Sprained muscles and ligaments of the lower leg: symptoms and treatment

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Such injuries are a stretch or tear of the muscle or connective tissue from which ligaments and tendons are formed. Significant physical exertion and gentle but sudden movements lead to damage. Due to the high elasticity of tendons, ligaments and muscle fibers, ruptures are less common than sprains.

Sprains and tears

Morphologically, a stretch represents a partial tear of the fibers while maintaining the anatomical integrity of the muscle. When a rupture occurs, the anatomical integrity is disrupted. According to ICD-10, both pathologies have code S86.1.

According to the type of injured fibers, sprains are distinguished:

muscles;
ligaments;
tendons.

Simultaneous damage to the above structures is possible. A pathognomonic sign of a sprain is a feeling of instability in the ankle and its incorrect position when walking.

Causes

In the etiology of injury, the leading role belongs to physical education:

running and fast walking;
exercises with dumbbells;
playing tennis, volleyball or basketball;
rock climbing or jumping from heights;
gymnastics classes.

Trauma occurs when:

prolonged and/or excessive loads (pathognomonic sprain of the lower leg);
falls;
jumping (tear ligaments of the lower leg are more often observed);
shocks from the ground;
ankle sprains (often accompanied by complete rupture of the ligaments);
bruises on the back of the leg (a blow to the calf muscle).

Overwork and hypothermia contribute to damage to muscles and ligaments.

What are these injuries and how do they appear?

In medical practice, sprains are a very common type of injury that involves damage to the integrity of muscles, ligaments or tendons.
If the injury was too severe, a rupture occurs. Physiologically, tendons and ligaments consist of a strong connective tissue structure; they are elastic, but are susceptible to various injuries. Typically, a sprain occurs when sharply extending a joint, jumping in sports, martial arts, or trying to suddenly lift too much weight.

The most commonly diagnosed muscle strains are the lower extremities, namely in the ankle joint. When excessive weight shifts from the inside to the outside of the foot, damage or tearing occurs. As a rule, this happens in winter, or when moving over rough terrain.

The second most common injury is the knee joint, which can be damaged by falling, twisting, or playing sports such as football, hockey, and skiing.

Symptoms of sprain and tear, severity

Often the patient feels a rupture followed by intense pain. Movement after injury is significantly limited. Swelling and hemorrhage may occur in the sprained area. When sprained, the manifestations stop within 1-2 weeks. In case of muscle tissue rupture - within 2 months.

In medical practice, there are three degrees of severity:

the pain is moderate, aching, micro-tears of muscle fibers are present (damage is less than 25% morphologically determined);
severe pain, swelling at the site of injury, walking is difficult due to severe pain, there are ruptures of some muscle fibers (25-75% are susceptible to rupture);
the pain is pronounced, there are signs of complete rupture of muscle tissue, the stability of the ankle joint and its contraction muscles are impaired (75-100% of myofibrils are damaged).

If symptoms manifest at the time of injury, there is reason to think about a muscle rupture. With a sprain, symptoms of injury appear after a delayed period of time, measured in hours.

Frequent accompaniments of damage are:

swelling of the injured area;
hematoma in the damaged area;
typical sound at the time of injury.

Clinical picture[edit | edit code]

History and complaints[edit | edit code]

Damage to the triceps surae muscle is possible when playing sports that require jumping and quick changes in direction of movement - basketball, football, including American football, tennis and squash. After severe injury, an athlete is usually unable to continue playing. Of great importance is information about damage to the triceps muscle, even minimal, in the recent past, since repeated damage is usually more severe. Patients complain of acute pain in the calf. There may be a crunching or cracking sensation at the time of damage. Athletes often complain of feeling like “someone hit them in the calf.”

