The lower leg is the portion of the lower extremity between the bottom of the knee and top of the ankle. The lower leg must absorb a great deal of impact during exercise and sport activities involving running and jumping movements. Therefore, it's a frequent site of lower extremity injuries.
Anatomy Of The Lower Leg
The lower leg broadly describes the section of the leg located between the ankle and knee. The back of the lower leg is referred to as the calf and the front of the lower leg is referred to as the shin.
There are two bones in the lower leg. The tibia, also called the shin bone, is the larger and more medial of the two and carries most of the weight of the body. It can be felt running down the center of the front of the leg. The upper end of the tibia forms a portion of the knee joint and is the attachment point for the patellar ligament. The lower end of the tibia forms a portion of the ankle joint. The fibula runs alongside the tibia, acting as a stabilizer.
The tibia and fibula articulate with each other via two tibiofibular joints. The superior tibiofibular joint is a synovial joint that provides a very slight rotation of the lower leg below the knee. The lower ends of the two bones articulate at the inferior tibiofibular joint. This joint is a syndesmosis joint that doesn’t provide very much motion. It and the associated ligaments ( anterior inferior tibiofibular ligament, posterior inferior tibiofibular ligament, transverse ligament, interosseous ligament) mainly function to hold the two bones together. Another important ligament is the middle tibiofibular ligament. This ligament serves to separate the muscles on the front of the lower leg from those on the back of the lower leg.
The lower leg muscles, as well as their associated tendons, blood supply, and nerve supply, are anatomically divided into four compartments:
1. The anterior compartment - contains the tibialis anterior, extensor digitorum longus, extensor hallucis longus, and peroneus tertius muscles and tendons.
2. The lateral compartment - contains the peroneus longus and peroneus brevis muscles (the peroneals) and tendons.
3. The superficial posterior compartment - contains the soleus, gastrocnemius, and plantaris muscles and tendons.
4. The deep posterior compartment - contains the popliteus, tibialis posterior, flexor digitorum longus, and flexor hallucis longus muscles and tendons.
The tissues within the compartment are covered with a tough membrane called fascia. Fascia keeps the structures in place and isn’t very pliable.
What Causes Lower Leg Pain?
Pain in the lower leg means that one or more of the structures within the lower leg has suffered an injury or is otherwise not performing normally. Lower leg injuries may be caused by a direct trauma, such as a blow to the lower leg during a sport-related activity or car accident. It may also be the cumulative result of overuse, misuse, or repetitive use of the lower leg. Since the lower leg is a necessary component in running, jumping, sprinting, and cutting motions, lower leg injuries are commonplace in many sports. There are also certain disease processes that may affect the performance and function of the muscles, tendons, ligaments, or bones in the lower leg.
What Are Some Common Lower Leg Injuries?
Shin Splints / Medial Tibial Stress Syndrome
Shin splints, also called medial tibial stress syndrome, are the result of placing too much stress on the tibia bone or the muscles or ligaments running along the tibia bone. The affected structure(s) swell and cause pain on the front outer aspect of the lower leg. The stress is usually caused by vigorous or high-impact walking, jumping, and running activities or excessive outward rotation of the foot. Improper foot wear, exercising on hard surfaces, and suddenly changing the frequency or intensity of physical activities increases the risk of developing shin splints.
Tibial Stress Fractures
Stress fractures usually occur in the weight bearing bones of the body. The tibia bone, being a weight bearing bone, is a common site of stress fractures. A tibial stress fracture is an incomplete fracture of the tibia. This small crack in the bone is usually the result of compression forces upon the bone or forceful muscle contractions during repetitive or intense running, jumping, and walking activities. Shin splint pain and tenderness is very similar to that of a stress fracture.
Compartment Syndrome
Compartment syndrome can be acute, which is caused by a severe injury and is classified as a medical emergency, or chronic, which is generally not as severe and caused by overuse or repetitive use. Compartment syndrome occurs when the muscles, nerves, and blood vessels within one of the compartments become compressed due to swelling and bleeding within the compartment after an injury. Since the fascia isn’t pliable, the tissues don’t have anywhere to expand. This raises the normal pressure within the compartment and decreases blood flow to the compartment. In acute compartment syndrome, tissue death soon follows if the substantial increase in pressure isn’t relieved. In chronic compartment syndrome, the pressure usually subsides with rest.
Calf Strain
A calf strain, also called a pulled calf, is an injury to one of the calf muscles or their tendons. It occurs when the calf muscle or tendon fibers are abnormally stretched or torn. This injury is especially common in sports involving sudden changes in direction and sudden stops and starts that place a great deal of stress on the calf muscles and tendons. Strains can also occur if the muscle is already fatigued, tight, or weaker than opposing muscle groups. Strains are graded based on the degree of damage to the muscle or tendon. A grade one strain involves the fibers abnormally stretching or microscopically tearing. A grade one strain doesn’t typically interfere with muscle/tendon function. A grade two strain involves moderate tissue tearing and some limitations in muscle/tendon function. A grade three strain involves extensive (over 90%) or complete tearing of fibers and significant to complete disruption in muscle/tendon function.
Strengthening Exercises
These Calf Exercises are ideal to build strength and flexibility.
