For individuals experiencing a turf toe injury, can knowing the symptoms help athletes and non-athletes with treatment, recovery time, and returning to activities?
Turf Toe Injury
A turf toe injury affects the soft tissue ligaments and tendons at the base of the big toe under the foot. This condition usually occurs when the toe is hyperextended/forced upward, such as when the ball of the foot is on the ground and the heel is lifted. (American Academy of Orthopaedic Surgeons. 2021) The injury is common among athletes who play sports on artificial turf, which is how the injury got its name. However, it can also affect non-athletes, like individuals working on their feet all day.
Recovery time after turf toe injury depends on the severity and the type of activities the individual plans to return to.
Returning to high-level sports activities after a severe injury can take six months.
These injuries vary in severity but usually improve with conservative treatment. In severe cases, surgery could be required.
Pain is the primary issue that stops physical activities after a grade 1 injury, while grades 2 and 3 can take weeks to months to heal completely.
Meaning
A turf toe injury refers to a metatarsophalangeal joint strain. This joint comprises ligaments that connect the bone on the sole of the foot, below the big toe/proximal phalanx, to the bones that connect the toes to the larger bones in the feet/metatarsals. The injury is usually caused by hyperextension that often results from a pushing-off motion, like running or jumping.
If experiencing turf toe symptoms, see a healthcare provider for a proper diagnosis so they can develop a personalized treatment plan. They will perform a physical exam to assess pain, swelling, and range of motion. (American Academy of Orthopaedic Surgeons. 2021) If the healthcare provider suspects tissue damage, they may recommend imaging with X-rays and (MRI) to grade the injury and determine the proper course of action.
Grades 2 and 3 come with partial or complete tissue tearing, severe pain, and swelling. Treatments for more severe turf toe can include: (Ali-Asgar Najefi et al., 2018)
Limited weight bearing
Using assistive devices like crutches, a walking boot, or a cast.
Physical therapy also includes proprioception and agility training exercises, orthotics, and wearing recommended shoes for specific physical activities. (Lisa Chinn, Jay Hertel. 2010)
A physical therapist can also help ensure that the individual does not return to physical activities before the injury is fully healed and prevent the risk of re-injury.
Grade 1 – Subjective as it varies depending on the individual’s pain tolerance.
Grade 2 – Four to six weeks of immobilization.
Grade 3 – Eight weeks minimum of immobilization.
It can take up to six months to return to normal function.
Returning To Normal Activities
After a grade 1 turf toe injury, individuals can return to normal activities once the pain is under control. Grades 2 and 3 take longer to heal. Returning to sports activities after a grade 2 injury can take around two or three months, while grade 3 injuries and cases that require surgery can take up to six months. (Ali-Asgar Najefi et al., 2018)
Sports Chiropractic Treatment
References
American Academy of Orthopaedic Surgeons. (2021). Turf toe.
American College of Foot and Ankle Surgeons. Foot Health Facts. (2023). RICE protocol.
