Leg injuries in athletes are usually the result of overuse or sudden acute trauma.

Runners and athletes like basketball players who engage in repetitive running and jumping have a higher risk of leg injuries. These injuries range from common strains, muscle cramps and muscle soreness to more serious injuries.

Other injuries include stress fractures (overuse fractures of the legs and feet) and chronic exertional compartment syndrome (CECS), which occurs when the leg muscles swell, causing pressure and creating pain. An anterior cruciate ligament (ACL) tear in the knee is also a serious leg injury that is common among athletes.

Next to prompt and proper diagnosis and treatment, return-to-play decision making can have the greatest impact on an athlete’s recovery. It is our philosophy that athletes be given the best evidence available to guide their time frame for return to sport and physical activity.


Physical Therapy and Rehab

Physical Therapy and Rehabilitation

Physical Therapy and Rehabilitation

A physical therapist may work with you on a variety of strengthening, flexibility and mobility techniques, post-surgery or as an alternative to surgery. That may include:

Instrument-Assisted Soft Tissue Mobilization

In addition to applying manual muscle therapy, our physical therapists use an instrument-assisted technique to detect scar tissue and restrictions in affected areas of the body. Once detected, the instrumentation is used to break up the scar tissue.

Intramuscular Manual Therapy

Dry needling is an alternative pain relief technique that physical therapists may administer. It involves the insertion of a small, solid filament needle into a stressed muscle’s site of spasm and pain, also known as a trigger point. By doing so, the muscle relaxes and blood flow increases into the area, alleviating pain and improving motion.

Trigger points can often be the result of a different overuse injury, because muscles overcompensate for imbalances and weakness in the injured area. Inflammation and spasm develop and lead to discomfort and pain in the muscle.

Isokinetic Testing

Isokinetic testing uses computerized equipment to isolate muscle groups and test their tolerance. By doing this, our therapists and trainers can identify vulnerable areas and what positions or movements may be causing pain and soreness. This is used as part of a rehab/return-to-sport program or for assessment of the athlete at different stages.

Level Belt

The level belt was developed at Ohio State's Wexner Medical Center. An elastic strap aligned with your pelvis is worn as a phone application detects core stability and mobility. It’s initially used for assessment and then is applied as training support. As an example, a baseball pitcher needs a stable core to perform well and reduce injury to the shoulder and arm. The level belt can help the pitcher isolate pelvic mobility and strengthen the core.

Aquatic Therapy

Aquatic therapy is well-suited for early athletic rehab and for patients experiencing a great deal of pain or a weight-bearing restriction that doesn’t permit land-based rehab. Water provides the resistance for a workout and the buoyancy for low impact. Aquatic therapy helps to restore mechanics and is best suited for lower body injuries, including those of the lower back, postop knee and areas affected by arthritis.

Ask your physical therapist about our locations for aquatic therapy that offer warm water and Olympic-size pools.

Nonsurgical Treatments

Nonsurgical treatments

Nonsurgical treatments

We always exhaust all possible nonsurgical methods before proceeding with surgery. After a risk assessment of your injury, you may need to back off on sports for a while and reduce the intensity of training. 

Cold or Heat Therapy

Soft tissue injuries to the legs such as sprains or strains are most commonly treated with ice initially. Heat treatment may be used on tears to the leg muscles or tendons to help stimulate the blood flow necessary for healing. Immobilization in a splint or brace, along with limited weight bearing with crutches, may be required for initial treatment as well with more severe injuries.

Intramuscular Manual Therapy

Dry needling is an alternative pain relief technique that physical therapists may administer for leg symptoms such as hamstring or calf tightness. It involves the insertion of a small, solid filament into a stressed muscle’s site of spasm and pain, also known as a trigger point. By doing so, the muscle relaxes and blood flow increases into the area, alleviating pain and improving motion.

Trigger points are often the result of an injury to a different part of the body, because other muscles overcompensate for imbalances and weakness in the injured area. Because of this overcompensation, muscle spasm occurs, causing discomfort and pain in the muscle.


Once dry needling resets the tone of muscle, your physical therapist works on correcting strength and mobility deficits in the muscle, which allows healing and prevents injury.

