
Electrical tingling sensations down the leg or arm.
Muscle groups around the stenosis area are built up to take the pressure off of the area, alleviating symptoms.
Medications
A doctor or spine specialist may recommend or prescribe medication to ease symptoms. These include:
Tylenol – acetaminophen.
NSAIDS – Advil/ibuprofen or Aleve/naproxen.
Muscle relaxers
Steroid Injections
According to a study, neurogenic claudication is the main reason for disability and loss of independence in the elderly.
Neurogenic claudication describes pain and weakness in the buttocks and legs during physical activity that originates from the nerves, not the vessels.
This can happen from inflammation and swelling around a compressed nerve.
A steroid injection can decrease inflammation for several months.
Surgery
If activity modification, NSAIDs, bracing, and physical therapy don’t work or provide adequate relief, a doctor or specialist could recommend surgery.
Fusion is reserved when there is instability combined with the condition.
Back Problems Chiropractor
References
American College of Rheumatology (n.d.) “Spinal Stenosis” https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Spinal-Stenosis
Arthritis Foundation (n.d.) “Corticosteroids” https://www.arthritis.org/drug-guide/corticosteroids/corticosteroids
Drug Design, Development and Therapy (2014) “Steroid for epidural injection in spinal stenosis: a systematic review and meta-analysis” https://doi.org/10.2147/DDDT.S78070
Lee, Seung Yeop, et al. “Lumbar Stenosis: A Recent Update by Review of Literature.” Asian spine journal vol. 9,5 (2015): 818-28. doi:10.4184/asj.2015.9.5.818
Liu, Kuan, et al. “Steroid for epidural injection in spinal stenosis: a systematic review and meta-analysis.” Drug design, development, and therapy vol. 9 707-16. Jan 30, 2015, doi:10.2147/DDDT.S78070
Medline Plus (n.d.) “Achondroplasia” https://medlineplus.gov/genetics/condition/achondroplasia/
As one of the stabilizers for the body, the knees are located between the thighs and legs, allowing flexion and extension. The knees help the hips by supporting the upper body’s weight and allowing the legs to move from one place to another without feeling pain. The knee has various muscles and ligaments surrounding the knee joint, allowing the leg to be bent when active. One of the muscles is located behind the knee, known as the popliteus, and supports the legs. However, minor injuries or actions can affect the knees causing the joint to be in a “lock” position and develop myofascial trigger points that can induce muscle spasms in the knees. Today’s article focuses on the popliteus muscle, how knee pain is associated with trigger points, and how to manage knee pain through various treatments. We refer patients to certified providers that incorporate multiple methods in the lower body extremities, like knee pain treatments correlating to myofascial trigger points, to aid many people dealing with pain symptoms along the popliteus muscles. We encourage and appreciate each patient by referring them to associated medical providers based on their diagnosis, especially when appropriate. We understand that education is an excellent source to asking our providers intricated questions at the patient’s request. Dr. Alex Jimenez, D.C., only utilizes this information as an educational service. Disclaimer
What Is The Popliteus Muscle?
Have you been dealing with pain behind your knees? Do you have issues bending your knees when climbing up or down the stairs? Or do your back knee muscles start to twitch uncontrollably, causing muscle spasms? Many knee issues correlate with various factors that can affect the popliteus muscle and develop trigger points. The popliteus is a small muscle with a very important job as it is a major stabilizing muscle to the knees. The popliteus muscle originates from the lateral side of the femur and inserts itself into the posterior surface of the tibia. Some attachments are between the popliteus and lateral meniscus, allowing the knees to be in motion and providing flexion without pain and entrapment. Additional studies reveal that when a person exercises, the popliteus’s basic function helps bring about and maintain internal rotation of the tibia on the femur. The popliteus also helps prevent the foot from external rotation and allows the individual to stand correctly. However, injuries to the knee could overstretch the popliteus muscle and cause mobility issues to the knee flexion.
Knee Pain Associated With Trigger Points
When dealing with knee pain, it could often be a joint disorder like osteoarthritis or a musculoskeletal condition like sciatica pain associated with the knee. These issues could be due to normal factors like constantly sitting down or bending down to lift heavy objects that cause the knees to buckle. However, when the popliteus muscle has been continuously overused from being bent, it can form tiny nodules known as trigger points to cause knee pain. Studies reveal that trigger points on the muscles surrounding the knee are often ignored during a clinical diagnosis. Trigger points cause referred pain to the surrounding muscles, accompanied by various sensory sensations like heaviness, tingling, and hypersensitivity to the popliteus muscle. In “Myofascial Pain and Dysfunction,” written by Dr. Travell, M.D. stated that one of the chief complaints that many patients often talk to their doctors about is the pain they feel in the back of their knees when they are in a crouch position. The book also states when normal actions like running or twisting have overloaded the popliteus muscle, it can cause trauma or strain to the popliteus muscle and tear the posterior cruciate ligament to the knees.