Najefi, A. A., Jeyaseelan, L., & Welck, M. (2018). Turf toe: A clinical update. EFORT open reviews, 3(9), 501–506. doi.org/10.1302/2058-5241.3.180012
Pinter, Z. W., Farnell, C. G., Huntley, S., Patel, H. A., Peng, J., McMurtrie, J., Ray, J. L., Naranje, S., & Shah, A. B. (2020). Outcomes of Chronic Turf Toe Repair in Non-athlete Population: A Retrospective Study. Indian journal of orthopaedics, 54(1), 43–48. doi.org/10.1007/s43465-019-00010-8
Chinn, L., & Hertel, J. (2010). Rehabilitation of ankle and foot injuries in athletes. Clinics in sports medicine, 29(1), 157–167. doi.org/10.1016/j.csm.2009.09.006
When everyday factors affect how many of us function, our back muscles begin to suffer. The back muscles in the cervical, thoracic, and lumbar section surround the spine and spinal cord, which helps the body stay upright and promotes good posture. The muscles allow the upper portions of the body to bend down and twist without pain while providing stability to the lower parts of the body. However, when the body ages or everyday activities cause issues, it can develop low back pain associated with weak back muscles. There are many ways to prevent these issues from escalating with various hyperextension exercises for low back pain. This 2-part series examines how low back pain affects the body and how different hyperextension exercises can help strengthen the back. Part 1 examines how hyperextension affects the body and how it is associated with low back pain. We mention our patients to certified medical providers that provide available therapy treatments for individuals suffering from chronic low back pain. We encourage each patient when it is appropriate by referring them to associated medical providers based on their diagnosis or needs. We understand and accept that education is a marvelous way when asking our providers’ crucial questions at the patient’s request and acknowledgment. Dr. Jimenez, D.C., makes use of this information as an educational service. Disclaimer
Low Back Pain Affecting The Body
Have you been dealing with aches and pains when bending down? Do you feel stiffness in your torso when twisting? Or have you experienced limited mobility in your hips? Many of these symptoms correlate with low back pain. Studies reveal that back pain is one of the most common issues in the emergency room. Low back pain is associated with many factors that put pressure on the various muscles in the back and can lead to underlying conditions that can cause symptoms to make the body dysfunctional. Additional studies have revealed that chronic low back pain can have influenced overlapping risk profiles, which include:
Stress
Dietary habits
Lifting heavy objects
Musculoskeletal disorders
When these factors affect the back, many individuals will be in constant pain and take medication to relieve their pain. However, medicine can only go so far as it only masks the pain, but there are other ways to reduce low back pain and help strengthen the various muscles surrounding the low back.
An Overview Of Hyperextension (Part 2)
Biomedical physiologist Alex Jimenez explains how there are a couple of different variations that you can do to prevent low back pain. The first one is the elbows in front. The second one is the elbows in front while pointing them forward and keeping them pointed forward throughout the entire movement. The third one is the hands behind the head. And then the fourth variation is putting weight behind your back once you work up to this level. And then using that weight to put more stress on a pivot point. You can also hold the weight to your chest, but putting it behind your head gives you a further pivot point or a further point on the fulcrum, which are your hips putting more stress on your spinal rectors. The repetitions and frequency should be performed at the beginning of most workouts, before or after your abdominal exercises on leg days. You can use this exercise as a warmup before deadlifting or squatting. I’ll remember you don’t have to go as much weight or as many reps when you’re doing this on leg days. So we recommend starting with four sets of 20 reps and slowly working up to four sets of 40 reps. This seems like a lot, but it will be beneficial in the end.
Various Hyperextension Exercises For The Back
When it comes to low back pain, the various muscles are weak, which can lead to multiple symptoms affecting a person’s mobility. Luckily making small changes in a daily structure, like incorporating exercises that target the back, can be beneficial. Studies reveal that exercises targeting the back muscles can help strengthen the targeted muscles to have mobility and stability in the back. As a bonus, exercises combined with chiropractic treatments can help restore the body and allow the spine to be realigned. When it comes to back exercises, hyperextension exercises can help prevent low back symptoms from reoccurring and strengthen weak back muscles. Here are some of the various hyperextension exercises that benefit the back.
Reverse Flys
There are different variations of how to do reverse flys. You can pick a moderate or lightweight dumbbell or a resistance band. This exercise is great for the upper back muscles and rear deltoids.
Sit in a chair where the dumbbells are in front of you. *For resistance bands, make sure the bands are under your feet.
Pick up the dumbbells/resistance bands with the palms of your hands and bend forward.
Squeeze the shoulder blades together, lift the arms to shoulder level with slightly bent elbows, and lower them.
Repeat for three sets of 12 reps and rest in between.
Hip Thrust
Different variations to this exercise can help with the posterior muscles in the lower back. You can use barbells, dumbbells, resistance bands, or your body weight to strengthen your core back muscles.
Lean against a bench with the knees bent and the feet flat on the floor.
Rest the shoulder blades on the bench for support and have the weight placed near your core.
Raise your body slightly by pushing your heels down to the floor and walking out slowly beyond your knees.
