Knee Ligament Injuries

Winter is usually a time where we tend to see an increase in knee injuries, especially knee ligament injuries. This is largely thanks to the variety of ‘change of direction’ sports that are played during this time of year. Rugby league, union, AFL, netball, soccer and skiing are all sports that are multidirectional and/or have contact involved with huge forces going through the knee joint.

The aim of this blog is to take you through the four major knee ligaments, their roles, how they might get injured and how long you might be on the sideline if you are unlucky enough to find yourself nursing one of these.

ACL (Anterior Cruciate Ligament)

We’ll start with the big one and the one that can quickly end your favourite sports star’s season. The ACL’s role is essential to stop you shin from coming forward and medially (internally) rotating. It’s important as it plays a huge stabilising role in your knee. Often the ACL is actually injuries in a non-contact scenario  such as pivoting,  landing, or changing direction but can also occur (must less likely) in a contact situation. ACL tears will often result in a person needing to undergo surgery which will see them out of non-contact sports for 6-9 months and contact sports for 12 + months. Rehab plays a vital role to strengthen the graft (replacement ligament) and ensure full recovery. More on this in a latter blog.

PCL (Posterior Cruciate Ligament)

The PCL’s role is essentially the reverse of the ACL,working to prevent backwards and lateral (external) rotation of the shin. It is much less frequently injured than the ACL and typically comes from contact where a direct blow occurs on the shin in a bent knee position. They can also occur when the knee is forcefully hyperextended. Generally PCL injuries are treated non-operatively with a comprehensive rehabilitation program, More severe injuries can sometimes be placed in a brace for the first two weeks. Isolated PCL tears, even if completely torn, have good non-surgical outcomes despite some ongoing laxity. They will however sideline an athlete for 6-8 weeks. If a PCL is combined with damage to other structures or if significant instability is present surgical reconstruction might be appropriate.

LCL (Lateral Collateral Ligament)

Probably the least common knee ligament to be injured is your LCL.  The LCL’s role in the knee is stabilise the outside of the knee. Injuries to the LCL are usually due to a direct and forceful lateral stress (contact injury) to the knee. Complete tears will often be associated with other injuries (often PCL rupture) and will result in the need for surgery. Incomplete tears may require a period of bracing if severe enough, however the majority shouldn’t. A specific rehabilitation period will be required nevertheless but it shouldn’t see you out of action more than 6 weeks.

MCL (Medial Collateral Ligament)

MCL injuries are common in the rugby codes. The MCL’s role is to stabilise the inside of the knee. Injuries here occur when there is a medial force to the knee and can occur in both contact and non-contact incidents. More often they are treated non-operatively, however there will be a period of bracing that can last from 6-10 weeks depending on the severity of the tear. For mild injuries bracing may not be required. All people suffering an MCL injury will need a strengthening program and modified training to reduce stress on the healing ligament. Many will return to sport with supportive strapping.

The extent of the damage to a ligament will significantly impact the management and recovery time. Rehabilitation, strengthening and activity modifications are going to be necessary in all forms of these injuries and play a vital role in return to play as well as  reducing the risk of re-occurrence. The best thing you can do is make sure you get a diagnosis and start on the road to recovery as soon as possible. As physio’s we have a variety of tests that we can do to determine the integrity of these ligaments. An MRI may be required in cases where surgical intervention may be necessary but your physio may also suggest a scan to assess other structures within the knee that can also be damaged.

Em & Nick are both experienced in dealing with acute knee ligament injuries. If you have any questions or have an injury you would like assessed feel free to contact us to make an appointment.

Sever’s Disease

Aches and pains are relatively common in growing children, especially these days where it seems to be the norm for kids to play multiple different sports during the one season. Often it can be tricky for parents of younger kids, some aren’t sure if they are being completely over protective while others feel they may not be empathetic enough to their child’s complaints of musculoskeletal pain.

We see kids regularly in our practice and 90% of them are suffering from a form of ‘growing pain’ with one of the most common areas being pain around the heels. This condition is known Severs Disease.

What is Severs Disease and what are the symptoms?

