Posterior Leg Pain - Page 1
Posted by: Admin on Sep 04, 03 | 6:17 am |
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Having already looked at hamstring muscle problems in a previous article, we now move down to the calf region, or posterior leg.
The back of the lower leg is divided in to two compartments, one deep and the other superficial. The deep compartment houses the flexor hallucis longus and flexor digitorum longus muscles (flexor muscles of the toes) and the tibialis posterior muscle. This compartment contains the nerves and blood vessels to the back of the leg and sole of the foot. The superficial compartment contains the soleus and gastrocnemius muscles.
Compartment syndromes
These are defined as pain caused by increased pressure inside a muscle compartment. The syndromes may be chronic or acute.
Acute compartment syndromes may be caused by intra-muscular bleeding from muscles tears or direct impact trauma. Overuse injuries can also be a cause of acute compartment syndromes, one of the most common being running on a hard surface without properly preparing or adjusting to it.
First aid treatment should consist of rest and ice and elevation to reduce the pressure in the compartment. A doctor may prescribe anti-inflammatory drugs, diuretics, and, if necessary an operation called a fasciotomy, which is where the tight “skin” around the compartment is split to relieve the pressure inside.
Chronic compartment syndromes can be brought about by the increase in muscle bulk from prolonged training. The enlarged muscle is prevented from fully expanding by the relatively inelastic fasciae or membranes which form the wall of the compartment. When the muscles are working hard the blood flow in to the muscles increases, thus increasing the muscle bulk further. This expansion in the tightly enclosed area leads to a build up in pressure, which blocks the normal blood flow. This results in the formation of lactic acid, and oedema (swelling), thus further increasing the pressure on the muscle within the compartment. This cycle continues until exercise is stopped.
Treatments are very similar to those suggested for acute compartment syndromes. In addition it is worth analysing running style, gait, shoe types, training schedules, running surfaces etc.
Posterior compartment syndrome is more usually chronic in runners. Pain will be present on toeing off (especially from a hard surface) and with heel-raises. The pain will be slight at first, but will increase in intensity until the provocative action becomes impossible. There may be a sensation of numbness in the foot , and some weakness in springing off from the foot. These symptoms will ease with rest, but recur with renewed exertion.
A sportsman who has been troubled over a long time by soft–tissue inflammation of the flexor muscles may eventually arrive at a position where the muscles are so scarred that he cannot stretch them back in to action after each run. If the tibialis posterior muscle is involved, the pain may not present at the back of the calf, but along the medial (inside) border of the leg.