Push through your heels to have your hips at shoulder level, hold for a second, and lower your hips back down.
Repeat for three sets of 12 reps and rest in between.
Supermans
This exercise has two different variations and makes you aware of your back muscles. This exercise helps improve muscle mobility in all three sections of the back.
Lay on the mat face down with your arms in front and your legs straight.
Keep the head in a neutral position and raise both the arms and legs off the mat. This allows the body to be in a banana shape in a comfortable position. *If you want more challenge, lift the opposite arms and legs simultaneously.
Hold for a couple of seconds for the upper and lower back and hamstrings to maintain their positions.
Lower down with control.
Repeat for three sets of 12 reps and rest in between.
Fire Hydrants
This exercise helps the lower back and glute muscles reduce the effects of low back pain and make it more challenging to use a resistance band.
Be in a cat/cow position on your mat, allowing the wrist to be aligned under the shoulders and the knees to be aligned under the hips.
Maintain a neutral spine while engaging the core.
Squeeze the glutes and lift your right leg off the mat, keeping the knee at 90 degrees. *The hips should be the only ones moving to keep the core and pelvis stable.
Lower the right leg down with control.
Repeat for three sets of 12 reps and rest before repeating the motion on the left leg.
Conclusion
All in all, having low back pain doesn’t mean your life is over. Incorporating hyperextension exercises as part of your daily routine can help strengthen your back muscles and ensure that you won’t have reoccurring symptoms from low back pain. Making these small changes can lead to beneficial results in the long run for your health and wellness journey.
References
Allegri, Massimo, et al. “Mechanisms of Low Back Pain: A Guide for Diagnosis and Therapy.” F1000Research, U.S. National Library of Medicine, 28 June 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4926733/.
Casiano, Vincent E, et al. “Back Pain – Statpearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 4 Sept. 2022, www.ncbi.nlm.nih.gov/books/NBK538173/.
Koes, B W, et al. “Diagnosis and Treatment of Low Back Pain.” BMJ (Clinical Research Ed.), U.S. National Library of Medicine, 17 June 2006, www.ncbi.nlm.nih.gov/pmc/articles/PMC1479671/.
The body is an amazingly complex machine as it allows the individual to move each section, like the back, arms, legs, torso, neck, and head, without feeling any pain. Each section has various muscles, ligaments, and tissues that surround the skeletal joint and allow mobility, stability, and range of motion when the host is active. However, when underlying conditions start to affect the body, each section can be affected and cause pain-like symptoms associated with the muscles, ligaments, and tissues. Sometimes it can even cause referred pain in the vital organs, leading to more problems when not treated immediately. To that point, various exercises combined with therapy can help prevent pain-like symptoms from affecting the body and restore mobility to the upper and lower portions. This 2-part series will look at an exercise called hyperextension, which can help strengthen these muscles in the upper and lower portions. Part 1 will examine how hyperextension affects the body and how it is associated with low back pain. Part 2 will look at the various hyperextension exercises that can help strengthen each muscle group. We refer our patients to certified medical providers that provide available therapy treatments for individuals suffering from chronic pain-like conditions associated with low back pain. We encourage each patient when it is appropriate by referring them to associated medical providers based on their diagnosis or needs. We understand and accept that education is a marvelous way when asking our providers’ crucial questions at the patient’s request and acknowledgment. Dr. Jimenez, D.C., makes use of this information as an educational service. Disclaimer
What Is Hyperextension?
Have you been experiencing pain-like symptoms in different areas of your body? Does it hurt when twisting and turning? Or do you constantly ache when bending over? Many of these symptoms are associated with muscle and joint pain that can affect the body and lead to hyperextension. Hyperextension is when a skeletal joint has a greater range of motion without feeling pain.
