Lower body injuries are common in athletes but happen in non-athletes as well.
We will consider any injury that begins at the level of the lumbar spine (low back) or below as a lower body injury.
Some examples of injuries that affect the lower body are muscle, tendon, ligament, cartilage, joint and bone injuries. These injuries can be acute or chronic as well as traumatic or non-traumatic. Acute injuries are recent injuries that have occurred within the past few days. A chronic injury is one that has been present for a period of time.
Examples of traumatic injury would be falling off your bike or a collision with the ground while snowboarding. An example of non-traumatic injury would be a pain that develops in your knee while running or a pain that develops in your glutes while sitting.
Below are the most common lower body injuries that we diagnose and treat successfully at San Diego Running Institute.
Lower Back Injuries
Lumbar Disc Injuries – Can be acute or chronic, traumatic or non-traumatic. Typically affects the L4-L5 Disc or L5-S1 Disc and results in either;
- Lumbar Disc Bulge/Swelling – Stage 1 disc injury is easily treated and can be reversed.
- Lumbar Disc Protrusion – Stage 2 disc injury is treatable conservatively and will typically not require surgery.
- Lumbar Disc Herniation – Stage 3 disc injury that is treatable with conservative methods but may require extended treatment.
- Lumbar Disc Extrusion – typically will require surgery to correct.
Lumbar Ligament Injuries – Are usually acute but can chronic, traumatic or non-traumatic. Lumbar ligaments are usually sprained/torn while lifting something in an awkward way or position. Lumbar ligament injuries will typically respond to the correct conservative treatment.
Lumbar Muscle Injuries – Are usually acute but can chronic, traumatic or non-traumatic. Lumbar ligaments are usually strained/torn while lifting something in an awkward way or position. Lumbar muscle injuries will typically respond well to correct conservative treatment.
- Gluteus Medius Syndrome – Gluteus Medius Syndrome is often misdiagnosed as Sciatica, Ischial Bursitis and Hamstring sprain/strain otherwise known as hamstring tendonitis or tendonosis. There are some obvious signs and symptoms that can help accurately diagnose Gluteus Medius Syndrome while differentiating it from the others. https://www.sdri.net/running-injuries/how-to-differentiate-and-diagnose-hip-gluteal-back-pain/gluteus-medius-syndromea-k-a-runners-butt/
- Piriformis Syndrome – Piriformis Syndrome is a condition where the Piriformis muscle irritates the sciatic nerve. This can result in pain in the glute area, as well as possible pain down the back of the leg, which is similar to pain resulting from sciatica. https://www.sdri.net/running-injuries/piriformis-pain/
- Ischial Bursitis – The pain will usually start with the runner feeling a sensation of weakness, stiffness, locking or catching in the involved hip. The sensation is often difficult to locate appearing in the front and/or back of the hip joint. The pain will often get progressively worse as the runner continues to run and cause a deep throbbing or ache in the hip joint. https://www.sdri.net/running-injuries/ischial-bursitis/
- Trochanteric Bursitis – The pain will usually start with discomfort on the outside of the thigh and might be painful during walking, running or jumping activity. The pain will typically increase if you lie on that side and can cause a deep throbbing or ache in the hip joint.
- Hip Stress Fracture – A common injury that presents in those newer to impact activities such as long distance walking, hiking or running. Other risk factors are being female, overweight, low bone density and sudden increase in mileage. The pain will usually feel deep inside the hip and may at first feel muscular. As the injury progresses patients will report that they limp after activity.
- Hip Flexor Strain – Pain will be felt in the lower abdominal and/or groin while walking, running or hiking. Pain can be reproduced with manual muscle testing by the doctor resisting attempted hip flexion. The prime hip flexor is the Psoas muscle also known as the Iliopsoas muscle.