Massage Treatment
These Calf Massage Techniques are of great value in pain relief; circulation stimulation; dispersing blood and fluid accumulations; swelling reduction; and relaxing muscle spasms, especially when used alongside the Sinew Therapeutics liniments and soaks.
ACUTE STAGE SYMPTOMS AND TREATMENT
When there is swelling and inflammation in your calf.
ACUTE STAGE SYMPTOMS:
The acute stage starts the moment an injury occurs and lasts until the swelling and inflammation are gone. The swelling is the result of the blockage of blood, tissue fluids and circulation in the calf because their normal movement has been disrupted by the force of the injury. Just like cars back up behind a traffic jam, causing congestion, exhaust and overheating; blood and fluids back up behind the injured calf, causing pain, inflammation, lumps and swelling.
The sensation of heat is due to the warming action of the blood and fluids overheating in the injured calf as they back up and accumulate. Stiffness and decreased mobility are due to spasms in tendons and ligaments that have contracted reflexively beyond their normal range from the impact of the injury.
As ligaments and tendons stretch and tear, blood from ruptured blood vessels becomes trapped in the local tissues. As the trapped blood clots up, it sticks the tissues together creating adhesions. Adhesions cause pain, inflammation and restricted movement because the layers of tissue that used to slide smoothly across one another now adhere and snap which interferes with normal functioning. It is essential to break up clotted blood as quickly as possible to prevent adhesions and scar tissue from forming.
During the acute stage it is very important to restore normal circulation to the calf, break up clotted blood and stagnant fluids, reduce swelling, and reduce the redness and heat associated with inflammation. By restoring the flow of blood, fluids, and circulation in the calf, then pain is relieved, damaged tissues can regenerate with healthy functional tissue, and the calf can strengthen and regain it's mobility.
ACUTE STAGE TREATMENT:
1. Apply the Sinew Herbal Ice on your calf to reduce redness, swelling, and inflammation while dispersing accumulated blood and fluids to help restore normal circulation to the calf. This first-aid treatment is used in place of ice to significantly speed up the healing process. It reduces the swelling and inflammation more effectively than ice, allowing you to more quickly regain range of motion. Acute Sinew Liniment can be used in-between applications.
Ice is not recommended because it does not help repair damaged tissues and keeps everything in the injured area frozen, causing the stagnation of blood and fluids and the contraction of muscles, tendons and ligaments. In Chinese sports medicine ice is not used and is considered a culprit in injuries that don’t heal well.
2. Massage your calf with Acute Sinew Liniment to relieve pain, reduce swelling and inflammation, break up clotted blood and stagnant fluids, and stimulate circulation of blood and fluids to help cells quickly repair damaged tissues. Sinew Herbal Ice can be used in-between applications.
3. The Sinew Sports Massage Oil is recommended for use before and after exercise, sports and strenuous activity. It warms and stimulates your muscles, increases circulation and relieves tightness, hence improving your performance and helping to prevent injury.
CHRONIC STAGE SYMPTOMS AND TREATMENT
When there is NO swelling and inflammation in your calf.
CHRONIC STAGE SYMPTOMS:
The chronic stage begins once the swelling and inflammation are gone, but you still feel aching pain and stiffness. This is because there are still accumulations of stagnant blood and fluids in your calf that are blocking circulation and blood supply to damaged tissues, creating residual pain, stiffness and weakness. You may actually feel hard nodules like sand in the tissue, indicating accumulation, calcification, and adhesions, which all cause pain, stiffness, and joint instability.
Your calf may feel more sensitive to the cold and ache in cold and damp weather due to impaired circulation. When you move your calf you may hear a clicking or popping sound from the tendons and ligaments slipping very slightly in and out of their natural alignment indicating weakness and joint instability, causing chronic pain and a cycle of reinjury. These symptoms are often the result of failure to treat the injury properly from the outset and overicing.
Increasing circulation and blood supply to the damaged tissues is very important in treating chronic injuries because tendons and ligaments do not have an extensive direct supply of blood. That is why chronic injuries can be slow to heal. Increasing local circulation also prevents cold and dampness from penetrating the injured area, preventing pain and stiffness.
During the chronic stage it is very important to break up remaining accumulations of blood and fluids, and increase circulation and blood supply to the damaged tissues. By increasing circulation and blood flow in the calf, then pain and stiffness is relieved, and the tendons and ligaments can strengthen to restore stability.
CHRONIC STAGE TREATMENT:
1. Massage your calf with Chronic Sinew Liniment to relieve pain and stiffness, strongly stimulate circulation and blood flow to damaged tissues, and promote the healing of overstretched tendons and ligaments. The Sinew Relaxing Soak can be used in-between applications.
2. Soak your calf with the Sinew Relaxing Soak to relax muscles and tendons that are in spasm, ease joint pain and stiffness, and improve range of motion. The Sinew Relaxing Soak is particularly useful if you feel restricted mobility in your calf. The soak can be used by saturating a towel in the liquid and applying it to your calf. Chronic Sinew Liniment can be used in-between applications.
3. The Sinew Sports Massage Oil is recommended for use before and after exercise, sports and strenuous activity. It warms and stimulates your muscles, increases circulation and relieves tightness, hence improving your performance and helping to prevent injury.
