Lower Extremity

The current evidence on the effectiveness of manual therapy for MSDs of the lower extremity is limited. The available evidence supports the use of manual therapy for ankle sprains, muscle sprains, and various tendinopathies.

Myofascial release therapy has been shown to be effective for treating plantar fasciitis. Eccentric exercise has been demonstrated to be effective in the treatment of lower extremity tendinopathies and subsequently should be considered as an initial treatment measure. Furthermore, the use of surgical treatment for the majority of biomechanical disorders of the lower extremity should only be taken into account in cases of failed response to conservative treatment.

ESSENTIAL LITERATURE

THE EFFECTIVENESS OF SOFT-TISSUE THERAPY FOR THE MANAGEMENT OF MUSCULOSKELETAL DISORDERS AND INJURIES OF THE UPPER AND LOWER EXTREMITIES: A SYSTEMATIC REVIEW
Piper et. al. 2016 
Conclusion:
Our review clarifies the role of soft-tissue therapy for the management of upper and lower extremity musculoskeletal disorders and injuries. Myofascial release therapy was effective for treating lateral epicondylitis and plantar fasciitis. Movement re-education was also effective for managing lateral epicondylitis. Localized relaxation massage combined with multimodal care may provide short-term benefit for treating carpal tunnel syndrome. More high quality research is needed to study the appropriateness and comparative effectiveness of this widely utilized form of treatment.

THE EFFECTIVENESS OF MULTIMODAL CARE FOR SOFT TISSUE INJURIES OF THE LOWER EXTREMITY: A SYSTEMATIC REVIEW
Sutton et. al. 2016 
Conclusion:
A multimodal program of care for the management of persistent plantar heel pain may include mobilization and stretching exercise. Multimodal care for adductor-related groin pain is not recommended based on the current evidence. There is inconclusive evidence to support the use of multimodal care for the management of persistent patellofemoral pain.

THE EFFECTIVENESS OF EXERCISE ON RECOVERY AND CLINICAL OUTCOMES IN PATIENTS WITH SOFT TISSUE INJURIES OF THE HIP, THIGH, OR KNEE: A SYSTEMATIC REVIEW
Brown et. al. 2016 
Conclusion:
We found limited high-quality evidence to support the use of exercise for the management of soft tissue injuries of the lower extremity. The evidence suggests that clinic-based exercise programs may benefit patients with patellofemoral pain syndrome and persistent groin pain. Further high-quality research is needed.

TENDINOPATHIES OF THE LOWER EXTREMITIES IN SPORT–DIAGNOSTICS AND THERAPY
Christine Clar et. al. 2014 
Conclusion: (Translated from German)
Eccentric exercise is effective in the treatment of lower extremity tendinopathies and should be considered as an initial treatment measure. To improve load compensation sensorimotor exercises are also recommended. Load frequency ranges, anywhere from three times per week to several times per day, dependent upon the training scope. It seems very high intensity training is most effective. Shockwave therapy is particularly useful in early stages of care, however, the long term effectiveness of shockwave therapy is yet to be determined. The use of surgical treatment procedures should only be taken into account in case of failed response to conservative treatment.

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THE EFFECTIVENESS OF MANUAL THERAPY FOR THE MANAGEMENT OF MUSCULOSKELETAL DISORDERS OF THE UPPER AND LOWER EXTREMITIES: A SYSTEMATIC REVIEW
Southerst et. al. 2015
Conclusion:
The current evidence on the effectiveness of manual therapy for MSDs of the upper and lower extremities is limited. The available evidence supports the use of manual therapy for non-specific shoulder pain and ankle sprains, but not for subacromial impingement syndrome in adults. Future research is needed to determine the effectiveness of manual therapy and guide clinical practice.