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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.
Is that pain, or an injury?
How running injuries happen
How to Know When to Address Pain: Lessons from Hank
This week, I had an interesting conversation with a runner named Hank. He asked a question that many of us have pondered:
"But I’m sore so often from running and mountain biking... how am I supposed to know if it’s something I need to take care of or just power through?"
This is a great question and one that’s harder to answer than it seems. How do you know when something is truly wrong? If you’re an active person, you’ve undoubtedly experienced pain during your activities. But does that mean you should stop doing the things you love whenever there’s pain? Fortunately, no!
The I3 Model: How Overuse Injuries Happen
At Base Camp, we use the Incomplete, Incidence, Injury (I3) model to help determine when to take pain seriously and when it might not be a big deal.
Injuries happen and develop over three phases:
Incomplete mechanics or recovery
Incident
Injury
1. Incomplete Mechanics or Incomplete Recovery
INCOMPLETE MECHANICS:
Imagine trying to do high-level CrossFit, but you can’t get your arms all the way overhead. Or running a marathon when you can only do seven single-leg calf raises. These are examples of incomplete mechanics. While they don’t guarantee injury, they certainly set you on the wrong path in the injury cycle.
INCOMPLETE RECOVERY:
There are three primary domains for recovery:
- Sleep
- Nutrition/Hydration
- Stress Management
If any of these are below 80% (rate yourself on a scale of 1-10), you’re not fully recovering from your activities. It's always a combination of these two factors. Better mechanics can buffer for poor recovery, and vice versa.
CASE STUDY: Hank, runner with Achilles tendon pain
Hank was limited in his ankle range of motion and sleeps an average of 6 hours per night.
2. Incident: Check Engine Light
This is the first sign that something is wrong—the 'check engine light' your body sends to signal that something is off. Incidents include any symptoms or signs of pain and are often the hardest to interpret. Take these signals seriously. Part of why injury prediction is tricky is that the incident may not even be in the area of the actual injury. You may have a shoulder 'hot spot' that turns into a lower back injury or ankle stiffness that turns into knee pain.
CASE STUDY: Hank, runner with Achilles tendon pain
Hank has hamstring tightness that always worsens when he increases his volume.
3. Injury: Limiting
The word 'injury' can be hard to define. Can we call it pain? Well, we’ve all had pain during activity that went away on its own or was just part of the activity itself (looking at you, hill repeats). What about tissue damage? There are millions of people walking around with meniscus tears who don’t even know it and have no symptoms.
Here’s the definition we use at Base Camp: Any time you have a symptom that keeps you from doing what you WANT to do, or HAVE to do, then it is an injury.
- Tingling so bad you can’t carry your groceries in? Injury.
- Knee pain that only starts when you hit 22 km, but you’re training for a marathon? Injury.
CASE STUDY: Hank, runner with Achilles tendon pain
Hank triggered his Achilles pain after a hard hill session.
Take Home Lessons
LISTEN TO YOUR BODY. Your body will send you signs that something is wrong, and that you need to do something about it.
ACT EARLY. When you are injured, it's late in the game to take action. We can't focus on the incomplete mechanics or recovery until we get the pain under control. It is way more efficient to focus on your mechanics and recovery BEFORE they become an issue.
YOU CAN GET BACK TO YOUR ACTIVITY. Injuries suck, but they don't have to limit you forever. Most of the time you don't even have to stop your activity.
CASE STUDY: Hank, runner with Achilles pain
Hank and I are now working to calm down his tendon pain, while he is prioritizing his sleep. Next, we will shift to improving Hank's ankle range of motion, and improving his lower back stiffness (the cause of his hamstring tension). Finally, we will reintroduce volume, intensity, and elevation to his running.
Dr Mark Murdoch is a runner, chiropractor, and rehab specialist in Vernon, BC.
Every week he works with runners, mountain bikers, and adventure athletes who want to get back to their sport better than ever.
Ready to get back to running PAIN FREE?
Start with a free consult with Dr Mark here: CONTACT
How I fixed my knee pain (and then crushed a 47 km run)
How I fixed my knee pain and ran 47 km!
Last year I couldn't run.
In September 2023, a friend and I ran the Juan De Fuca on Vancouver Island. It was an awesome experience. 45 km, 2000 m of elevation and 13 hours.
