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Flexor Hallucis Muscle Strains: Causes, Recovery, and Treatment Options
Flexor hallucis muscle strains, while not as commonly discussed as hamstring or calf strains, can significantly impact movement and quality of life—especially for runners, dancers, and other active individuals. Let’s break down what this injury entails, how it happens, and the steps you can take to recover effectively.
What is the Flexor Hallucis Muscle?
The flexor hallucis longus (FHL) is a muscle in the lower leg that plays a key role in controlling your big toe. It allows you to push off during walking, running, or jumping and stabilizes your foot during movement. Despite its small size, the FHL is critical for activities requiring balance and power.
A strain in this muscle happens when the fibers are overstretched or torn, which can range from a mild pull to a more significant tear.
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How Do Flexor Hallucis Strains Happen?
The most common causes include:
- **Overuse:** Repetitive motion, such as running or jumping, can lead to microtrauma in the muscle.
- **Biomechanics:** Issues like overpronation (rolling your foot inward) or tight calves can put extra strain on the FHL.
- **Acute injury:** A sudden, forceful movement can overstretch the muscle, leading to a strain.
Athletes, particularly runners, dancers, and those involved in sports requiring rapid direction changes, are most at risk for this type of injury.
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Symptoms to Watch For
- Pain or tenderness along the inner side of the lower leg or ankle.
- Swelling or inflammation in the area.
- Difficulty pushing off the ground or pointing your toes.
- Pain that increases with activity but may lessen with rest.
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Diagnosis and Imaging
Diagnosing a flexor hallucis muscle strain often starts with a physical examination. A healthcare provider will assess your pain, range of motion, and strength.
In some cases, imaging can help:
- **Ultrasound:** Useful for detecting tears or inflammation in the muscle.
- **MRI:** Provides a detailed look at soft tissues, which can help confirm the diagnosis if the strain is severe.
For most mild-to-moderate strains, imaging isn’t necessary unless symptoms persist or worsen despite treatment.
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Treatment and Recovery Options
1. Conservative Care: The Foundation of Recovery
Most flexor hallucis strains respond well to conservative care. This includes:
- Rest: Allow the muscle to heal by avoiding activities that exacerbate pain.
- Compression and elevation: Support the area and reduce inflammation.
2. Rehabilitation and Exercise
Rehabilitation is essential to restore strength, flexibility, and function. A well-rounded rehab plan might include:
- **Stretching:** Gentle stretches to improve calf and ankle flexibility, reducing strain on the FHL.
- **Strengthening exercises:** Targeting not only the FHL but also the surrounding muscles to improve overall foot and leg stability.
- **Gradual return to activity:** Slowly reintroducing movements like running or jumping to build tolerance.
Working with a rehab professional ensures exercises are tailored to your injury and activity goals.
3. Manual Therapy
Techniques like soft tissue mobilization or dry needling can reduce muscle tension, improve circulation, and support recovery.
4. Footwear Adjustments
Wearing supportive shoes or orthotics can offload the strain on the FHL, especially if poor biomechanics contributed to the injury.
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How Long Does Recovery Take?
Recovery times vary depending on the severity of the strain:
- Mild strain: 2-4 weeks with consistent rehab and rest.
- Moderate strain: 4-8 weeks, requiring a more structured rehab program.
- Severe strain: Several months, especially if a significant tear occurred.
The key to recovery is patience and consistency with your rehab plan. While it’s tempting to return to full activity quickly, rushing can lead to setbacks.
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Why Conservative Care is the Best Starting Point
For most flexor hallucis strains, conservative care is highly effective. Surgery is rarely needed unless there’s a complete tear, which is uncommon. By focusing on rest, rehabilitation, and proper biomechanics, you can not only recover but also prevent future injuries.
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Optimistic Outcomes: Get Back to Doing What You Love
While flexor hallucis muscle strains can be frustrating, they don’t have to sideline you permanently. With the right care and guidance, you can make a full recovery and return to your favorite activities stronger than before.
If you’re experiencing pain or suspect an injury, don’t hesitate to seek help. A thorough assessment and personalized rehab plan can set you on the path to recovery and long-term success.
Ready to take the next step?
Reach out today to start your recovery journey.
The 3 most common types of knee pain in runners
Learn the most common types of knee pain in runners and why most runners never get better.
It's Dr Mark here from Base Camp.
Knee pain sucks. Straight up. Almost every runner will experience an injury at some point. The knee is the most common running-related injury runners experience.
The good news is, for most runners, it doesn't have to stop you.
