Background: The knee and the injuries that are involved in this joint are proved to be common and difficult to rehabilitate. In this blog, we will focus on injuries specifically to one of the four ligaments of the knee as shown above. Ligament sprains/strains/tears are most commonly acquired through sport related activities. The most common by far is the ACL tear which usually requires surgery to fix and can force an athlete to miss entire seasons before training again.
The best way to prevent a ligament sprain and especially a tear, is to maintain stability and strength in the muscles of the legs, glutes and core, ensuring you are warmed up before a workout/practice, and consulting a physiotherapist if you experience any sudden pain. Also, for prevention of any injury, be sure to stretch, ease into new exercises, and ensure you have a proper form with a stable base of support before and during an exercise (even in sports, think about how kicking a soccer ball for example affects your joints).
If you have injured your knee in the past, are currently rehabilitating, or would like to work at strengthening the ligaments of the knee for your personal athletic ventures, check out our latest series on the INSYNC youtube channel such as the ones here below!
Anterior Cruciate Ligament Knee Injury: Roller Bridges
Knee Ligament Injuries: Looped Band Bridges
If you have any pain during exercises, or are unsure about what you are doing, please consult your local physiotherapist before continuing.
pTHealth Canada. (2018). Ligaments of the Knee [Photo]. Retrieved from https://www.pthealth.ca/app/uploads/2018/10/knee-ligaments.jpg
What is a medial collateral ligament (MCL) sprain?
The medial collateral ligament (MCL) is the knee ligament on the inner part of your knee. It is one of the four major knee ligaments that help stabilize the knee joint. An injury is caused when the a force is too great for the ligament to resist, thus causing an overstretch of the MCL. This can be caused by sudden movements such as a sharp change in direction, twisting the knee while the foot is planted on the ground, or a blunt force to the knee.
The knee ligament has a slight stretch, but it doesn’t actually tear. Although the knee joint may not hurt or swell very much, a grade I sprain can increase the risk of a repeat injury. Resting from painful activity and icing the injury can be useful to subside the pain.
The knee ligament tears partially. Swelling and bruising around the injury site are common, and use of the knee joint is usually painful and difficult. Use of a weight-bearing brace, or supportive taping are common treatments of this sprain. A physiotherapist may also help by providing strengthening and joint exercises to guide the healing process.
The knee ligament fully tears. Swelling and bleeding can sometimes be present under the skin. The joint is unstable and it can be difficult to bear weight. You can also feel the knee giving way. With a grade III sprain, surrounding structures, such as the meniscus and/or ACL also become at risk of injury. A grade III sprain should be rehabilitated under the guidance of a physiotherapist and/or knee specialist.
If you have any pain during exercises, or are unsure about what you are doing, please consult your local physiotherapist before continuing.
Healthwise Staff (2017). Medial collateral ligament injury.
Retrieved from https://www.healthlinkbc.ca/health-topics/abn2411
Ever wondered whether to use ice or heat for your sore muscles, your healing fracture, or any injury? Both ice and heat have been commonly used to treat an array of injuries, but when to use either one is critical in preventing further damage and promoting faster recovery.
Acute irritation or inflammation of a muscle, ligament, or tendon is typically treated with ice. The cold application reduces inflammation and numbs the pain, especially when the superficial tissues are red, hot, and swollen. The inflammatory response associated with damage to tissues is a defence mechanism in the human body that lasts for the first several days to protect against infection. The response involves immediate changes to blood flow, increased permeability of blood vessels, and flow of white blood cells to the affected site.
Ice can be used for gout flare-ups, headaches, sprains, and strains. It is crucial to apply ice to the site of injury during the first 48 hours post-injury to minimize swelling. For soft tissue injuries such as muscle strains or ligament sprains, an ice massage involving elevation of the injured body part above the heart and circular movement of an ice pack around the affected area may promote faster recovery of these acute injuries. Apply for 10 minutes at a time, then take a break from icing for another 10 minutes. Repeat this process 3 to 5 times a day. Remember to wrap the ice pack in a dry cloth or towel.
Heat can also be used for headaches, sprains, and strains as well as arthritis or tendinosis. Heat causes blood vessels to dilate which increases blood flow and relaxes tight or stiff muscles and joints. Do not use heat during the initial inflammatory response as this will further aggravate the site of injury. For minor injuries, applying heat for 15 to 20 minutes at a time may be sufficient to relieve tension. However, longer periods of heat application such as 30 minutes to an hour may be required for major chronic injuries. Hot baths, steamed towels, or moist heating packs can be used as different heat options.