But in July of 2023... I could barely hike downhill. Forget running.
I was dealing with a long-standing knee injury, that came back when I increased my downhill running.
At the time, we were living up at Silver Star. The trails up there are incredible. They're exciting and flowy, and a true joy to run.
They are also uphill or downhill in just about every direction.
This meant that every single run I was hammering downhill, which is a surefire way for me to trigger my knee pain.
My injury is likely my meniscus. I have an old twisting injury that has given me issue in the past.
It shows up as pain along the inside of my knee that SPIKES with downhill strides. It's sharp, and intense and can often take my breath away.
So... when this came up again, with Juan De Fuca already on the calendar, I took it seriously.
Here is the strategy I used:
RESET.
RESTORE.
RELOAD.
Before we get to that, we need to understand why running injuries happen in the first place.
Whenever we experience a running-related injury, we are dealing with an overuse injury. We did too much too soon.
WE ALL HAVE AN INJURY THRESHOLD.
No matter how fit you are, we all have an injury threshold. For you, it might be 25 km. For the next, it might be 10 km. For another, it could be 100 km.
AFTER AN INJURY…
After an injury, that threshold is lowered. We can no longer handle the same amount we could before we triggered the injury.
Here is exactly what I did to fix my knee pain and successfully conquer the Juan De Fuca in a single day:
Step 1: RESET.
This meant rest... but not complete rest.
I still had to train for the 45 km trail run with almost 2,000 m of elevation gain.
But... I couldn't. Instead, I focused on what I COULD do: flat running and strength training. I focused on continuing to build my leg strength so that when I did return to smashing downhill I was strong enough to do so.
In the CALM IT DOWN phase, my main goal was to maintain fitness and strength, while letting my pain triggers lessen.
Step 2: RESTORE.
The goal of Step 2 was to build my tissue tolerance (the resilience of my knee) up beyond the demands of a 10 hr day.
In order to return to running the distance and terrain I wanted to, I knew I needed to build my strength, endurance and tolerance back up.
Since I had been already working on my leg strength, I was in a good spot.
I added in some specific exercises (in this case step downs, pogos, and adductor planks) to target the muscles and parts of the knee that needed it the most.
Step 3: RELOAD.
Then came the fun / nerve-racking part... running downhill.
Thankfully, I had put in the work and was ready to get back to running downhill with speed.
I reintroduced it gradually, on moderate trails, before turning on the jets.
I was lucky because I didn't experience a single flare-up. I was ready for Juan De Fuca.
Result?
Juan De Fuca was a blast (big thank you for the weather on that one).
Now?
It still bothers me on occasion.
But that is inevitably when I have neglected my rehab exercises. I started to experience sharp knee pain and need to add in a few weeks of consistent strength movements.
Here are the takeaways...
When you have pain, take it seriously. Do something about it!
When you are injured, you will need rest. Relative rest doesn't mean you can't do anything, it means you need to do less and modify.
STRENGTH is your ARMOUR. It's your bank account, your insurance policy, and your treatment. It will get you back to activity faster than anything else.
If you are struggling with how manage and treat your injuries, we can help.
-Dr Mark Murdoch
Chiropractor, MS Sports Medicine
Dr Mark Murdoch is a runner, chiropractor, and rehab specialist in Vernon, BC.
Every week he works with runners, mountain bikers, and adventure athletes who want to get back to their sport better than ever.
Request a free consult with him here: CONTACT
Tips for Running in the Heat
How I fixed my knee pain and ran 47 km!
It was 39 degrees yesterday.
As the summer sun blazes and temperatures rise, runners face unique challenges that can impact performance and safety. In this post, we delve into the science behind running in the heat and offer practical tips to help you navigate your summer training effectively.
Understanding the Heat's Impact on Running
The shift to hot weather running presents immediate physiological challenges. Heat increases cardiac output demands, forcing your heart to work harder to maintain circulation. This results in elevated heart rates even at familiar paces, making zone-based training adjustments crucial for maintaining performance goals.
Managing Hydration and Performance
Dehydration compounds these challenges, reducing blood volume and hindering your body's ability to cool itself through sweat. Simply drinking water isn't enough; replenishing electrolytes lost through sweat is essential for muscle function and temperature regulation. Electrolyte-infused fluids can help maintain performance and prevent heat-related issues.