Severs disease is characterised by pain where the Achilles tendon attaches onto the heel bone (calcaneus). In children who are still growing this is a soft area of the bone where the growth plate has not yet closed. During periods of growth the skeleton grows slightly faster than the soft tissues, resulting in a ‘pulling’ of muscles at their attachment sites, in this case the Achilles into the heel bone. This results in pain right at this junction between tendon and bone or in some cases higher up in the tendon.

Quite often the symptoms can occur on both sides and can include;

  • Heel pain during exercise – traditionally this is increased with jumping and high velocity activities
  • Increased pain or ache after exercise
  • Limping or toe walking as they try to take pressure off the heal
  • Localised heel pain on palpation

Factors that contribute to Severs Disease

  • Growth Spurts – sometimes difficult to gauge as a parent that sees their child every day but kids tend to go through some noticeable spurts where they may jump a shoe size or shoot up a few cm in a short period.
  • Physical Activity Level – Sports that involve running & jumping. Kids that play multiple sports may be at a higher risk.
  • Shoes – Poor footwear choice can place extra strain on the Achilles Tendon.
  • Foot Posture – tight muscles, ankle joints, foot and calf strength can all contribute.

TREATMENT

Severs is an activity related and ‘self-limiting’ condition. For this reason parent & patient education play a very important role as the solution for Severs related pain is not to simply stop sport altogether. Relative rest, load management and activity modification will be important to reducing symptoms and improving recovery.

Potential contributing factors should be addressed by your physio such as;

  • Stiff joints: in this case the two ankle joints – subtalar and talocrural should be assessed
  • Tight muscles – especially the gastrocnemius & soleus muscles (aka the calf) may benefit from massage
  • Muscle weakness around the ankle joint.
  • Other biomechanical factors such as pelvic stability & proprioception.

Generally physiotherapy management will incorporate a strengthening and stretching program that will need to be performed on a regular basis.  Your physio may also offer heel raises / inserts which can be placed inside sports shoes – these work to unload the Achilles tendon and can be a useful aid during painful periods.

Analgesic strategies such as cold packs and medication can provide short term symptomatic relief.

Sever’s Disease can be painful and quite debilitating. We think its definitely worth getting on top of early it as early as a proper diagnosis combined with correct treatment strategies can greatly assist with pain levels and performance.

Sciatica. How do we treat it?

As discussed in part 1 there are numerous causes of sciatica, so if you missed part 1 you can read it HERE.

Part 2 of this blog will be discussing some of the treatment options that are available to help relieve sciatica. Remember these are only a guide and we always recommend you see your Physio for a thorough examination to ensure the exercises are appropriate for you.

Trigger Balls

Trigger Balls or foam rolling are both great tools to help provide short term pain relief. Our suggested focus areas would be the lower back, glutes and hamstrings. We always recommend these should include an active component to get the muscles moving. The reasoning behind the effectiveness of a trigger ball is still a bit of a mystery but studies have suggested that it can have a short term analgesic response. Reduction in pain may enable you to complete further exercises that will be effective in creating longer change.

Stretching and Mobility

Light stretching and mobility can also be beneficial in providing short term relief. Stretching should be pain-free and gentle to begin with, again focusing on the lower back, glutes and hamstrings. In certain cases some stretching positions can actually further aggravate sciatica so if you are unsure make sure you check with your physio!  Mobility work should be about controlling movement of joints through pain-free range of motion. Avoiding positions that create pain should be paramount during these exercises.

Neural Gliding

Neural gliding is essentially a stretching exercise that focuses on ‘sliding the nerves’. We use the analogy of the nerve being a piece of string traveling from the base of the skull down the spine out into the leg and down too the foot (this is the route of the sciatic nerve). Along its path it crosses underneath, between and over certain muscles. In order to function efficiently this nerve slides freely along this path. Sometimes with Sciatica the neural pathway gets ‘stuck’ and this sliding mechanism is affected. A neural gliding exercises aims to restore the smooth sliding of the nerve along its path. These exercises are different to static stretches, should be pain free and form an important part of the rehabilitation for neural irritations that are causes by muscles and joints. Due to their ability to aggravate symptoms further we would recommend checking with your physio before you begin.