Recent research has shown that nearly 40% of 7 to 18 year old baseball players endure elbow and shoulder pain during their baseball season. Nearly half of these injured players report their ongoing participation despite having pain. A recent epidemiological study of ulnar collateral ligament (UCL) injuries in athletes 17 to 20 years old reported the number of UCL reconstructions has increased dramatically for this age group. Early education and detection of elbow injuries in throwing sports may help reduce the number of overuse injuries from developing.
“Little league elbow,” or known as medial epicondyle apophysitis, is most commonly found in young throwers. Sports such as baseball, softball, tennis, or golf, can result in this overuse injury to the growth plate on the inside of the elbow. Repeated stress to the growth plates may cause inflammation and lead to pain or swelling. Serious injury may even result in separation of the growth plate from the rest of the bone. Players may also experience a reduced range of motion and a decreased ability to throw hard or far. A child experiencing any symptoms involving their arm should cease activity and see a pediatric specialist or their family physician. X-rays may be required to determine the extent of damage.
Prevention begins with identifying causative factors early in the season and adhering to strict guidelines such as the pitch count for young players and the duration of participation in a given year. Total body conditioning that involves strengthening the hip, back, and legs may help reduce the strain on the athlete’s arms. See below for exercises on how to stretch and strengthen the forearm.
It used to be that joint problems were something only older guys had to worry about.
But today orthopedic surgeons are seeing people in their 40s or younger for joint replacements. In fact, data from the National Center for Health Statistics finds the number of hip replacements has more than doubled in a 10-year span, skyrocketing by 205 percent in people ages 45 to 54.
Surgeons attribute the rise to people wanting to stay active as they age.
Today’s implants also last longer than they once did, so joint replacements are now an option at a younger age, since physicians aren’t as worried about having to replace them.
But while the surgeries are effective, we’d all prefer to skip a trip to the hospital, right?
Here, the top mistakes we all make when it comes to our joints and how to stay out of harm’s way.
You’re Only a Runner
Many patients seeking joint replacement are in good cardiovascular health, but not necessarily good physical health.
If you only run, you might have imbalances when it comes to muscle strength and flexibility. And this, paired with repetitive trauma over time, could lead to arthritis, causing your joints to wear away. It’s important to cross-train.
Giving certain muscle groups (like the ones you use on long, slow jogs) a break once or twice a week while activating new muscles (like the ones you might use sprinting) can fend off injury.
You Let Your Weight Go
When you run, your knee joints carry 7 to 9 times your body weight. While your body can handle this, some research suggests that runners aren’t at an increased risk for issues like osteoarthritis, so it’s important to keep the scale in check.
From a biomechanical standpoint, increased weight is a lot of stress. Overweight people are at a 40 percent or higher increased risk of a knee replacement down the line compared to those at normal weights. The link was even stronger in younger people.
You Skip Stretching
The key to joint health is achieving a good balance between strength and flexibility. As you get older, you need to spend as much time, if not more time, stretching than strengthening. Why? Because the more candles on the birthday cake, the less flexible your muscles become, and flexible muscles help keep joints mobile.
You Push Your Flexibility Too Far
Intense workouts like mud runs aren’t the only way to injure your joints. While exercises like yoga are great ways to boost flexibility and strength, anything extreme when it comes to range of motion—like reaching for that pose your body’s not quite ready for—can put you at risk for a joint injury.
When you create range of motion extremes, you can create bony spurs (projections along a bone’s edges) that may predispose you to arthritis. Your best bet isn’t to skip yoga but rather to stick with the modifications that work for you. And give yourself time before trying anything you might not be ready for.
What ice and heat are for:
Ice is for injuries, and heat is for muscles. Roughly.
Ice is for injuries — calming down damaged superficial tissues that are inflamed, red, hot and swollen. The inflammatory process is a healthy, normal, natural process that also happens to be incredibly painful and more biologically stubborn than it needs to be. Icing is mostly just a mild, drugless way of dulling the pain of inflammation. Examples: a freshly pulled muscle or a new case of IT band syndrome (which is more likely to respond than the other kind of runner’s knee, patellofemoral pain, because ITBS is superficial and PFPS is often a problem with deeper tissues).
Heat is for muscles, chronic pain, and stress — taking the edge off the pain of whole muscle spasms and trigger points, or conditions that are often dominated by them, like back pain and neck pain), for soothing the nervous system and the mind (stress and fear are major factors in many chronic pain problems, of course).
What ice and heat are not for:
Heat can make inflammation worse, and ice can make muscle tension and spasms worse, so they have the potential to do some mild harm when mixed up.
Both ice and heat are pointless or worse when unwanted: icing when you’re already shivering, or heating when you’re already sweating. The brain may interpret an excess of either one as a threat — and when brains think there’s a threat, they may also amp up the pain.