- High Hamstring Tendonitis – An acute condition causing pain in the high posterior thigh that can radiate down the thigh towards the back of the knee. The pain will usually increase while walking uphill or running faster and can hurt while sitting or driving. Most runners mistakenly interpret this hamstring pain as “hamstring tightness” or spasm. They attempt to stretch the area and massage it often only aggravating the problem.
- High Hamstring Tendonosis – Tendonosis is a chronic condition as opposed to tendonitis which is an acute condition. Pain is usually reported in the high posterior thigh that can radiate down the thigh towards the back of the knee. The pain will usually increase while walking uphill or running faster and can hurt while sitting or driving. Most runners mistakenly interpret this hamstring pain as “hamstring tightness” or spasm. They attempt to stretch the area and massage it which often causes long term tendonosis and scarring of the hamstring origin attachment at the Ischial Tuberosity.
- High Hamstring Tendonopathy – Is a chronic hamstring injury that usually affects the origin near the Ischial Tuberosity. The term “opathy” simply means pathological. The diagnostic name implies that the tendon is damaged and weakened in some fashion. Pain is usually reported in the high posterior thigh that can radiate down the thigh towards the back of the knee. The pain will usually increase while walking uphill or running faster and can hurt while sitting or driving. Most runners mistakenly interpret this hamstring pain as “hamstring tightness” or spasm. They attempt to stretch the area and massage it
- High Hamstring Tendon Tear – The hamstring can tear at its attachment on the Ischial Tuberosity. Hamstring tears come in 3 degrees of severity.
- Grade 1 – Small tear that will typically respond well to conservative therapy
- Grade 2 – partial rupture. May respond to conservative therapy but typically prolonged treatment and healing time is anticipated.
- Grade 3 – A rupture of the hamstring tendon will require surgical intervention.
- Hamstring muscle strains/tears – Tears in the Hamstring muscle belly are also called strains and come in 3 degrees of severity
- Grade 1 Strain – Will normally respond well to conservative treatment.
- Grade 2 Strain – Typically responds well to conservative therapy but prolonged treatment and healing time is anticipated.
- Grade 3 Strain – May require surgery.
- Distal Hamstring Tendonitis – Tendonitis can develop on the distal insertion of the hamstring near the outside (lateral) back of the knee. Often this is confused with Iliotibial Band Syndrome.
- Hip Flexor Strain – Strains in the Psoas muscle or Rectus Femoris Muscle are common in running and jumping sports and can result in pain in the abdominal region and groin area. These are often confused with sports hernias and hip stress fractures.
- Quadriceps Strains – Come in 3 degrees of severity
- Grade 1 – Will normally respond well to conservative treatment.
- Grade 2 – Typically responds well to conservative therapy but prolonged treatment and healing time is anticipated.
- Grade 3 – May require surgery
- Femoral Stress Fracture – Is often confused with a quadriceps or hip flexor strain. Stress fractures are common injuries that present in those newer to impact activities such as long distance walking, hiking or running. Other risk factors are being female, overweight, low bone density and sudden increase in mileage. The pain will usually feel deep inside the hip and may at first feel muscular. As the injury progresses patients will report that they limp after activity.
- Hip Arthritis – Characterized by deep aching pain in the hip joint and can be accompanied by muscle spasms in the glutes, hip flexors or adductor muscle groups. This muscular reaction is known as muscle “splinting” as the muscles are tightening/spasming in response to the joint injury.
- Runner’s Knee a.k.a. Patellofemoral Pain Syndrome PFPS – Can be acute or chronic and results in pain that feels like it is deep or under the kneecap. In severe situations there is pain while bending the knee or even sitting with your knee bent.
- Chondromalacia Patella – Similar to Runner’s Knee it causes anterior knee pain that gets worse while running or going up and down stairs. People also report pain while sitting with their knee in a bent position, for example, while driving, sitting at their desk at work or on an airplane.