How To Find Trigger Points In The Popliteus- Video
Have you been having knee issues that make walking difficult for a long period? Do you feel like your knees are locking up constantly? What about feeling unstable when standing or carrying objects around? These issues that affect the knees are associated with trigger points along the popliteus muscles. The popliteus muscle is small, located at the back of the knees, and assists with knee flexion. When the popliteus muscle becomes overused, it can cause trigger points to form and cause knee issues. Studies reveal that various issues, like tendon injuries, are associated with repetitive mechanical stresses that can cause degenerative knee lesions. Any trauma or muscle strain can affect the knee’s function of flexing and bending without pain for trigger points to form along the popliteus muscles. The video above focuses on the popliteus muscle, where the trigger points are located, and where the referred pain patterns are situated in the knees. On the bright side, all is not lost, as various treatments offer ways to manage knee pain associated with trigger points.
Managing Knee Pain Through Various Treatments
When it comes to knee pain, many individuals will apply an ice or heat compress to allow the surrounding muscles to relax while reducing the pain and swelling. Other individuals use over-the-counter medicines to eliminate the pain for a few hours. While these work at managing knee pain, various treatments target trigger points and can help improve flexion mobility back to the knees. Studies reveal that muscle stretching on the popliteus muscle contributes to joint position sense to knee joint stability and function. Stretching the popliteus muscles can reduce the pain in the back of the knee while elongating the muscle fibers to manage trigger points from forming again. Other treatments that people can do to avoid trigger points from returning is to avoid walking or running in a lateral sloped area to prevent the knees from locking up. Incorporating these treatments to prevent knee issues and allow the knee to function properly.
Conclusion
The knees are one of the stabilizers in the body that are located between the thighs and legs, allowing flexion and extension. As a small muscle located in the back of the knees, the popliteus stabilizes the knees and enables them to be in motion without pain. However, when the popliteus muscle becomes overstretched and overused, it can develop trigger points in the popliteus that invoke referred pain to the surrounding muscles and cause the knees to lock up. To that point, it causes the body to be unstable and mimics knee pain issues. Fortunately, trigger points are treatable through various treatments that help relieve the pain and reduce the trigger points from returning. When these treatments are utilized on the knees, the surrounding muscles regain flexion mobility in the lower body.
References
English, S, and D Perret. “Posterior Knee Pain.” Current Reviews in Musculoskeletal Medicine, U.S. National Library of Medicine, 12 June 2010, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941578/.
Ghaffarinejad, Farahnaz, et al. “Effect of Static Stretching of Muscles Surrounding the Knee on Knee Joint Position Sense.” British Journal of Sports Medicine, U.S. National Library of Medicine, Oct. 2007, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2465159/.
Hyland, Scott, and Matthew Varacallo. “Anatomy, Bony Pelvis and Lower Limb, Popliteus Muscle.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 6 June 2022, https://www.ncbi.nlm.nih.gov/books/NBK526084/.
Mann, R A, and J L Hagy. “The Popliteus Muscle.” The Journal of Bone and Joint Surgery. American Volume, U.S. National Library of Medicine, Oct. 1977, https://pubmed.ncbi.nlm.nih.gov/908724/.
Sánchez Romero, Eleuterio A, et al. “Prevalence of Myofascial Trigger Points in Patients with Mild to Moderate Painful Knee Osteoarthritis: A Secondary Analysis.” Journal of Clinical Medicine, U.S. National Library of Medicine, 7 Aug. 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7464556/.
Travell, J. G., et al. Myofascial Pain and Dysfunction: The Trigger Point Manual: Vol. 2:the Lower Extremities. Williams & Wilkins, 1999.
Before you begin running, talk with your physician, prosthetist, and other clinicians involved in your rehabilitation/health care treatment. Learning to use a prosthetic takes time and practice. Individuals that meet the minimum recommendations for running and have mastered walking on a prosthesis can begin running. The world of sports prosthetics has realized technological advancements to become highly refined and targeted for all levels of competition.
Before Running Recommendations
Every individual has specific healthcare needs, and guidelines should be considered to prevent injuries.
To become a runner and progress to a good runner, individuals need to focus on strengthening their legs to build endurance levels to meet the energy demands.