Most often, running-related knee pain from 1 of 3 different causes:
The Patellofemoral joint pain (the knee cap, the muscles, and the tendons associated with it)
The Iliotibial Band pain (aka the IT Band)
Osteoarthritis (inflammation of the knee joint)
All three of these injuries have their causes and specific solutions.
Despite that, they all come down to the same thing: doing too much, too soon.
Your body wasn't prepared for the demands you placed on it.
It happens.
BUT... if you don't want to end up in REHAB PURGATORY then take them seriously.
For runners, there are three types of knee pain you need to understand.
The first is Patellofemoral Pain (PFP) in the FRONT of the knee, and the second is Iliotibial Band (ITB) Pain on the OUTSIDE of the knee.
None of them are fun.
But they don’t have to be permanent or keep you from hitting your running goals.
In fact, chances are good if you are a runner that you will experience either PFP of ITB pain at some point in your running career.
The WRONG thing to do is ignore it, keep running at the same intensity and volume, and just hope it goes away.
Let’s talk a little bit about both types of pain and your first line of defence for both of them…
1. PATELLOFEMORAL PAIN (PFP)
Patellofemoral Pain (PFP) is pain that is located on the anterior aspect of the knee (the front).
The word sounds scary, but really it just means pain related to the patella (your knee cap) and your femur (your leg bone). Often, the tendon is involved and can be one of the primary pain generators for PFP. It tends to be MUCH more common in women (2-3 times as common in fact) and can take a long time to resolve (for some stubborn cases it can last more than a year).
Pain tends to come on slowly, and may or may not be present during every run.
In my experience, runs with a lot of downhill mileage are notorious for flaring up PFP. This is likely mainly due to the way the quad muscles need to contract to stabilize the knee while travelling downhill, even at moderate grades.
One of the most common symptoms of PFP is pain with ascending and descending stairs.
2. Iliotibial Band Pain
Iliotibial Band Pain is pain that is located on the lateral aspect of the knee, where the Iliotibial Band (ITB) connects to the lower leg bone (the tibia, which is your shin bone).
Like PFP, ITB Pain tends to come on slowly, but once it comes it rarely goes away without a fight. The pain is often worse with early knee bending (when the knee is bent to about 30 degrees) and wreaks havoc on activities like cycling and downhill running.
The function of the ITB is to preserve force while we are walking or running, and stabilize the lateral knee. Pain comes on when the bursa (and fluid-filled sack) that is located deep to the ITB insertion becomes irritated.
ITB pain is often intense and debilitating.
3. Osteoarthritis (OA)
The third type of knee pain is osteoarthritis-related knee pain.
A lot of people think that running is bad for your knees and causes OA. The reality is that osteoarthritis is LESS common in recreational runners, which means that it is actually PROTECTIVE from arthritis!
The key is to get the dosage right.
If you have already had a knee injury, there is a higher chance you will develop OA and OA-related knee pain, but it is not guaranteed.
When there is degeneration, joint changes, or arthritis in the knee, your knee is more sensitive to triggering pain. But… the dosage makes the poison. Over time, you can build up your running volume and run without pain, even if you have arthritis.
WHAT TO DO ABOUT RUNNING KNEE PAIN?
THE TYPICAL CYCLE OF RUNNING INJURIES…
Unfortunately… most running injuries tend to follow this pattern:
Initial Injury from too much running volume
> Runner takes a couple of days off because of the pain
>> The pain gets better because the pain trigger (running) is absent, but because they took time off, their tissue fitness also decreased
>>> Runner returns to running at their usual pace and volume without building the tissue tolerance back up or following a progressive plan
>>>>> The runner gets injured AGAIN and starts the cycle all over.
Ready to BREAK THE CYCLE?
the better strategy:
Regardless of the type of knee pain, the approach remains pretty much the same, with some subtle tweaks.
The first step is to try and rule out something worse PFP or ITB Pain which are both ‘non-complex’ biomechanical conditions. We want to make sure it isn’t something more severe like a bone-stress injury (stress fracture), connective tissue injury like a meniscus tear or ligament damage, or infection/disease-related. We can’t always rule these things out, but we try and be as confident as possible that the pain is in fact something we can deal with conservatively (without drugs/injections or surgery).
Don’t misinterpret the above information though. Just because something isn’t ‘medically’ serious, doesn’t mean the pain isn’t severe or debilitating.
IF the pain does in fact fall into the category of either PFP or ITB Pain, we take a 3-step approach to managing, fixing, and preventing the condition from coming back.
Step 1: CALM STUFF DOWN
Step 2: BUILD BACK UP
Step 3: BRIDGE THE GAP
Step 1: CalM Stuff Down
The first thing we need to do with either knee pain condition is to calm down the pain so you can get back to running without making things worse.