- Iliotibial Band Syndrome a.k.a. ITBS – Can be acute or chronic. Pain that begins while running and eventually feels like a knife in the side of your knee forcing you to stop running. People usually report that the pain subsides when they stop running but in severe cases it may take days for the pain to entirely go away. It is not unusual for runner’s to report that they can run without pain for a certain amount of time/miles before the pain begins and gradually gets worse.
- Subiliotibial bursitis – The pain is chronic and is often confused with Iliotibial Band Syndrome. Subiliotibial Bursitis is usually present when a runners report taking weeks to months off running but when they attempt to run again the sharp pain in the knee is still there. It is possible to have subiliotibial band bursitis AND ITBS.
- Popliteal Tendonitis – Is often confused with ITBS. Popliteal tendonitis usually results in lateral knee pain while running.
- Patella Tendonitis – An acute injury that results in tendonitis in the anterior portion of the knee just below the kneecap (inferior) at the site of the Patella Tendon. It is also called “Jumper’s Knee”. The pain will usually be felt during lunging, squatting and jumping activities.
- Patella Tendonosis – A chronic condition that affects the patella tendon after long term tendonitis. Long term, repetitive tearing of the patella tendon results in scarring of the Patella Tendon and chronic pain and dysfunction.
- Medial Collateral Ligament Sprains a.k.a. MCL – Can be acute or chronic. The pain is made worse with walking, running and jumping and results in pain on the inside of the knee (medial).
- Medial Meniscus Tears – Can be acute or chronic. The pain is made worse with walking, running, jumping and bending the knee and is present on the inside of the knee (medial).
- Chronic ACL Tears – The ACL prevents excessive rotation of the tibia during walking, running and jumping. Old and/or repaired ACL ligaments often do not prevent enough rotation and this can result in many different knee conditions. If you have had an ACL tear that either was or was not surgically repaired and you have chronic knee issues this may be the underlying cause. It is both treatable and correctable without requiring surgery.
- Pes Anserine Tendonitis/Bursitis – The Pes Anserine is an area on the inside of your knee where 3 muscles meet and attach. The condition is common in those that also have Knee Arthritis leading scientists to believe that all of the factors that contribute to knee arthritis also can cause Pes Anserine Bursitis/Tendonitis. These variables include being overweight, flat feet and having “knock-knees”.
- Knee Arthritis – A degenerative condition of the knee resulting in excessive wearing of the cartilage, usually the medial side. This will result in inside(medial) knee pain in addition to weight bearing activity such as hiking, running or jumping. Pain will also be felt during activities such as lunging, squatting or going up and down stairs.
- Osgood Schlatter Disease – A painful knee condition that affects young children, especially those participating in sports that involve running and jumping. The area of pain is on the top (superior) portion of the child’s Tibia where the Quadriceps muscles attach. The pain can be mild or severe and can result in a bone deformity at the site of the pain (Tibial Tuberosity). https://www.sdri.net/running-injuries/osgood-schlatters-disease/
Lower Leg & Calf Injuries
- Shin Splints a.k.a. Posterior Tibialis Tendonitis a.k.a Medial Tibial Stress Syndrome (MTSS) – Shin Splints or Medial Tibial Stress Syndrome (MTSS) is typically described as sharp radiating pain that occurs while running and either gets progressively worse with every step or seems to warm up as you run. Running in the wrong type of shoe, not having enough arch support, overpronation can predispose a runner to shin splints or medial tibial stress syndrome (MTSS). https://www.sdri.net/running-injuries/shin-splints/
- Peroneal Insertion Tendonitis – Results severe initial pain along the lateral/outside of the foot near its insertion on the 5th Can also cause pain in the outside/lateral plantar surface/underside of your foot. This injury is often confused with a stress fracture. It is not uncommon for patients to explain that they went to urgent care or their primary care doctor only to have them say nothing was wrong because the X-ray did not show anything.
- Lateral Compartment Syndrome – Pain that begins while you are walking or running forcing you to stop. The pain usually subsides almost instantly when you stop walking or running. This condition is also known as Exercise Induced Compartment Syndrome and should not be confused with Acute Compartment Syndrome which may be a medical emergency.