  • Results can be immediate or take up to 72 hours
  • One to five treatments is the expected course
  • Rehab exercises are part of the treatment

Osteopathic Manipulation

Osteopathic manipulative therapy, or the use of manual pressure, can be employed to relieve pain for many musculoskeletal issues and repetitive stress injuries. Our osteopathic physician will complete a thorough physical examination and determine the most appropriate stretching, resistance or use of pressure technique that will help ease your pain or heal your injury. Osteopathic manipulation can be a complement to your physical therapy or injection therapy as well.

Lifestyle Modification

The conservative – albeit sometimes short-term – solution to many leg injuries is to adjust your exercise routine or utilize nonsteroidal anti-inflammatory drugs (NSAIDs). Most stress fractures heal with relative rest and activity modification.

For certain tibia injuries, immobilization with a splint, protective boot or crutches may be necessary.

Exercise prescriptions could come in a variety of formats. Specific movements may be suggested to stretch and strengthen key leg muscles. Biomechanical adjustments to your technique or form may help alleviate pain. You may have to take a complete break from your sport or switch to a low-impact activity such as swimming to allow the injury to heal and/or prevent recurrence.

Orthotics

Orthotic shoe inserts may be required to alleviate activity-related pain in the foot or throughout the lower extremity. These can be designed and constructed by our physical therapists upon recommendation and referral from our physicians.

Surgical Treatments

Surgical treatments

Surgical treatments

Needle Manometry

Chronic exertional compartment syndrome, or CECS, occurs when lower leg musculature expands and creates pain and pressure, potentially causing numbness in the foot and cutting off vascular supply, thereby impeding movement. Surgeons use needle manometry – a needle fixed with a pressure gauge – to measure the pressures within the muscular compartments. Once the diagnosis is confirmed, the surgical procedure to release the pressure involves making a slit in muscle casing to give the muscle more room to expand when activity demands it. This relieves the pressure and helps restore blood flow, which diminishes foot numbness, allowing you to resume regular activity.

Tibia Stress Fracture Surgery

A common, high-risk injury for athletes is a tibia (shin) stress fracture. This results from repetitive overuse, which is common in many running and jumping sports. A tibial stress fracture may look normal on initial X-rays. A bone scan or MRI is usually required to confirm the diagnosis. Stress fractures that do not heal with nonsurgical treatment, involve multiple bone fragments or have a significant gap between sections of fractured bone usually require one of three types of specialized surgery:

Intramedullary nailing/rodding

This is one of the most preferred surgeries for tibial fractures. A metal rod is inserted through the knee and into the tibia to stabilize the bone from the inside out. An intramedullary “nail” is maintained in place while the fracture heals. This procedure usually results in a firm bonding of the fractured tibia and protects the remaining portions of the bone from later injury.

External fixation

This is another procedure that can be used for significant fractures. Metal screws or pins are externally affixed to the bone above and below the fracture. A bar is then attached to the screws or pins outside the skin to keep the fractured bone to maintain stability either temporarily or until the fracture heals. This surgery is somewhat less invasive than intramedullary nailing.

Open reduction and internal fixation (plates and screws)

When other surgical procedures are not an option because the fracture runs into the knee or ankle joint or if there are multiple fragments present, plates and screws can be used. First the bone fragments are realigned , and then they are held in place using surgical screws and metal plates.

Why Ohio State?

Why choose The Ohio State University Wexner Medical Center for treatment of sports-related leg injuries?

Diagnostic expertise: We introduced the first-ever system for diagnosing and classifying stress fractures. This five-tier system includes fracture grade, fracture location and imaging modality. Our industry leadership in developing better ways to diagnose your condition leads to quicker and more appropriate treatment, which means you’ll heal faster.

Innovative research: Our sports medicine research on chronic exertional compartment syndrome (CECS) is designed to ultimately develop a multicenter database for collecting outcome information on this condition as well.

High-level training: We offer fellowship-level physician care and physical therapy. That means our providers have completed up to two years of intense, specialized experiential training in the field, which translates to extensive proficiency in patient care.
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