Our first line of defence is some DELOAD work. This means taking a few days or weeks off. No runner likes to hear this. But some sort of deload is essential for calming the pain down. For some runners, that does not mean COMPLETELY stopping running. We try really hard to keep runners running, because we know one thing is true: RUNNERS LIKE TO RUN.
Step 2: Build Back Up
Once the pain has calmed down a bit, then we move into our Build phase. This focuses on building your strength, endurance, and tissue tolerance back up to handle the demands of running. This usually looks like some strength and cardio training BELOW symptom threshold.
Step 3: Bridge the Gap
Once we have built the tissue tolerance back up, we need to bridge the gap from rehab back to performance. Just because the tissue is strong, does not mean it is necessarily ready for the demands of the running you were doing before injury.
This process is collaborative and involves some trial and error. Too much too soon? We take two steps backwards.
While it is tempting to jump right back into your regular running routine because you are feeling so much better, it is a much better idea to gradually build your running volume back up.
Ok… but what does that actually LOOK like?
Fair question, that I wish I had a straightforward answer to. Unfortunately, everyone is different. There is no single exercise, stretch, or rehab plan that works for everyone.
If your knee pain is keeping you from running, or doing anything else you love, I HIGHLY recommend you seek out a qualified provider.
That said, if you want to take a shot at fixing your pain yourself from home, here are some of the exercises I often use with my patients.
PFP EXERCISES:
Tempo Squats (3-seconds down, 1-second hold, 1-second up, 0-second rest at the top)
Rear Foot Elevated Split Squats
ITB Pain Exercises
Stationary Cycling (with your knee flexed to about 35 degrees at the bottom of the stroke. Move your seat forward and down to accomplish this).
Uphill Treadmill Walking (8-10 degrees incline)
Rear Foot Elevated Split Squats
Want 1-on-1, personalised rehab?
Author: Dr Mark Murdoch, Chiropractor and Co-Founder at Base Camp Chiropractic and Sports Rehab in Vernon, BC.
Mark Murdoch is a Doctor of Chiropractic with a Master’s Degree in Sports Medicine.
Contact: drmurdoch@basecampclinic.com
Instagram: Base.Camp.Doc
3 ways to manage pain with running (without stopping!)
Embarking on a run is not just a physical activity; it's a journey into self-discovery and the great outdoors.
Yet, what do you do when the joy of each stride is overshadowed by the unwelcome companionship of pain? At Base Camp Chiropractic and Sports Rehab, we've witnessed countless runners grappling with this predicament. The prospect of giving up something you love is disheartening, but fear not! Let’s take a look at three alternatives that can keep you on track, pain-free and on track to hit your running goals.
Running is a fantastic way to stay in shape and explore the outdoors. But what happens when every stride sends a jolt of pain through your body? At Base Camp Chiropractic and Sports Rehab, we've seen many runners struggle with this issue. Rather than quitting this activity that you love, consider these three alternatives.
1. Manipulate the Volume
One of the most common mistakes runners make is trying to do too much, too soon. This approach often leads to overuse injuries and burnout. Instead of stopping completely or pushing through the pain, consider adjusting the volume of your runs.
For example, if you have a long run planned for Saturday with a target of 20 km, you could split this into two separate runs. You could run 10 km in the morning and then another 10 km in the evening. This approach reduces the strain on your body while still allowing you to reach your mileage goals.
2. Change Your Pace or Cadence
Another way to address running-related pain is by changing your pace or cadence. Your pace (your mph or km/h), and your cadence (the number of steps you take per minute), both play a significant role in how your body absorbs the impact of each stride.
Adjusting your pace can change the load on your joints and muscles. Increasing or decreasing your pace can sometimes alleviate pain by changing the way your foot strikes the ground.
Similarly, increasing your cadence by 10% can also change the joint loads. By taking more steps per minute, you reduce the impact of each individual step, spreading the load more evenly across your stride.
3. Warm Up!
Our final tip is to always warm up before running. A thorough warm-up can prepare your body for the demands of running and potentially reduce the risk of injury. Some of our favourite warm-up exercises include calf raises, lunges, squats, and toe lifts. These movements target the muscles used most during running, ensuring they are ready for action.
Running should be an enjoyable activity, not something that causes you pain. If you're experiencing pain while running and these tips don't help, don't hesitate to reach out to us at Base Camp Chiropractic and Sports Rehab. We're here to help you get back on track and enjoy your runs again.
Remember, running is an exhilarating pursuit, and pain shouldn't be a constant companion on your journey.
Instead of succumbing to the frustration of persistent discomfort, consider manipulating the volume, changing your pace or cadence, and incorporating a thorough warm-up into your routine.