- Anterior Tibialis Tendonitis – Acute injury that results in pain on the lower front/anterior of the shin. The pain will be made worse with walking or running uphill or with resisted dorsiflexion (pulling the foot-ankle back towards your shin) of the ankle.
- Gastrocnemius Strains/Tears – Comes in 3 Degrees of severity and causes pain with walking, running or jumping in the calf.
- Grade 1 – Can feel like a cramp or “Charliehorse”. Can be corrected with correct conservative therapy.
- Grade 2 – Patients will report that it felt like someone “punched” them in their calf. People will usually notice a small black and blue near the painful site within a few days.
- Grade 3 – A complete rupture will result in severe black and blue from the bleeding and the patient will not be able to weight bear on that side or have to compensate in order to walk.
- Soleus Strains/Tears – Comes in 3 degrees of severity and feels like sharp pain down near the back of the ankle.
- Grade 1 – Sharp pain that increases with running or jumping. Can be fixed using correct conservative treatments.
- Grade 2 – Intense pain that increases with running, jumping or doing toe raises. Can be fixed using correct conservative treatments.
- Grade 3 – Severe pain with the inability to weight bear normally on that side. May require surgery.
- Achilles Tendonitis – Acute injury to the Achilles tendon may result in small tears and ensuing tendonitis. Inflammation will only last 3 days if the offending activity is ceased. Pain is felt during walking, hiking, running and jumping as well as while doing toe raises. This injury will respond to conservative therapy as long as the patient does not continue to offend their Achilles at the time of treatment. https://www.sdri.net/running-injuries/achilles-tendonitis/
- Achilles Tendonosis – This chronic condition results from excessive and repetitive inflammation that eventually causes scarring of the Achilles tendon. https://www.sdri.net/running-injuries/achilles-tendonopathy/
- Achilles Entheseopathy a.k.a. Achilles pump bump – Chronic inflammation at the insertion of the Achilles Tendon on the calcaneus (heel bone). Pain is increased with walking, running, jumping and sometimes any contact by the shoe to the inflamed area.
- Achilles Bone Spur – These spurs can form at the attachment of the Achilles tendon on the calcaneus.
- Plantaris Tendon (rupture) – The Plantaris muscle is not found in the entire population and is referred to as a vestigial muscle. Some people report chronic tightness of their calf muscles and chronic and repetitive strains and cramping. On occasion the Plantaris Tendon will spontaneously rupture resulting in initial pain in the medial portion of the calf. They may also compensate by walking up on their toe.
- Lateral Ankle Sprain – Also known as an inversion sprain or “rolling” your ankle. Causes pain in the outside/lateral portion of your ankle and can result in tearing of 1,2 or 3 ligaments.
- Medial Ankle Sprain – Also known as an eversion ankle sprain. Causes pain in the inside/medial portion of your ankle and can result in partial or complete tearing of your deltoid ligament.
- Ankle Arthritis – Also known as joint degeneration. Arthritis is characterized by bone spurs found on X-ray and can result in diffuse ankle pain during weight bearing activity and loss of range of motion.
- Ankle Subluxation – The ankle joint can be become partially dislocated also known as Subluxation. Specifically the Talus can shift where it forms a joint with your tibia and this can result in ankle pain and loss of range of motion. It is easily corrected with joint adjustments/manipulation by a skilled doctor.
- Ankle Stress Fracture – Usually occurs in the distal, medial tibia. An increase in pain is felt during impact such as in running. Interestingly in the early stages runners will report that there is minimal pain while running but that it hurts worse after, even causing them to limp.