Working with a sports chiropractic and physical therapy team is recommended to build, strengthen, and condition the muscles and develop healthy posture and walking habits.
Skin Health
Talk with your healthcare team to ensure the skin can withstand the forces while running. If limb skin quality is insufficient, running can result in sores and blisters that prevent wearing a prosthesis until they heal. Other considerations include the following:
The incision should be healed.
All stitches and staples have been removed.
There should be no drainage.
Ensure there are no open wounds or blisters.
Bone Health
Research suggests in some cases that a decrease in bone density/osteopenia or osteoporosis of the residual limb can occur after amputation.
This can result in pain when applying weight through the residual limb.
Some amputations can result in heterotopic ossification – bone growth in the soft tissues outside the normal skeleton.
If heterotopic ossification is causing symptoms, it is not recommended to run and talk to your physician and prosthetist about options.
Proper Fitting of Prosthetic
Suboptimal socket fit can result in an altered gait.
If there is any compensation when walking, the gait deviations will be exacerbated when running.
Gait deviations can result in abnormal loading, resulting in injuries.
Talk to your prosthetist about the fit if it is less than optimal.
It is recommended to participate in gait training with a chiropractic physical therapy team to learn to walk with proper form.
Balance and Agility
Agility drills are recommended to transition from walking to running.
They help coordinate the limbs and can be done with a regular prosthesis.
Agility and balance exercises promote stability in the socket to become more stabilized during quick movements.
They can help to prevent balance-related falls.
When working on balance, do it in a safe environment with a friend, family, or something to hold on to.
Strength Training
The unaffected leg will now be the main powerhouse, so the focus needs to be on strengthening all the muscles in that leg.
If you have bilateral amputations or both legs, the hips will be the powerhouse for running. It needs to generate all the force to propel the body forward.
Individuals with a below-knee amputation will also have the hamstrings to help out.
Hip musculature needs to be strong to meet running demands.
Without proper strength, the body will compensate in various ways, which can lead to injuries.
Endurance
Endurance training is essential.
A high level of endurance is required before training to run to meet the energy demands.
Running on a prosthesis requires more energy. It could be recommended to use a running prosthesis instead of the everyday prosthesis. The energy needed to run is:
Greater for individuals with amputations above the knee than those below the knee.
Even greater for those with amputations on both sides.
Asymmetry
Asymmetrical loading is a common problem when running with a prosthesis. Runners want to use the unaffected limb more than maintain balance for reasons that include:
Not trusting the prosthetic.
Discomfort when loading the residual limb.
Not enough strength in the residual limb.
Unbalanced amounts of force from impact can result in injuries.
Practice Schedule
In the first week, asses how the socket fits and if there is any discomfort.
If something does not feel correct, check with your prosthetist.
Don’t run for more than 10 minutes in the beginning without stopping to check the skin to see if any red spots appear.
The pressure will be increased, so be aware of anything irritating or rubbing the skin.
Individuals who had their amputations some time ago may be able to tolerate the load more easily at the beginning than individuals who recently had an amputation.
Too much too soon can result in injuries.
Slowly ease into running and give the limbs and body time to adapt to the physical and mental stress.
Running With A Prosthetic Limb
References
Beck, Owen N et al. “Reduced prosthetic stiffness lowers the metabolic cost of running for athletes with bilateral transtibial amputations.” Journal of applied physiology (Bethesda, Md.: 1985) vol. 122,4 (2017): 976-984. doi:10.1152/japplphysiol.00587.2016
Bragaru, Mihai, et al. “Sport prostheses and prosthetic adaptations for the upper and lower limb amputees: an overview of peer-reviewed literature.” Prosthetics and orthotics international vol. 36,3 (2012): 290-6. doi:10.1177/0309364612447093
Kanas, Joanne L, and Mark Holowka. “Adaptive upper extremity prostheses for recreation and play.” Journal of pediatric rehabilitation medicine vol. 2,3 (2009): 181-7. doi:10.3233/PRM-2009-0082
Matthews, D et al. “Return to sport following amputation.” The Journal of sports medicine and physical fitness vol. 54,4 (2014): 481-6.
Meyers, Carolyn, et al. “Heterotopic Ossification: A Comprehensive Review.” JBMR plus vol. 3,4 e10172. 27 Feb. 2019, doi:10.1002/jbm4.10172
Morgan, Sara J et al. “Mobility with a lower limb prosthesis: experiences of users with high levels of functional ability.” Disability and rehabilitation vol. 44,13 (2022): 3236-3244. doi:10.1080/09638288.2020.1851400
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