Sun Exposure and Protection
Sun exposure poses another risk, especially for those unaccustomed to intense sunlight. While sunscreen is recommended for most, some runners find it affects their ability to sweat effectively. Instead, opting for UPF-rated clothing can provide protection without compromising cooling mechanisms, ensuring you stay comfortable and protected during extended runs.
Practical Tips for Summer Running
Adjust Expectations: Understand that running in higher temperatures will affect your pace and endurance. Adjust training plans accordingly to avoid overexertion.
Hydrate Smartly: Incorporate electrolyte-rich fluids to replenish losses from sweat. Focus on maintaining hydration levels before, during, and after your run.
Protect Your Skin: Choose lightweight, UPF-rated clothing to shield against UV rays while allowing for adequate ventilation.
Know Your Limits: Monitor your body's response to heat and adjust your running schedule or intensity as needed to prevent overheating or exhaustion.
Cool Down Effectively: After running, prioritize cooling down with a cool shower or ice packs to lower core body temperature and aid in recovery.
Take home message:
Summer running offers unique challenges, but with proper preparation and awareness, you can continue to enjoy and excel in your training regimen. By understanding the impact of heat on your body and implementing these practical tips, you'll stay safe, perform better, and make the most of your summer miles.
Whether you're training for a race or simply maintaining fitness, embracing these strategies will ensure that your summer runs are as enjoyable and effective as possible. Stay cool, stay hydrated, and keep moving forward in your running journey!
Dr Mark Murdoch is a runner, chiropractor, and rehab specialist in Vernon, BC.
Every week he works with runners, mountain bikers, and adventure athletes who want to get back to their sport better than ever.
Request a free consult with him here: CONTACT
How to Train your Core for Running
How to train your core for running
I had two conversations with patients last week that reminded me of something that I take for granted.
Most of us have been told we should 'strengthen our core'
Ok...
...but what does that even mean?
And why is it even relevant?
Because you can't fire a cannon from a canoe.
The results of this would be... comical.
Instead, we want to fire our cannons (i.e. our LEG POWER!) from a BATTLESHIP.
The stronger your core, the more stable and efficient your legs can function to propel you forward.
This is why core strength has always been such a popular topic for runners. IT MATTERS.
Not only for performance, but for injury prevention too.
But... where should you start?
My favourite test to put runners through is the Side Bridge Endurance Test.
This test targets the lateral core, which helps stabilize us EVERY SINGLE STEP so that our legs can propel us forward.
It is a common spot that will fatigue, which is why we see so many marathon and Ironman competitors coming across the finish line looking like wet noodles.
I use this test with runners every single week.
STANDARDS
When we set our standards, it depends on what the goals are.
For the general population, just to prevent lower back pain, I like to see a 75-second hold in anyone under 40. We get a bit more lenient in 41+, but shooting for a 75-second hold is a great goal.
For RUNNERS though, I have a high standard, depending on your distance.
10 km: 75 seconds
25 km: 90 seconds
42.2 km: 1 min 45 seconds
50+ km: 2 min+
Here is where it gets tricky... we don't train the lateral core by doing a bunch of long hold side planks... because the core doesn't hold tension the whole time you are running.
Instead, it stiffens and relaxes with every step.
Instead of holding the side bridge for minutes at a time, I have my patients and clients hold it for 10-30 seconds and then repeat with a short rest (2-5 seconds) in between.
This trains not only the core endurance but also the contract, relax, contract cycle.
We also use things like lateral bends, suitcase carries, and step-ups to train the same function.
For my serious runners, some sort of lateral core training needs to be in your program EVERY SINGLE WEEK.
Add this in and you will see some serious performance gains.
-Dr Mark Murdoch
Chiropractor, MS Sports Medicine
P.S. Need to get in touch with us or have any additional questions?
Give us a call at (250)-307-7819 between 8am-5pm Monday-Friday, or email us at drmurdoch@basecampclinic.com
Dr Mark Murdoch is a runner, chiropractor, and rehab specialist in Vernon, BC.
Every week he works with runners, mountain bikers, and adventure athletes who want to get back to their sport better than ever.
Request a free consult with him here: CONTACT
How running injuries happen