Align Yourself – Lower Leg Injuries

As all you outdoor enthusiasts in the Foothills embark on summer trail running, hiking, biking and sunny dog walks, we see an increase in hip and knee issues. These injuries may be traumatic in nature, a trip and fall, landing on a hip or twisting your knee. However, more often than not, we find they are related to common muscle imbalances in the hip and lower leg.  

One aspect we always assess is the alignment of the lower leg during movement, such as a squat. A single leg squat is especially indicative of alignment problems in the lower leg.  This movement requires the pelvis and lumbar spine to stay neutral as the hip, knee and ankle all flex in sequence. 

If there is poor coordination and alignment along these joints, we aim to figure out where it may be coming from. Weak core muscles, such as the transverse abdominus – the deepest abdominal layer, and the iliopsoas – a spine stabilizer, can contribute by not being efficient in stabilizing the spine during motion.  The gluteal muscles may contribute by not being efficient at stabilizing the pelvis as the hip is flexing. If the gluteal muscles are weak, the pelvis will slightly drop on one side and cause the knee to fall inwards (which is caused by the hip adduction). The hip is not able to maintain its neutral position. This motion of the knee falling inwards can put stress on the soft tissues surrounding the kneecap. Iliotibial Band Syndrome (IT Band), Patellofemoral Pain Syndrome, and tendonopathies are common problems that develop.  This mal-alignment at the knee can also stress the ligaments and meniscus structures, putting you more at risk of ligament tears (MCL, ACL), meniscal derangements and bursitis issues (Baker’s Cyst for example).  

Locally at the knee, the inner quadriceps muscle may be underdeveloped.  A previous injury, postural habits, or general de-conditioning may cause this.  The Vastus Medialis Oblique (VMO) is important in the last 30 degrees of knee extension (think going down stairs, gradual downhill hiking). The VMO largely contributes to the proper tracking of the patella (kneecap) and coordinated motion throughout knee extension. 

Further down the leg, the ankle and foot may contribute to hip and knee problems as well. An excessively pronated foot, when the inner arch of the foot is flattened, may contribute to the knee falling inwards during a squat. As the body weight is shifted more onto the big toe and inner aspect of the foot, the knee is drawn towards the big toe and the whole lower leg rotates inwards. A previous ankle sprain may also contribute to this issue as the ankle joint may be stiff and prevent the knee from flexing directly over the ankle.  Plantar fasciitis, achilles tendonopathies and Morton’s Neuroma nerve impingements may develop. 

Some remedies used for these common problems are taping procedures to encourage proprioception (joint and muscle awareness) and relieve tension on stressed tissues, Active Release Techniques/soft tissue stretching for tight and overused muscles, Electrical Muscle Stimulation to help engage de-conditioned muscles, Intramuscular Stimulation to relieve tight muscle bands, and exercise prescription.  Specific exercises tailored to your unique posture are the most helpful in prevention and healing. This is what will make the difference in reshaping your movement patterns and teaching your body proper mechanics.  Here are a couple of great exercises that help target some of these common issues. 

Wall Sit:

Assume a sitting position with your back up against a wall, hips and knees bent to 90 degrees, and your torso straight. Place a soccer size ball between your knees, ensuring that your legs are parallel with knees over the ankles and aligned over the mid forefoot. Squeeze the ball with your knees and hold for 5 seconds. Relax, but don’t remove the ball yet. Repeat with 10 squeezes, held for 5 seconds each. 

Windshield Wipers:

Sit in a chair with an elastic theraband looped around both ankles. Keeping your knees together and bent at 90 degrees, pull your right foot away from the left (your left leg is the anchor and stays still until you switch sides). As if your lower leg is a windshield wiper – it moves back and forth. This motion is actually coming from the posterior hip muscles and the thigh should remain relaxed. Repeat 2 sets of 20 reps on each side.

It is worth having a full body assessment if you are experiencing any of the common injuries mentioned above. We can tailor a specific exercise program suitable for you and the activities you enjoy. 

The crew at Bragg Creek Physiotherapy wish you all a great summer!

Jennifer Gordon (BScPT, AFCI, GIMS)