- Plantar Fasciitis – Acute condition that results in micro-tearing of the plantar fascia where it connects to your heel bone (calcaneus). Patient’s will usually complain of pain in the morning when getting out of bed or after sitting for prolonged periods. The pain will usually “warm up”. https://www.sdri.net/running-injuries/plantar-fasciitis/
- Plantar Fasciosis – Chronic condition resulting from excessive and repetitive inflammation of the plantar fascia. This results in severe heel pain when getting out of bed or after prolonged sitting. This condition can be treated and corrected with accurate diagnosis and correct therapy.
- Heel Spur Syndrome – This chronic condition presents similar to the symptoms present with plantar fasciitis. One of the most noticeable distinguishing differences is that patients with heel spurs will usually say they DO NOT have pain when getting out of bed and that stretching either does not help or even aggravates the condition. https://www.sdri.net/running-injuries/heel-pain/
- Metatarsalgia – Can be acute or chronic condition that causes pain in the metatarsal region of the foot. The pain may be due to bruised or broken metatarsal bone, injured metatarsal joint, tendon or ligament. https://www.sdri.net/running-injuries/metatarsalgia/
- Plantar Plate Tear – A torn Plantar Plate will cause metatarsal pain and most often be misdiagnosed as either Metatarsalgia or Morton’s Neuroma. A plantar plate tear causes presents in 3 grades of severity. https://www.sdri.net/running-injuries/plantar-plate-sprains/
- Grade 1 – a grade one tear will cause a bruised pain sensation. The person will often explain that it feels as if they are walking on a rock or marble. Sometimes they say it feels as if their sock is bunched up. This type of sprain will respond to correct conservative therapy.
- Grade 2 – A grade two sprain is a partial rupture. This pain is similar to a grade one except that it causes limping after running or walking. Typically if you look down at your feet you will notice the second toe deviating towards the big toe if a grade 2 tear is present. This type of sprain will usually respond to correct conservative therapy.
- Grade 3 – A grade three tear is a complete rupture. Your toe will be noticeably deviated, usually towards your big toe and is partially dislocated. The pain is severe with any amount of weight bearing. This type of sprain will normally require surgery.
- Capsulitis – Inflammation of the joint capsule that surrounds the metatarsal-phalangeal joint. This is a common under-diagnosis or misdiagnosis and is usually a plantar plate tear.
- Tenosynovitis – Inflammation of the tendon sheath that surrounds the plantar flexor tendons. This is a common under diagnosis or misdiagnosis and is usually a plantar plate sprain.
- Sesamoiditis – Inflammation of either one or both sesamoid bones located on the distal portion of your first metatarsal. This is sometimes misdiagnosed instead of distal plantar fasciits. The pain is increased during impact. In severe, chronic cases the sesamoid bones may have to be removed surgically. https://www.sdri.net/running-injuries/sesamoiditis/
- Cuboid Subluxation – This partial dislocation of the lateral foot bone called the Cuboid can result in chronic lateral ankle pain following an inversion sprain.
- Navicular Subluxation – The Navicular bone is found at the apex of your medial arch. Due to repetitive stress and gravity the Navicular bone will sometimes partially dislocate/subluxate downward (inferior). This condition is easily remedied with an expert foot adjustment to relocate the Navicular and supported with correct taping techniques to help stabilize the joint. Sometimes custom arch supports are necessary to stabilize the arch. https://www.sdri.net/services/custom-orthotics/videos-how-to-choose-the-right-orthotic-for-you/
- Adult Acquired Flat Foot Deformity – “Dropped Arches” accompanied by Navicular subluxations and arch pain. Can be due to stressed or toen ligaments and tendons in the foot. Will usually respond to conservative treatment and custom orthotics to help stabilize the medial arch and Navicular Bones. https://www.sdri.net/services/custom-orthotics/videos-how-to-choose-the-right-orthotic-for-you/
- Foot Stress Fracture – Usually occurs in the Navicular or metatarsal bones. An increase in pain is felt during impact such as in running. Interestingly in the early stages runners will report that there is minimal pain while running but that it hurts worse after, even causing them to limp.