But heat and inflammation are a particularly bad combination. If you add heat to an fresh injury, watch out: it’s going to get worse! If you heat a freshly injured knee, it can swell up like a balloon, and three times more painful. (That is a rare example of a particularly severe negative reaction to heat. Most cases are not going to be that bad!)
The lesser known threat is from icing at the wrong time, or when it’s unwanted.
If you ice painful muscles, be careful: it might get worse! Ice can aggravate sensations of muscle pain and stiffness, which are often present in low back and neck pain. Trigger points (painfully sensitive spots) can be surprisingly intense and easily mistaken for “iceable” injury and inflammation. But if you ice trigger points, they may burn and ache even more acutely. This mistake is made particularly often with low back pain and neck pain — the very condition people often try to treat with ice.
What about injured muscle?
If you’re supposed to ice injuries, but not muscle pain, what do you with injured muscles (a muscle tear or muscle strain)? That can be a tough call, but ice usually wins — but only for the first few days at most, and only if it really is a true muscle injury. A true muscle injury usually involves obvious trauma during intense effort, causing severe pain suddenly. If the muscle is truly torn, then use ice to take the edge off the inflammation at first. Once the worst is over, switch to heat.
Which is better?
Ice packs and heating pads are not especially powerful medicine: some experiments have shown that both have only mild benefits, and those benefits are roughly equal in treating back pain.
The bottom line
The bottom line is: use whatever feels best to you! Your own preference is the tie-breaker and probably the most important consideration. For instance, heat cannot help if you already feel unpleasantly flushed and don’t want to be heated. And ice is unlikely to be effective if you have a chill and hate the idea of being iced!
If you start to use one and you don’t like the feel of it… just switch to the other.
How To Prevent Ankle Pain
How To Prevent Knee Pain
How To Prevent Hip Pain
How To Prevent Neck Pain
How To Prevent Wrist Pain And Numb Hands
Tips To Stay Healthy And Injury-free
Every time you exercise, you put microscopic tears in your muscles. That’s what’s behind that next-day hurts-so-good soreness. And after your body repairs these tears, you become stronger, faster, and fitter. But if you stretch a muscle too far, lift too much, or are working out with a muscle imbalance, you might not just have microscopic tears to deal with. You could literally tear your muscle into pieces. We have your solution.
Pulls, sprains, and tears (all the same thing) range in severity. Grade 1 means the injury hurts but you can still move the muscle without too much trouble and it could heal in less than a week. Grade 3 means the muscle has ripped clean off of your tendon or bone and you’ll probably need surgery to reattach it. Ouch.
Think of your muscles like a piece of fabric that you’re holding in front of you, between your two hands, If you were to pull that fabric in opposite directions, it would stretch up to a certain point. If you continued to pull, some of those fibers would start to break. Then, given enough force, the entire thing would eventually rip right in half. Yeahhh, your muscles can do the same thing. Fun times.
Despite the gnarly description, exercisers rarely know how to treat a pulled muscle or do anything to treat their muscle sprains. They just try to tough it out. Bad idea. When not treated properly, even seemingly minor pulls can contribute to more severe ones later on. And those can send you to surgery and take you out of commission of several months.
Plus, if you do have a serious strain, you only have a window of a few weeks before your doctor really can’t do anything for you.
So how do you know if your post-workout pain is a strain? Typically, the pain will be sharp, intense, and localized to one specific spot along your muscle, Beckstrand says. Massaging the area will likely hurt, and you may even feel a knot. While it generally hurts less when you’re resting the muscle, it may still feel uncomfortable and spasm. Usually, the pain comes on all at once.
Sound all too familiar? Here’s how to treat a pulled muscle and feel better STAT:
1. Elevate, compress, and ice it.
The sooner you can get the pulled muscle above your heart, apply compression, and ice it, the better. All will help reduce inflammation and keep blood from pooling in your muscle—because, yes, torn muscles can bleed. Ice it for 15 minutes every hour or two for at least 24 hours following the pull, and continue elevating the area for an entire week whenever possible. As far as compression goes, it is recommended to wear a neoprene sleeve, ACE wrap, or compression garment to squeeze excess blood out of the area, support the muscle, and speed recovery. Wait at least a week to wean yourself off of compression gear.
2. Avoid pain medications.
Granted, of course, you can bear it. Pain medications like over-the-counter anti-inflammatory drugs may not be your friend here. By interfering with the normal inflammatory process—an important part of healing—pain medications may interfere with the cascade of events needed to jump-start tissue regeneration and repair. If you do take pain meds, make sure to follow the bottle’s directions. If they say to take two, don’t go ahead and take three.
3. Watch for bruising.
If a bruise pops up around the pain site, your pulled muscle is likely serious. Bruising occurs when the muscle is torn so badly that it bleeds into your body. That’s a surefire sign you need to go to the doctor. But keep in mind, if the tear is deep in your muscle, it could take a few days for any blood to rise to your skin’s surface and cause bruising, she says.