When a person suffers from a traumatic injury or has a chronic condition, it can cause the various muscles in the body to extend their range of motion and cause more pain that can affect their quality of life. A perfect example would be a person who is double-jointed in their hands, knee, elbows, and back. Even though many double-jointed people can further extend their joints, it can lead to various issues that can impact the body and lead to pain-like symptoms. For example, studies reveal that if a person has been in an auto accident and suffers from whiplash, the hyper-extended muscles can cause pain-like symptoms in the soft tissues, leading to neck pain. When this happens, it can cause symptoms of limited mobility and affect the individual.
Now if it is chronic conditions like EDS (Ehlers-Danlos syndrome) or chronic back conditions, it can affect the lower extremity muscles while affecting the mobility and stability of the body. Studies reveal that low back pain associated with hyperextension is developed when various factors can cause the spine to be in subluxation and compress the different vertebrate discs, muscles, ligaments, and tissues, which can cause pain over time. Additional studies have also found that when there are injuries in the thoracolumbar and lumbar spine, it is often combined with various forces that can cause mobility issues which leads to spinal subluxation and spinal compression.
An Overview Of Hyperextension
Biomedical physiologist Alex Jimenez will be explaining a specific exercise called Hyperextensions. Hyperextensions are an exercise that is designed to strengthen the erectors of the spine. They usually involve an extension type of maneuver for the concentric portion and AF flexion for the eccentric portion. Hyperextension relies on a pivot point, usually at the hips, which stresses the lower back muscles. It also allows you to work on the lower back muscles, which we said, the glutes, hamstrings, and even the mid back, depending on the arc of the movement. So why are hyperextensions important? They strengthen the lower back muscles, also known as the spinal rectors, and are responsible for stabilizing the spine. It can help decrease the chances of lower back pain or injuries, and it also helps strengthen your deadlift and squats. And it does this by allowing you to have better stabilization throughout these dynamic movements. So what muscles are involved? Numerous muscles are involved in the upper and lower body extremities, allowing hyperextension exercises to provide more range of motion without pain. The next part will show different variations of hyperextension exercises that can help each muscle.
Hyperextension Associated With Low Back Pain
Spinal subluxation often leads to low back pain and can affect a person’s ability to move. So how is hyperextension associated with low back pain? Some factors leading to low back pain, like incorrect posture or excessive lifting of heavy objects, can affect the low back muscles. The low back muscles support the low back, stabilize the spine, and help maintain good posture. When these muscles have been overused, it can lead to various injuries. All is not lost, as studies reveal that hyperextension exercises for low back pain, when done slowly, can provide isometric endurance improvement to the back muscles and allow flexibility back to the spine. Hyperextension exercises can strengthen the lower back muscles and reduce pain. However, exercise combined with chiropractic care can enable the body to restore itself and reduce the pain-like symptoms associated with spinal subluxation to allow the range of motion back in the muscles.
Conclusion
Hyperextension in the body allows the various muscle groups to extend their full range of motion. When multiple factors or chronic conditions begin to affect the different muscles in the body, it can lead to pain-like symptoms associated with the upper and lower extremities. Fortunately, the combination of exercises and chiropractic care can restore the body and the muscles to relax. In part 2 of this series, we will look at the various hyperextension exercises for low back pain and how they can help increase the body’s range of motion.
References
Johnson, G. “Hyperextension Soft Tissue Injuries of the Cervical Spine–a Review.” Journal of Accident & Emergency Medicine, U.S. National Library of Medicine, Jan. 1996, www.ncbi.nlm.nih.gov/pmc/articles/PMC1342595/.
MACNAB, I. “Low Back Pain. the Hyperextension Syndrome.” Canadian Medical Association Journal, U.S. National Library of Medicine, 15 Sept. 1955, www.ncbi.nlm.nih.gov/pmc/articles/PMC1826142/.
Manniche, C, et al. “Intensive Dynamic Back Exercises with or without Hyperextension in Chronic Back Pain after Surgery for Lumbar Disc Protrusion. A Clinical Trial.” Spine, U.S. National Library of Medicine, Apr. 1993, pubmed.ncbi.nlm.nih.gov/8484146/.
Oh, In-Soo, et al. “Pure Hyperextension Injury of the Lower Lumbar Spine with an Ureteral Impingement.” European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, U.S. National Library of Medicine, May 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC3641240/.