Physical examination[edit | edit code]

It is necessary to conduct a very thorough physical examination to determine which part of the muscle is damaged: the belly (medial or lateral head of the gastrocnemius muscle) or the junction of the connective tissue of the muscle with the tendon. When stretched, you can palpate the swelling of the calf. If a muscle fiber rupture occurs, then before the swelling occurs or after the swelling disappears, the defect in the muscle can be palpated. Both the defect and the swelling are usually located in the abdominal area. A rupture of the medial head of the gastrocnemius muscle is more common than a rupture of the lateral head. Accordingly, the defect is palpated medially or laterally from the midline. Differential diagnosis for damage to the triceps surae muscle is carried out primarily with a rupture of the Achilles tendon. The latter should be suspected if the defect is palpated clearly in the midline distal to the transition of the belly to the tendon. The Thompson test helps make a diagnosis: the patient lies on his stomach with his feet hanging off the table; the doctor squeezes the calf muscle and monitors the plantar flexion of the foot. If the foot flexes, then the test is negative and the muscle is intact. The absence of plantar flexion indicates that there is a tear either at the belly-tendon junction or along the Achilles tendon.

Radiation diagnostics[edit | edit code]

The need for radiation diagnostics depends on the severity of the injury. If physical examination suggests a large or complete tear of the medial or lateral head of the gastrocnemius muscle, an MRI is performed. It is also useful for planning surgery and monitoring healing.

Damage to the triceps surae muscle may be accompanied by damage to the ankle ligaments, fractures of the fibula, and injuries to blood vessels and nerves, which also requires examination with radiation methods.

First aid for sprains, treatment at home

Sprains of the lower leg muscles, as well as ligament ruptures, are within the competence of traumatologists; therefore, in order to avoid possible negative consequences, the victim should be shown to a specialized specialist.

On an outpatient basis, treatment is permitted if there are signs of sprain:

maintaining motor functions of the leg;
moderate severity of pain.

The ankle should not be overloaded. After receiving an injury, he must be kept at rest for at least 48 hours, secured with an elastic bandage and placed in an elevated position. If necessary, crutches can be used for mobility purposes.

In order to relieve swelling, dry ice should be applied to the injured area (in a bag wrapped in cloth) for 2 days for 20 minutes every 4 hours. On day 3 you should refrain from using compresses. From day 4, switch to warm compresses and baths (to stimulate resorption).

Optionally, on the recommendation of a doctor, you can use NSAIDs (non-steroidal anti-inflammatory drugs - Diclofenac, Ibuprofen), including in the form of ointments (Traumel, Apizartron, Voltaren emulgel, Viprosal, Ketonal gel).

Shin sprain - what does pain mean?

Skiing

Considering that even in such a less extreme form of recreation as hiking, sprained lower leg muscles account for 50% of complaints, it is very important to know how to prevent injury or relieve pain. 40% of all cases of damage to the ankle joint lead to chronic pathology that precludes participation in sports.

Symptoms of a sprained calf muscle:

sharp pain in the calf.
rising on tiptoes is impossible or is accompanied by severe pain;
calf swelling and bruising;
feeling of a blow to the calf;
presence of crunching or crackling sounds (in case of severe damage)

A shin injury is no joke

A quarter of sports injuries occur to the ankle. 25% of injuries in sports such as baseball, volleyball, football, and figure skating occur in this area of the leg. It is no coincidence that a kind of joke was born: “If you don’t want to injure your shin, go swimming!”

Sprinting and running with jumps puts the triceps surae muscle under attack. Here it is important to follow the technique and select special shock-absorbing sneakers. The triceps muscle receives a high load, and treating the muscles in this area is a very difficult medical task.

It is important to heal a damaged shin completely. No matter how long the doctor prescribes the rehabilitation period, it must be endured. For example: Leonid Slutsky, coach of PFC CSKA, in his youth spent a whole year in the hospital, restoring the functionality of the joint. The shorter the period between injury and the start of training, the higher the risk of relapse.

The rehabilitation period for damage to the triceps muscle or ankle joint ranges from 1 to 4 weeks on average. There should be no pain in the recovered muscle. To do this, you can conduct a simple test: try to quickly change the direction of movement, forward, backward, forward, to the side. The clinical indicator is that after therapy the muscle shows an isometric contraction force of at least 90% of the pre-traumatic indicators.

Treatment of lower leg injuries

Therapy can be conservative and surgical. The latter is rare, since a complete rupture of the triceps muscle is difficult to obtain. However, surgical intervention is indicated in this case, since the scar after suturing will be smaller, and the functionality of the lower leg will be preserved.

Conservative therapy is based on standard conditions for muscle injuries: rest, cold, tight bandage, elevated position of the leg. Treatment period is up to 2 days. After this, warming ointments and nonsteroidal anti-inflammatory drugs (NSAIDs) are applied to the area of injury. The drugs are prescribed for a course of no more than 7–10 days, otherwise they will have a negative effect.