Should these tips fall short, the experts at Base Camp Chiropractic and Sports Rehab stand ready to guide you back to pain-free runs, ensuring that every step is not just a stride but a leap towards your wellness. Embrace the joy of running – we're here to make sure it remains a source of delight in your life.
How long does it take for Achilles tendonitis to heal? (updated 2024!)
Achilles Tendon pain can be super frustrating. Learn how long it might take you to recover
Achilles Tendon pain can be INCREDIBLY frustrating.
This is especially true if you can’t participate in your activities of choice because of the pain. I often see Achilles Tendinopathy in runners, hikers, volleyball players… It sucks for everyone.
The most common question I get when someone comes in with Achilles Tendon pain is “how long is this going to take?”
This is not my favourite question to answer, because Achilles Tendon pain can last a LONG TIME.
The short answer to that question is “1-12 months”, but that doesn’t really help anyone. The slightly longer answer to that question is “it depends”, which ALSO is not very helpful…
In order to estimate your recovery time, you need to understand two things:
Severity and Stage of your injury
Other factors that influence your performance
Let’s break it down a little bit, and you can see where you might fall in the estimated recovery time.
Stop letting Achilles pain slow you down!
Get started with our client success guide.
Where does it come from?
Why does it come back?
How to do a self-assessment at home
Recovery expectations
and more!
Grading the Severity and Stage of your Injury
Achilles Tendinopathy falls into 3 Stages:
Acute (new onset of pain, up to 2 weeks)
Subacute (immediately after acute, 3 weeks-2 months
Chronic (3 months plus)
The later longer it has been since the onset of injury, the longer it generally takes to recover.
Acute Achilles Tendinitis will usually calm down in 3-4 weeks (I say CALM DOWN, not GET BETTER here. This is explained later in this article under the header ‘Calmed Down vs Gotten Better).
Subacute Achilles Tendinopathy will usually take 2-6 months to calm down. (Again, not better yet)
Chronic Achilles Tendinopathy is a tricky one and can take anywhere from 3 months to 18 months to calm down and get better.
FACTORS THAT INFLUENCE RECOVERY TIME
This list is a long one, so I will only list the ones I feel are most important. These include:
Overall Health
Crappy Diet? Super stressed out? Smoker? Comorbidities like diabetes, metabolic syndrome or heart disease? All of these things lengthen the expected recovery time.
Mindset
Positive mindsets win the rehab game.
Sleep
You can’t out rehab 5hrs per night of sleep, especially while trying to recover from an injury. You NEED 8hrs + of sleep per night if you want to get better in a reasonable time and keep the injury from coming back.
Rehab Plan
Your rehab plan needs to be well-thought-out, progressive, and appropriate to both your current state and the activities you want to get back to. If you are a runner and your rehab plan does not involve running at some point, you are following the wrong plan. Volleyball? You better be jumping at some point in your plan. (But not too much too soon…)
Calm Down vs Get Better
This happens time and time again. Someone comes to see me and together we are able to get them out of pain, and they feel better, so they decide to cancel their follow up and get back to their activity.
Inevitably, a couple of weeks later they are back in my office, 2-steps back.
This is because their injury was not fully rehabbed. Only their PAIN is better, but they have not been fully prepared to get back into their activity at 100%. This takes time, deliberate effort, and a well-thought-out progressive rehab plan.
Moral of the story: just because the pain goes away, does not mean that you are ‘better’ (especially true with Tendon injuries).
Rehab programs should generally have 3 Steps.
Step 1: RESET - Calm Stuff Down
Step 2: Restore - Build Back Up
Step 3: Reload - Bridge the Gap
MOST rehab plans end after calming stuff down. SOME plans do a decent job of building strength and endurance back up. VERY FEW programs bridge the gap between recovering from an injury and performing the way you want to.
Need some help?
That is where we come in. If you are ready to get on a plan that will get you back in action and back to doing the things you love, and KEEP THIS INJURY FROM COMING BACK, we can help.
Author: Dr Mark Murdoch, Chiropractor and Co-Founder at Base Camp Sport and Spine in Vernon, BC.
Mark Murdoch is a Doctor of Chiropractic with a Master’s Degree in Sports Medicine.
Contact: drmurdoch@basecampclinic.com
Book an Appointment with Dr Murdoch: book here
Instagram: Base.Camp.Doc
The ultimate recovery tool for runners
Take a second to guess what I am doing to say.
Are you thinking foam rolling? What about stretching? Maybe yoga?
Nope.
What if I told you I am a Chiropractor and Sports Clinician?
