All posts by ramiro

May 08
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bicep

Biceps Tendinitis

By | Biceps | No Comments

Biceps Tendinitis and Injury

Anatomy of the Biceps

The Biceps Brachii (commonly called the biceps) is a muscle located at the front of the upper arm and attaches your arm bone (humerus) to your shoulder. It is the muscle that bumps up when you flex your arm and it functions to rotate your arm from pronation to supination (twist your palm upward), and to bend your elbow and shoulder.

Biceps tendinitis is often caused by repetitive overhead motions in our work, hobbies, and sports.

Biceps means ‘two heads’ in latin and the muscle earns its name because it joins at the shoulder in 2 places with 2 different ‘heads’, know as the proximal biceps tendonsbecause they are closest to the top of the arm. The short head of the biceps tendon originates at the coracoid process of the scapula (shoulder blade). The long head of the biceps originates just above the glenoid fossa (joint cavitiy) of the scapula (shoulder blade) and runs in front of the head of the humerus along thebicipital groove, like a rope through a pulley. The transverse humeral ligament runs over top of the long head biceps tendon, holding it against the humeral head. The 2 heads of the biceps then merge and go down the length of the upper arm. It attaches at the largest part of the radius(lower arm bone) at the elbow.

Both heads of the biceps muscle are attached to the shoulder bones with their respective tendons. These tendons can become irritated and inflamed from a strain or over use of the tendon. As a result, tendonitis, tenosynovitis or a biceps tendon rupture may occur.

Biceps Injuries

Biceps tendinitis can lead to tenosynovitis and possibly a biceps tendon rupture if left untreated

Biceps brachii tendon damage, inflammation, strain, or a tear typicallyaffects the long head tendon of the biceps, as it is much more involved with the biceps group of muscles and tendons. The biceps is a commonly injured area of the body due to the large range of motion and frequent use of the shoulder joint.

Biceps tendinitis, or bicipital tendinitis(also spelled tendonitis), is a painful condition that affects the fibres of the biceps brachii tendon. Tendinitis occurs when the biceps tendon experiences small tears, is irritated, and becomes inflamed. As tendonitis develops, the tendon shealth (covering) can becomethicker due to the tough scar tissue that builds up during healing. This thickening makes the tendon less flexible and prone to further injury.

Biceps tendonitis causes pain in your arm and/or shoulder and may lead to moresevere problems if left untreated. The tendon and its sheath can become bound together, a condition known as adhesive tenosynovitis, which can severely restrict the range of motion within the arm and shoulder. The walls of the tendon sheath can thicken which prevents the tendon from sliding through the opening that keeps it in place, a condition known as constrictive tenosynovitis. The bicep tendon can rupture, or tear, completely which may require surgery.

Biceps tenosynovitis is a common tendon injury that typically affects older athletes. The synovial sheath (outer covering) of the biceps brachii tendon becomes inflamed and swollen. This limits the biceps tendon’s ability to slide through the sheath smoothly and can cause scar tissue to build up between the tendon and its sheath restricting movement even more.

May 08
0
shin

Shin Splints

By | Shin Splints | No Comments

Shin Splints

Posteromedial and Anterolateral Shin Splints

A shin splint is a painful condition that occurs from damage to muscles along the shin, and the pain can occur anywhere from just below the knee to above the ankle.

The typical cause is continued, repeated stress to the lower leg, and is common in runners.

Shin splints may be caused by:

  • An inexperienced runner just beginning to run (too much too fast).
  • Running on side slopes (ie. banked tracks).
  • Tight Calf Muscles, exerting extra force on shin muscles.
  • A sudden change from soft to hard running surfaces.
  • Poor or worn out footwear.
  • Excessive uphill running.
  • Poor running mechanics. This could include:
    • Heavy forward lean
    • Excessive weight on the ball of the foot
    • Running with toes pointed outward
    • Landing too far back on the heels causing the foot to flap down
    • and overpronation.

Of all of the possible causes, pronation (foot roll) is the most likely to be overlooked.

Posteromedial shin splints

Posteromedial shin splints affect muscles in the back and inner part of the lower leg. These muscle groups are responsible for lifting the heel to support the runners weight on the ball portion of the foot when running.

Posteromedial Shin Splint pain areas

This type of shin splint is often caused by running on a banked track or non-level running surface or wearing improper shoes that do not protect the foot from rolling (pronation).

Pain begins on the inside of the lower leg (usually within 7 inches above the ankles), but will worsen and continue to rise up the leg.

Initially, only tendons of the muscles will become inflamed, but if running continues, the muscles themselves could become affected. At the worst, the tendon could become detached from the bone – a painful occurrence that causes bleeding and excessive inflammation.

To allow a posteromedial shin splint to heal, the runner must temporarily stop running and do other kinds of exercise recommended by their doctor or physical therapist.

Special shoes may be prescribed during the healing phase, and it may be advisable to look into potential problems with pronation of the feet. This can often be solved by researching and using shoes that better prevent pronation and/or the avoidance of running on side slopes.

Anterolateral Shin Splints

Anterolateral shin splints affect muscles in the front and outside parts of the shin, and is the result of a natural imbalance in the size of opposing muscles.

Anterolateral Shin Splint pain areas

Shin muscles pull the foot up, whereas the large and powerful calf muscle pulls the foot down everytime the heel strikes the ground when running. These calf muscles can exert a lot of force, enough force that can actually injure the shin muscles.

Anterolateral shin splints will cause pain in the front and outside of the shin. Initial pain is felt when the heel strikes the ground though eventually the pain just stays constant.