At the final stage of lower leg rehabilitation, ultrasound therapy, stretching and strengthening exercises are prescribed.

Age-related prevention of lower leg injuries

As we age, old ankle sprains and injuries become more noticeable. And this also needs to be remembered. Elderly people should avoid overworking their calf muscles, take strengthening supplements, and eat right to maintain muscle mass.

Stretching and warming up the calf muscles is a necessary element not only of training, but also of a healthy life. You need to stretch your muscles in cycles: tension - relaxation. You need to stretch the muscles to half the maximum possible stretch. Accordingly, you first need to determine this maximum, and then perform movements with half the voltage.

The beginning of the workout should be reserved for light warm-up exercises. This will increase the temperature of the muscles, making them more elastic and elastic.

Diagnosis and self-treatment of lower leg

Diagnosis of injury is carried out using MRI and physical examination. Radiation diagnostics is prescribed if an extensive or complete rupture of the medial or lateral head of the gastrocnemius muscle is suspected. MRI helps to plan the operation and determine whether the injury is accompanied by damage to the ligaments, injuries to blood vessels and nerves.

Since the restoration of the lower leg is a complex process, self-medication here is unacceptable and harmful. After muscle pain appears, you should consult a doctor at a fitness center or clinic for examination.

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Folk remedies

At home, you can apply an ointment based on yolk. The composition includes one spoon of laundry soap, two spoons of water and one yolk. The resulting suspension is wrapped in gauze and applied to the site of injury. The compress is secured with a bandage. It is recommended to do it daily. The desired application time is no more than an hour.

Among the medicinal plants that help:

plantain leaves;
elderberry juice;
eucalyptus oil;
aloe leaf pulp.

Ethanol, vodka, clay or puff pastry are used as warming compresses. To prepare clay lotions, 100 g of powdered substance is mixed with 5 tablespoons of apple cider vinegar and diluted with water until a homogeneous suspension is obtained. The resulting composition is applied to the damaged area and covered with a cloth. The duration of the lotion is about an hour.

Rehabilitation for lower leg injuries

Recovery time is determined by the severity of the alteration and usually takes from 1 week to 2 months. Rehabilitation tactics are developed by the attending physician in consultation with the physiotherapist and exercise therapy instructor.

Use:

local massage of damaged muscles;
magnetic therapy, diadynamic therapy, ultrasound, laser therapy;
taping – applying an elastic bandage to the back surface of the lower leg to prevent muscle tissue strain;
physical therapy:
walking;
lifting the sore leg onto the toe.

Depending on the severity, rehabilitation begins from 2 to 7 days after the injury.

Returning to full training is possible only in the complete absence of myalgia and discomfort.

Treatment[edit | edit code]

Conservative treatment[edit | edit code]

Treatment begins immediately, at the sideline, in accordance with the principles common to soft tissue injuries: rest, cold, tight bandage, elevated position. This treatment can be continued for 24-48 hours to prevent the formation of large hematomas, and then in their place - extensive scars.

Further treatment includes rehabilitation and pain relief with warming ointments and NSAIDs. In the early period, NSAIDs do not interfere with healing, but with long-term use (more than 7-10 days), the risk of their adverse effects increases. The basis of treatment is rehabilitation. Light stretching and strengthening exercises, as well as ultrasound therapy, significantly reduce pain, help restore the strength of muscle fibers and resolve scar tissue. Rehabilitation begins a few days after the injury, so as not to disrupt healing. Light stretching exercises, standing or sitting using a towel, with gradually increasing resistance can be started very early. Exercise shouldn't cause pain. After 7-10 days, they begin light strengthening exercises: standing on tiptoes, jumping on one leg with a gradual transition to special exercises: running with a quick change of direction and jumping.

Surgical treatment[edit | edit code]

Complete tears are more common in the abdominal and thigh muscles, but can also occur in the lower leg. In this case, a defect is palpable in the muscle and it loses its function. With conservative treatment, a large scar forms at the site of the rupture, which can become an obstacle to returning to sports. When the tear is sutured, the scar becomes thinner and muscle function is restored more fully.