Must be adjustments then, right? Or IMS and needling? Or what about active muscle release?
Negative again.
The number one recovery tool for runners is free, effective, and has no negative side effects.
It’s sleep.
Shocker. I know. You have heard it before (and if you are a patient of mine, you have heard it from me).
Why does Sleep matter?
Sleep is essential for you as a runner when it comes to bouncing back and performing at your best. While you may be focused on training hard and eating right, one thing that runners often neglect is shut-eye. But let me tell you, skimping on sleep can really hold you back, mess with your results, and increase your chance of injury. In this article, we're going to dive into how sleep plays a massive role in helping you recover from running and boost your performance.
Recovery is key for your training routine, and sleep is like the secret sauce for making it happen. When you run, your muscles experience microscopic damage and inflammation. It's a natural part of the process and helps you grow and get stronger. But without proper recovery, these little tears can build up and leave you feeling tired, performing worse, and even more prone to injuries.
When you snooze, your body gets to work repairing and rejuvenating. It releases growth hormones that are crucial for fixing up those muscle tears and promoting muscle growth. So, by catching enough Zzzs, you're giving your body the chance to make the most of these hormones and speed up your recovery.
Sleep is also your ticket to topping up your energy reserves. You see, when you run, your muscles use up glycogen, which is their fuel source. But don't worry, sleep helps you refill those glycogen stores, so you'll have plenty of pep for your next run.
Sleep isn't just good for your body—it's a total game-changer for your mind too. When you don't get enough sleep, your mood, focus, decision-making, and reaction time all suffer. And trust me, as a runner, you need all those things to be on point, especially during races or intense workouts.
On top of that, getting quality sleep seriously lowers your risk of getting injured. Not only will you recover better from the damage caused by running, if you're sleep-deprived, your coordination, balance, and muscle recovery take a hit, which makes you more accident-prone. But when you prioritize sleep, you're giving your muscles, tendons, and ligaments the chance to get stronger and reduce the chance of overuse injuries.
How much sleep do we need?
In a perfect world, you would go to sleep at the same time every night, and wake up without an alarm whenever your body tells you. But that is not a reality for most of us (myself included).
If you are taking your training seriously though, aim for 8+ hours per night of sleep. This has been shown repeatedly to be the threshold for injury prevention and performance.
Why I recommend 7.5 or 9 hrs instead of 8…
For most people, a full sleep cycle takes about 90 minutes (variation from 70-120 minutes). During a sleep cycle, we go through 4 stages of sleep: Stages 1, 2, Deep Sleep and REM sleep (rapid eye movement). MOST physical recovery happens in deep sleep, and our deep sleep increases in length as the night goes on.
But with a 90-minute sleep cycle, it is most comfortable to be woken up when we are in between sleep cycles. That is why when I wake up at 7.5 hours I feel way more alert and awake than when I am woken up at 8 hours (while I am heading back into another sleep cycle).
The takeaway here is to play around with your sleep length and see where you typically feel best waking up but aim for 7.5 hours at a minimum (9 hours even better!).
SLEEP HYGIENE (getting the most out of your sleep)
So, how do you make the most of your shut-eye?
1) Consistency: Well, first, establish a sleep routine. Try to hit the hay and wake up at around the same time every day. This helps regulate your internal clock and makes it easier for you to fall asleep and wake up feeling refreshed.
2) Cold and Dark: keep your room as cold and as dark as possible when going to sleep. This helps you get a deeper and more rejuvenating sleep.
3) Ditch the alcohol and caffeine: limit caffeine intake at least 6 hrs (9-12 is even better) and alcohol at least 3 hours before bed. Even if you don’t feel it, caffeine and alcohol can compromise the quality of your sleep.
4) Magnesium: most of us are limited in magnesium. Taking magnesium before bed can improve your sleep (heads up: weird dreams, incoming!)
And hey, if you're feeling tired during the day, don't be shy to take a power nap. Just 20-30 minutes can do wonders for your focus, reduce fatigue, and give your performance a boost, especially when you're training hard.
To wrap it up, sleep is like a secret weapon for you as a runner. It helps you recover, recharge your energy, and keep your mind sharp. By giving sleep the love it deserves, you'll supercharge your running performance, reduce the risk of injuries, and overall feel like a superstar. So, make sleep a priority in your training routine, and get ready to crush those running goals!
Author: Dr Mark Murdoch, Chiropractor and Co-Founder at Base Camp Sport and Spine in Vernon, BC.
Mark Murdoch is a Doctor of Chiropractic with a Master’s Degree in Sports Medicine.
Contact: drmurdoch@basecampclinic.com
Instagram: Base.Camp.Doc
How running injuries happen