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.

Are you sabotaging your recovery?

Coming back from an injury can be difficult, continuing to train through your injury though is even more difficult. At Active RX Physio we believe you should be able to train (in some capacity) whilst injured and we try to encourage active rehabilitation. With that said we certainly see some people that aren’t just pushing the envelope when it comes to training with an injury but are bursting through it.

We are hoping to provide a couple of pointers things you may be doing that are potentially sabotaging your rehab/recovery and keeping a little niggle around longer than it should be.

Training Through High Level Pain

When recovering, in most instances a little pain is something to be expected and not feared. However continuing to train when experiencing high levels of pain (not that good hard workout type of pain) is certainly not a good approach and its a sure way to keep an injury hanging around . We often will advise pain levels to stay around a 2-3/10 pain. Monitor how you  feel during, after and the next day, if you don’t feel any worse then you get the green light to keep training.. Most times too if you are truly honest with yourself you know when you’re pushing yourself too far.

Not Altering Your Workout

If you are finding that every time you back squat your hips hurts – don’t just keep doing them, there are literally over 10 + variations of the squat you could do to achieve a similar result. This can be extrapolated for nearly all training and it isn’t just limited in the gym – running, cycling etc. All have variations that could be used in the short term whilst you recover. Learn how to adapt, ask someone if you don’t know a alternative but altering a workout to keep you training should be something you can do. What’s that definition of insanity – doing the same thing every single day but expecting a different result?

Not Doing Rehabilitation Exercises

I know physio/rehab exercises sometimes aren’t the most exciting part of training, but if you’re injured they might be essential to your recovery. Remember you shouldn’t have to do these for the rest of your life they are a short term necessity for a quicker return to what you want to do. Not only do they help in recovery they also might be the missing link to make your future (uninjured) self run fast, lift heavier, move freer, jump higher, swim smoother, cycle further, breathe easier… I think you get the point. Physio’s don’t dream up boring exercises for no reason, most of the time they have a specific purpose related to your recovery goals.

Returning to What Injured You Too Soon

Yes we all want to get back to doing what we love to do as fast as possible BUT going back too soon to an activity that caused your injury in the first place may be a recipe for disaster.  You should be able to get back to whatever you like after most injuries (there are always exceptions to the rule) but slowly re-introducing yourself will be the key to making sure you don’t sabotage your recovery. Build the foundations for whatever you are training, whether that be running shorter distances before that marathon, lifting lighter weights before going for a PB – the key is to expose your body to the old movements hopefully with new found strength, mobility and resiliency.

The majority of injuries we see have the potential to recover 100% but I think 80% of injuries take a little longer than we may like thanks to one of the above mentioned factors. Yes it can be frustrating BUT short term self control and diligence will pay off in the long term.

Sciatica. What is it?

The word SCIATICA seems to instil fear in patients when it first gets mentioned. Everyone knows a person that has suffered from sciatica at some point in their life, which means that most people have heard the term Sciatica, and whole most people know it has something to do with leg pain very few people actually understand what Sciatica really is.

It’s not uncommon for people to be given the diagnosis of Sciatica, however Sciatica is not a diagnosis but rather a set of symptoms that can include buttock, leg and foot pain that originates from the back.

The goal of this blog is to give you a better understanding what Sciatica is, explain why one might get it and to explore some strategies to prevent it from returning.

What is Sciatica?

As mentioned sciatica is a description of symptoms rather than an actual diagnosis. What that means is – any pain/symptoms that travels from the glute, down the back of the leg to the foot that originate from the back is termed ‘sciatica.’

There are other potential musculoskeletal injuries that can cause a similar pain pattern, clients with these conditions do not have sciatica, even though their symptoms may present like so.

The term sciatica is derived from the sciatica nerve which is the largest single nerve of the body.  It is this nerve that gets ‘irritated’ resulting in this specific set of symptoms. As a result of this irritation one might experience one of more of the following:

  • Sharp pain or a dull ache in the back, glute, back of leg, foot with or without back pain
  • Burning, tingling, pins and needles down the back of the leg
  • Weakness or difficulty moving the leg, foot or toes
  • Pain with sitting (pain may be reduced with the use of a pillow)
  • Pain aggravated by coughing or sneezing

Why do people suffer from Sciatica?

There are numerous reasons why people get sciatica and to cover them all would require countless blogs, but let’s touch on a few in a broad sense.

It’s probably important to mention that sciatica ranges in severity and so too do the conditions that can cause sciatica.  From complete compression of the sciatic nerve which may cause alterations in strength and sensation of the leg to a more localised inflammation which may cause dull radiating pain into the leg. Part of our job is to determine the underlying cause which will ultimately guide the course of treatment.

  • Nerve Root Issues: The nerve root is the exiting portion of nerve that leaves the spinal cord. There are nerve roots for each level of the spine with one exiting each side. Compression and / or irritation of the nerve roots by surrounding structures can result in sciatica.
  • Spinal Stenosis:  This refers to the narrowing of the spinal canal which can place pressure on the sciatic nerve. This is a degenerative condition usually related to osteoarthritic changes of the spine.

    Image highlights a few of the intervertebral disc injuries that can contribute to sciatica
  • Injury of the intervertebral disc: The discs are the shock absorbers in the spine. Injury to these structures can vary from disc degeneration, disc irritation, disc herniation (commonly known as a disc bulge), or a disc rupture all of which have the potential to place pressure on the sciatic nerve.
  • Spondylolisthesis: A condition where one vertebrae slips forward in relation to another. This can often be the result of a stress fracture left untreated in a younger athlete.
  • Neural Irritation: After the nerves exit the spine they have a somewhat complicated pathway as they travel down, under and between all our anatomical structures to supply all the areas of he leg. If the nerve gets irritated or impinged at any point on this pathway you may see sciatic symptoms occurring.

They are just a few very brief descriptions of some issues that can lead to sciatica.

The key to treating sciatica lies in determining the underlying cause. That’s our job. How do we do that? Keep an eye out for next weeks blog which will touch on this.

In the meantime…. any questions? Feel free to email us or contact us via social media.

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.


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.


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.


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.