The low back is a common source of discomfort and soreness among volleyball players because of repetitive jumping, bending, and rotating of the trunk. Adolescents have an increased risk of this injury because their vertebral bones are still developing, which increases the risk for stress fractures. Chiropractic care, massage therapy, decompression, rest, and athletic training can help expedite pain relief and heal the injury.
Volley Back Pain
Muscle or ligament strains are the most common injury from repetitive jumping, bending, rotating movements, and hyperextension during serving, hitting and setting. This can lead to excessive compression forces on the discs and joints, causing reduced blood circulation, increasing the risk of overload injuries. One study reported that low back pain is experienced in 63% of players. However, if low-back pain is accompanied by pain that runs down the leg along with numbness or weakness in the foot or ankle, the issue could be a herniated disc.
Causes
One common reason is endurance imbalances in the muscles that stabilize the low back. The core muscles provide stability to the low back and spine for all movements. If imbalances are present, a player may spike or serve the ball with intense turning and arching. The added actions cause increased pressure in the joints and hip, gluteal, and leg muscles, affecting the spine’s stability.
The gluteals run from the back of the pelvis/hip bones down to the outside of the thigh.
The gluteal muscles prevent the trunk and hips from overbending forward when landing.
If the gluteal muscles do not have the strength and endurance to perform this motion, the upper body will bend too far forward, causing poor landing posture and decreased spine stability.
Anterior Pelvic Tilt
Studies have shown that players with low back pain tend to stand and land with an anterior pelvic tilt. This is an unhealthy posture when the front of the pelvis tilts forward, and the back of the pelvis raises. Landing hard with an anterior pelvic tilt causes increased arching and increases the pressure in the joints.
Chronic back pain
Warning signs of a more serious back problem include:
Pain that has lasted for more than 1 week and is not improving or getting worse.
Pain that prevents sleep or causes the individual to constantly wake up.
Difficulty sitting.
Back soreness when performing basic tasks and chores.
Significant pain on the court when jumping, landing, or rotating.
Chronic pain ranges from aches to shooting or throbbing pain that can run down the buttocks and legs.
Chiropractic Care
A chiropractor can alleviate volleyball back pain, rule out a more severe injury, such as a stress fracture or herniated disc, and provide a healthier and faster recovery. According to a study, athletes who received chiropractic care showed better speed and mobility. Quick reflexes and hand-eye coordination depend on an optimal functioning nervous system. 90% of the central nervous system travels through the spine. When one or more spinal segments are misaligned, the effect on the nervous system can seriously impact and disrupt nerve circulation, affecting speed, mobility, reflexes, and hand-eye coordination. Chiropractic adjustments will:
Relax and reset the back muscles.
Realign and decompress the spine.
Remove the pressure around the nerve roots.
Strengthen the core.
Improve and increase range of motion, strength, and overall endurance.
Anterior Pelvic Tilt
References
Haddas R, Sawyer SF, Sizer PS, Brooks T, Chyu MC, James CR. “Effects of Volitional Spine Stabilization and Lower-Extremity Fatigue on the Knee and Ankle During Landing Performance in a Population With Recurrent Low Back Pain.” J Sport Rehabil. 2017 Sep;26(5):329-338. doi: 10.1123/jsr.2015-0171.
Hangai M. et al., Relationship Between Low Back Pain and Competitive Sports Activities During Youth, Am J Sports Med 2010; 38: 791-796; published online before print January 5, 2010, doi:10.1177/0363546509350297.
Jadhav, K.G., Deshmukh, P.N., Tuppekar, R.P., Sinku, S.K.. A Survey of Injuries Prevalence in Varsity Volleyball Players. Journal of Exercise Science and Physiotherapy, Vol. 6, No. 2: 102-105, 2010 102
Mizoguchi, Yasuaki, et al. “Factors associated with low back pain in elite high school volleyball players.” Journal of physical therapy science vol. 31,8 (2019): 675-681. doi:10.1589/jpts.31.675
Movahed,Marziehet al. (2019). “Single leg landing kinematics in volleyball athletes: A comparison between athletes with and without active extension low back pain.”