Strengthening

Re-estabilishing strength shoulder be the long term focus of treatment. It is vital to firstly figure out why the nerve is irritated. Not all lower back pain and sciatica comes from weak core and glutes so focusing only on these two common areas to strengthen may not be  the solution for everyone with Sciatica. Addressing other muscles like the hips flexors, hamstrings, obliques or lats may be what you require.

Movement Patterns

Another treatment that is critical towards long term recovery is correcting movement patterns. Potentially the way you run, squat, deadlift and move in general might be contributing to your sciatica. If you get pain every time after you run, your running style may needs to be checked – and the same goes for other forms of exercise. People with chronic lower back pain or siactica also often pick up poor patterns as a response to long term pain so sometimes movement retraining is required. Most commonly individuals become very stiff in their back and develop fear avoidance patterns where never bend their back which will only contribute to further stiffness. Slow exposure to bending and moving the spine may be a way to get rid of this chronic irritation.

Ultimately to treat sciatica there needs to be a diagnosis and from there a longer term management plan that addresses strengthening what is weak combines with mobilising what is stiff. This will be totally dependent on the individual and one should seek a health care provider’s advice.  There are cases where conservative intervention may fail and more invasive treatments may need to be explored.

If you have any questions about Sciatica, it’s management or any other physio related question feel free to email us activerxphysio@gmail.com or head to our instagram page and send us a message!

Self management for long term pain relief

At Active RX one of our main aims is to give our clients the basic knowledge and understanding of how the body is put together in the hope that one will have the ability to SELF-MANAGE their problems and a visit to the physio becomes a complementary appointment.

At the end of taking a new clients history I will ask – What are the goals of your treatment? Often the first reply will be “to have no pain”  and the second most common answer being self-management strategies.

To achieve long term pain relief self-management strategies are vital and this blog post focuses on a few simple ways that you can start to help manage your own pain and dysfunction.

Strengthening

It’s our belief that strengthening is the key to long term pain relief. Of course there are many other factors that contribute but overall weakness is one that simply cannot and should not be overlooked. When we talk about strength it’s all relative, you don’t have to be the strongest person in the gym but what is required is the strength for you to complete your activities of daily living. For example a labourer who loves to lift weights, surf + run will require different strength to a grandmother who like to go on walks and read BUT both need to be strong in their own right. The key is be aware of where you might be lacking and implement exercises that target such weaknesses. It’s also important to remember that the need for strengthening doesn’t mean you need a gym membership, for many simple resistance exercises can be very effectively done at home.

Mobility

Being flexible and pliable is also extremely important, but the term mobility fits the bill a bit better as to be mobile you need to have strength in your flexibility. It’s all well and good to be flexible but if you can’t control that range of motion of your joints and muscles then you may well find yourself on the physio table. Self management requires awareness of flexibility and the ability to be strong through your entire range of movement.  Too often we see someone who has taken up a vigorous stretching program only to find themselves more injured than before. Why? Because they have not learnt to control their complete range of movement. Mobility requires a balance between strength and flexibility. Too little or too much of one just can easily be a contributing factor to longer term pain.

Recovery

Looking after yourself seems like a no-brainer but it’s actually a part of training many people neglect. Recovering from your workouts, games and even everyday life is another step towards long term pain relief. If you’ve put yourself through a grueling training week, slow down for just a moment– have a dip in the ocean, go get a massage, do some stretching. You can check out our blog on ‘there’s no such thing as over training just under recovering’ for some good ideas. Recovery also applies to every day life situations, if you’re a breastfeeding mother a 10 minute trigger ball session can go a long way to release the upper back and shoulder tension. If you’ve just put in a 60+ hour work week to hit a deadline, go for a long walk & swim on the weekend. Then there is recovery in forms you wouldn’t expect; like nutrition, hydration, adequate sleep, sunshine + Vitamin D.  A body that is physically + mentally worn out will be more sensitive to pain, and this is a conversation we often have with clients because their pain may not necessarily be solely musculoskeletal so for a  long term recovery these other holistic factors need to be addressed.