Lower extremity problems include problems with the hip; knee; ankle and foot joints, but also include pain from the big muscle groups such as: hamstrings; calf muscles; shin splints; groin or buttock pain.
The French call the Hip ‘Le Hinge’, because it is the point at which the body “folds” or flexes and extends to the greatest degree.
In modern life we spend much of our time sitting, which shortens the hip flexor muscles and reduces mobility in the hips. This increases the amount of movement demanded from the lumbar spine and tilts the pelvis forwards. Also by reducing the time spent standing and walking the gluteal muscles weaken and often diminish in size.
All these factors create muscle imbalances around the hips and pelvis increasing the chance of injury.
As we get older the hips start to show degenerative, (osteo) arthritic changes where there is roughening of the joint cartilage, which then wears through exposing the bone beneath which in turn roughens and degenerates.
Osteopaths work to improve the joint space between the affected boney surfaces, improve the tone in any tight muscles and thereby improve mobility of the hip joint alleviating some of the pain and symptoms.
The knee complex is made up of three joints: between the patella (knee cap) and the femur (thigh bone); the two shin bones (tibia and fibula) and the knee joint proper between the femur and tibia.
Osteopaths often consider the knee in the context of the whole lower extremity, considering its shape and the relative position of its component bones and structures, for example if someone has a Genu Valgus (knock knee) then the outside of the knee joint will compress reducing its ability to move, the inside of the knee will tend to open and overstretch the ligaments and structures here; the patella will shift laterally (to the outer side) allowing it to move out of the groove in the femur and rub against the femur causing pain, inflammation, loss of mobility and eventually potentially osteo-arthritic changes.
In this case an osteopath would seek to reduce the tone in the Ilio-Tibial Band (ITB), the attaching hip abductor muscles, the Peroneal muscles in the calf to reduce the restriction on the outer part of the knee and look at the foot and hip mechanics to reduce the Valgus Force through the knee.
The ankle is made up of three bones: the tibia, fibula and talus.
It is held together by ligaments and strengthened by the tendons of the long muscles coming from the calf to attach on to the foot. Damage to the ligaments is a common injury and the compensation of the muscles tightening to increase their support of the weakened ligaments gives symptoms distant to the sight of injury – indeed the whole lower extremity and low back will be affected by the change to the ankle.
Changes in the foot mechanics such as “flattening an arch” of the foot, will cause the ankle to deform; the ligaments and tendons to overstretch on the inside and tighten and constrict on the outside of the joint.
Osteopathy seeks to improve the mechanics of the foot and ankle by improving the mobility in the restricted parts of the joints, reducing the tone in tight muscles and using exercises of progressively increasing load and difficulty to improve the strength of muscles and the proprioceptive senses in the ankle ligaments and joint capsules.
The foot is made up of the Talus, Calcaneum, the Cuboid, the Navicular, three Cuneiforms, five Metatarsals and fourteen Phalanges (in the toes). There are also at least two small sesamoid bones at the base of the big toe – altogether making a lot joints for osteopaths to work on!
As we get older our gait changes, often turning our feet outwards as we walk and stand, combined with a tendency for our body weight to increase, the arches of our feet come under an increasing load and the ligaments and tendons supporting them become compromised allowing the arch to drop. This affects not only the distribution of weight across the bones of the foot (a cunningly engineered system of several arches, the biggest of which is in your instep) causing pain but also changes leg length which will cause compensation patterns that could potentially affect your neck and give you headaches. It may also contribute to:
- Arthritic pain in the knee or hip
- Arthritic Groin pain
- Muscle tears and strains, e.g. hamstrings
- Ligament strains around the knee and ankle
- Heel pain
- Pain from mechanical defects in the foot