Physiotherapy for Calf & Shin Injuries
The lower leg is also prone to injury, and like injuries of the knee and hip, can be debilitating in that an injury here will limit mobility and hence impinge on quality of life. These injuries need to be properly treated by a chartered physiotherapist for a complete functional recovery.
Common calf and shin injuries
- Broken Leg (Tibia and Fibula fracture) – Usually a consequence of motor vehicle accidents or impact sports, a direct trauma can cause a fracture in the two bones of the lower leg, the Tibia and Fibula. The former is the shin bone that is load bearing, while the latter is a supporting structure further to the outside of the limb. The Tibia is more commonly damaged because of its more prominent position, and these fractures can be closed (the skin remains intact) or open (bone fragments formed by the fracture puncture the skin), and are always emergency situations typified by extreme pain, loss of movement, bleeding if the fracture is open, visible deformity, swelling and discolouration (from internal bleeding as the broken bone loses blood).
- Shin Splints (Medial Tibial Stress Syndrome) – Many runners and athletes complain of a piercing pain that occurs whilst running. ‘Shin splints’ is actually an umbrella term for a number of different conditions, the most common of which is Medial Tibial Stress Syndrome. Essentially the injury develops as the shin bone is stressed repeatedly, resulting in micro-fractures causing pain. This pain will often present on the medial Tibia (the inside of the shin) and disappear during rest, only to return during and after exercise.
- Compartment Syndrome (Exertional Lower Limb Pain) – Often confused with shin splints, this is a condition which affects the same group of people (runners, dancers etc.) and presents with similar systems. However the pathology of the injury is quite different as Compartment Syndrome is an injury that occurs when the musculature, vasculature, and nerves of the leg become too large in volume for the compartment in which they exist, resulting in increased pressure and compression of these structures. This occurs as a consequence of either bleeding or inflammation because of trauma, or a substantial increase in muscle mass. This increased pressure can be felt as tension in the tissues of the lower leg, which is understandable as normal pressure in the compartments of the lower leg are in the 10-15 mmHg range, and can more than treble, exceeding 50mmHg in the condition.
- Calf Muscle Strain – The calf muscles are composed of three muscles along the backside of the lower leg which pull the heel upwards by way of the Achilles tendon to allow for movements in running and walking. A strain is a tear in any of these muscles, and can range from first degree (localised damage to a few muscle fibres) to third degree (muscular rupture). Like all strains, this injury occurs as the muscles of the calf are hyper-extended and thus stretched beyond their natural limits. Depending on its severity, this injury can present with some stiffness or cramp, or with intense and debilitating pain with subcutaneous bleeding visible as bruising.
Physiotherapy and Calf Injuries
Physiotherapists have a lot of experience in dealing with lower limb injuries because of the frequency with which these conditions present themselves. As discussed above, it takes some experience and skill to differentiate between conditions like Compartment Syndrome and Shin Splints, and if a misdiagnosis is made by the referring physician, assuming there is one and the patient hasn’t self-referred, it comes down to the physio and their assessment to determine the exact pathology of the injury.
Rehabilitation of muscle strains, unless extremely severe, is generally straightforward and will see your physiotherapist following what is called the RICE protocol. You are advised to rest your leg, regularly apply ice in 20 minute sessions to reduce swelling and bleeding, compression, and finally elevation. The physiotherapist will then proceed to suggest exercises and stretches to restore functionality while not impairing muscle repair. These strengthening exercises are not restricted to the leg and calf, but also involve recruiting core (back and abdominal muscle) muscles for improved stability and balance which prevent future injury and facilitate healing. The tools a physio will use to these ends include Swiss balls and resistance bands, the former designed to improve stability, the latter to build strength.
Fractures, particularly Tibial fractures which have a tendency of splintering, must be rehabilitated very carefully. The patient’s injury is first immobilised for up to 16 weeks, in this time there will be some degree of muscular atrophy which can exacerbate your existing frustration. Some hospitals, under advisement from a physio and with permission from an orthopaedic consultant, may use plastic cast walkers rather than traditional plaster casts. These actually allow for physiotherapy as the casts are removable, meaning that under a physio’s supervision you conduct basic exercises that prevent muscular atrophy and begin the rehabilitation process as early as it is safely possible to do so.
Hydrotherapy is key to physiotherapy and its success, with many physios using regular underwater exercises to aid in recovering strength and functionality without the risk of damaging the leg by premature load bearing. As discussed above, the use of Swiss balls and resistance bands are commonplace when restoring functionality and strength to the lower leg.
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