Sheikhhoseiniet al. (2018). “Altered Lower Limb Kinematics during Jumping among Athletes with Persistent Low Back Pain”
Athletes and fitness enthusiasts work hard to stay in shape, but they are also at an increased risk for a lumbar hyperextension injury. Lumbar hyperextension injuries happen when the low back is bent backward repeatedly or overarches repeatedly. The repetitive stress can lead to severe complications and damage the nerves, vertebrae, and backbones. Motorized decompression therapy could be a treatment option.
Lumbar Hyperextension Injury
Injuries can be caused by overuse, improper mechanics and technique, lack of proper conditioning, insufficient stretching, or trauma. When looking for symptoms of lumbar hyperextension injuries, the first is low back pain that is severe and lasts at least a few days while becoming more intense with time. The lower back pain that worsens when extending, or arching the back, in addition to stiffness, muscle spasms, radiating buttock and thigh pain, tight hamstrings, and difficulty standing or walking, can be indicators of a lumbar hyperextension injury. However, this could be difficult to distinguish from other injuries like muscle strain, disc herniation, and stenosis; this is why a proper examination by a medical professional is recommended.
Treatment
Initial treatment consists of resting, sitting out from the sport, and other activities that could aggravate the back.
A doctor may recommend over-the-counter non-steroidal anti-inflammatory medications.
Heat and ice can also be used to increase circulation and relieve pain.
If hyperextension of the back continues even after rest, it could signify a stress fracture in the vertebrae. This condition is referred to as spondylolysis.Spondylolysis is an overuse injury. It occurs in individuals who participate in sports like gymnastics, diving, volleyball, football, and weight lifting. Spondylolysis and spondylolisthesis are common in adolescent athletes experiencing lower back pain.
A doctor may assign a back brace to prevent movement, allowing the bone to heal back together.
A doctor could also recommend physical therapy for 6-12 weeks after the diagnosis and once the bones have had time to heal.
Rehabilitation exercises focus on improving back flexibility and strength.
Athletes can be cleared to return to their sport within 3-6 months.
Surgery is rarely necessary and only looked into if the individual continues to have persistent pain after 6-12 months of treatment.
This changes the spine’s position, takes the pressure off the nerves and discs, and restores the cushioning.
As the machine pulls the body, a vacuum effect fills the discs with oxygen and nutrients to stimulate healing.
Computer technology controls treatment duration, angle, intensity, and relaxation.
Prevention
Athletes and fitness enthusiasts are recommended to seek professional help to retrain how they perform repetitive and excessive high-impact activities. Specifically, those involving hyperextension movements like kicking, jumping, running, and back bending help minimize the risk of developing a back injury. They are also recommended to maintain body conditioning, back and hamstring flexibility, core muscle strength and endurance, cardiovascular fitness, and properly warming up and stretching before and after the physical activities.
DOC Decompression Table
References
Ball, J.R., Harris, C.B., Lee, J. et al. Lumbar Spine Injuries in Sports: Review of the Literature and Current Treatment Recommendations. Sports Med – Open 5, 26 (2019). doi.org/10.1186/s40798-019-0199-7
Carter, D R, and V H Frankel. “Biomechanics of hyperextension injuries to the cervical spine in football.” The American journal of sports medicine vol. 8,5 (1980): 302-9. doi:10.1177/036354658000800502
Goetzinger, Sara, et al. “Spondylolysis in Young Athletes: An Overview Emphasizing Nonoperative Management.” Journal of sports medicine (Hindawi Publishing Corporation) vol. 2020 9235958. 21 Jan. 2020, doi:10.1155/2020/9235958
Lawrence, Kevin J et al. “Lumbar spondylolysis in the adolescent athlete.” Physical therapy in sport: official journal of the Association of Chartered Physiotherapists in Sports Medicine vol. 20 (2016): 56-60. doi:10.1016/j.ptsp.2016.04.003
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