To allow this type of shin splint to heal, the person must stop running and do other kinds of exercise recommended by their doctor or physical therapist. Such exercises usually involve stretching the calf muscle, as tight calf muscles put a lot of pressure on the shin muscle and tendons.

A constant regimen of ultrasound is commonly recommended to help massage the affected muscles and tendons, allowing them to heal more quickly and reduce inflammation and pain in the area. Treatment of the calf muscle with ultrasound will also help increase the flexibility of this muscle, thus indirectly reducing the average level of strain on the shin muscle and tendon group.

May 08
0
quadriceps

Quadriceps

By | Quadriceps | No Comments

Quadricep Anatomy

The bones involved with your upper leg are your thighbone (femur), kneecap (patella) and shinbone (tibia).

quadricep muscle pull or strain

The upper leg muscles provide your knees with mobility (extension, flexion and rotation) and strength. Your quadriceps muscles are located on the front of your thigh and extend down to just below your kneecap. They work closely with your hamstring muscles (back of your thigh), your gluteal muscles, and your calf muscles to ensure proper movement of your leg, knee and hip.

Quadriceps are considered knee extensors that transmit a pulling force on your muscle which help you straighten and extend your knee, as seen in kicking motions. Your rectus femoris is the longest quadriceps muscle; it connects your hip and knee joint and is also considered a hip flexor. It starts from the iliac crest of your pelvis, and runs down the front of your thigh attaching to the top of the kneecap via the quadriceps femoris tendon. Your vastus medialis, vastus intermedius (lies under the rectus femoris) and vastus lateralis attach to the top of your thighbone and extend down to your kneecap.

They connect via your quadriceps tendon (tough fibers that connect muscle to bone) and patellar retinaculum (fibrous band-like membrane that extends from the tendons of your vastus lateralis and vastus medialis and attaches to the sides of your kneecap). Your quadriceps tendon then passes over your kneecap (patella), connects to your patellar tendon and inserts into the tibial tuberosity (bump) on the front of your shin just below your knee. These tendons and the patellar retinaculum help to stabilize your knee; as your quads contract (shorten), your tendons help to move your knee from a bent (flexed) position to a straight (extended) position; when your quads relax, they lengthen and move your knee from a straight to a bent position.

Your sartorius muscle is a rotator of the tibia that works with your quadriceps to help straighten your knee and flex the hip. Your quadriceps muscles are innervated by your femoral nerve and artery; there is a lot of connective tissues and fascia around the quadriceps attachments.

Quadriceps Strains

In Latin quadriceps means “four heads” or four muscles. They are long muscles and are therefore more prone to injury. Quadriceps strains (also called pulled quadriceps) are one of the most common injuries in vigorous sports activities. These occur when one or more quadriceps muscles are stretched beyond their limit or are in a vulnerable position, and the muscle tissues become strained or torn. The rectus femoris muscle is the most frequently injured, as it crosses 2 joints (hip and knee), it is rarely completely stretched and it is closest to the surface of the skin. Tears or major damage normally occur at the point where your quadriceps muscles and tendons meet (musculotendinous junction ­ in the quadriceps tendon just above the kneecap – Runner’s knee, or in the patellar tendon just below the kneecap ­ Jumper’s knee). However, they can also occur at any place along your quadriceps muscle bellies, or at the tendon attachments to the bone (generally the pelvis attachment).

Acute strains are caused by a direct hit, fall or overloading, whereas chronic strains are generally caused by overuse or prior unhealed injuries. The damage can range from overstretching to partial tearing to complete rupturing of the small fibers that make up your quadriceps muscles.

These injuries occur most often early in the activity as a result of a poor warm up, or in the later stages of practices or games as a result of fatigue and improper cool downs. It is important to recognize that quadriceps injuries are easy to mask; you may only notice them when you are running quickly or kicking far distances.

Not warming up before sports can cause injury.

Quadriceps strains tend to affect older athletes between 30 – 60 years old, who tend to be weekend warriors (active on weekends, but not during the week). Men are twice as likely to be injured compared to women. You will often experience referred pain from your hip joint, sacroiliac/pelvic joint, lumbar spine and nerves.

If quadriceps strains are not cared for properly these injuries can become chronic and carry on for long periods of time. They can definitely affect your ability to quickly accelerate and decelerate, and cause a lot of inflammation at their attachment to the bone. They will often lead to complete quadriceps muscle and/or tendon tears. Men over 65 years of age or male athletes between 15 – 40 years most often experience a ruptured quadriceps.

Other common quadriceps injuries involve quadriceps contusions caused by a direct hit to the muscle (bruising or hemorrhaging beneath unbroken skin), quadriceps tendonitis or tendinopathy caused by degeneration of the tendons, or avulsion fractures (a severely pulled quadricep will tear a piece of bone with it; this generally occurs where the quadriceps tendon attaches to the patella).

Weak, tight quadriceps muscles also play a role in knee injuries (affect kneecap alignment and knee extension causing strain or damage to ligament or tendon, for example Runner’s Knee) or low back injuries (cause your pelvis to tilt forward creating a sway back). If you allow quadriceps injuries to persist they can lead to repeated damage that is more severe, periostitis (inflammation of the periosteum), and prolonged disability.

Alternate names and/or associated conditions:

Quadriceps pull, strained quadriceps, quadriceps tendonitis, quadriceps tendinopathy, quadriceps tear, quadriceps muscle contusion, Charlie horse, quad injury, runner’s knee, jumper’s knee, avulsion injury, anterior femoral muscle strain, periostitis, quadriceps scar tissue, knee injury pain, compartment syndrome, Myositis Ossificans