4. Don’t stretch or roll it out.
At least don’t do it immediately after pulling it. After all, stretching a sprained muscle will only pull the torn ends farther apart, potentially making things a whole lot worse. The same goes for foam rolling. Give it a chance to try to knit back together before you get too aggressive with the foam roller. There’s a time and place for that but it’s not in the acute phase. If the strain is minor—and most are—you can try gently rolling the muscle a few days after pulling it. If foam rolling hurts, back off and try again in a couple days.
5. See a doctor.
The biggest issue I see with muscle strains is that people wait way too long before they come in to get help. After a few weeks, your body has already tried to heal itself, which often results in permanent scarring and tissue damage. Rehab for a muscle strain becomes much more difficult with time. It is recommended that if you’re experiencing symptoms of a muscle strain injury, don’t let symptoms go on for longer than two weeks without consulting your medical provider. The ideal expert is a physical therapist. Before scheduling an appointment, call your insurance company and find out if you have to see a primary care first to get a referral. Some insurance companies insist on a referral, and you want to make sure all visits are covered.
6. Take it easy.
Depending on the severity of your strain, you may need to take anywhere from a few days to a few months off of exercise so that the muscle can heal itself. When you do head back to the gym, start with gentle bodyweight exercises (no plyometrics). Progressively add more sets, reps, and eventually weight. All the while, remember that the muscle should never hurt. If it does, stop the exercise and either try a different variation or back off entirely.
7. Consider what went wrong.
As long as your pulled muscle isn’t a case of “I tripped and fell,” you need to address the cause of your muscle pull. You may have a muscle imbalance that, if left untreated, will continue to contribute muscle strain. (For instance, runners often suffer hamstring tears because their glutes are too weak, she says.) Consider how you’re training all of the muscles in your injured body part. And don’t hesitate to talk to a physical therapist or exercise physiologist about how you can correct any muscle imbalances.
Recurring acute injuries are not only painful and disruptive, they can also be damaging if left untreated. Treatment recommendations vary depending on each individual case, but often include a combination of the following approaches.
1. Wrist Wraps
A wrap or splint that immobilizes the wrist may be recommended for daytime and/or nighttime use to help relieve uncomfortable symptoms such as numbness or tingling. Wrist wraps are available in a variety of materials that provide a range of support from total immobilization to relative flexibility. Some people also choose to wear these types of wraps as a preventive measure to limit motions that may contribute to future injuries.
2. Bandages with Ice Packs
Cold therapy has long been used to help relieve pain and reduce inflammation. Soft elastic bandages are often used to keep an ice pack in place while also providing compression. Although this method has been used for decades, it is not an ideal solution because:
- It is not possible to regulate the temperature of the ice pack.
- Putting a cold source directly on skin comes with the risk of tissue damage and bandages are difficult to apply on upper extremities without assistance.
Even with the help of a healthcare professional, it can be difficult to find a comfortable hand position when wrapping an ice pack around your hand and wrist.
3. Physical Therapy
In some cases, physical therapy is recommended to help reduce the symptoms of recurring acute injuries and possibly prevent future injuries. A typical physical therapy program might include:
- Education about your injury and its causes.
- Recommendations for activities to avoid.
- Instructions for proper posture or body positions for certain tasks.
- Exercises to strengthen the muscles in your wrist and hand.
- Exercises to increase flexibility in your wrist and hand.
- Heat and/or cold treatments to help control pain.
- A wrist wrap or splint to help reduce discomfort.
- Every program will vary, but the objective is always to reduce or eliminate symptoms and create good habits that will help prevent future injury.
4. Cold Compression Therapy
Many physicians and physical therapists recommend heat and/or cold therapy to help reduce pain and swelling in hands and wrists. Active cold and compression is the most effective way to administer cryotherapy safely. Unlike a bandage and ice pack, active cold and compression therapy allows you to:
- Control the temperature of therapeutic cold.
- Provide consistent cold for the duration of the therapy session.
- Keep the hand and wrist in a natural, comfortable position.
- Benefit from consistent compression that actively removes excess fluid and promotes blood flow.
- Benefit from deeper, longer-lasting cooling.
- Regulating therapeutic cold is especially important for treatment of hands and wrists because temperatures that are too cold can potentially exacerbate symptoms of acute recurring injuries. Adding cold compression therapy to your recovery program is the best way to ensure the fastest rehabilitation.
If you experience recurring acute upper extremity injuries or plan to have upper extremity surgery, talk to your doctor or physical therapist about the benefits of cold and compression therapy.
Over the past 20 years more children are participating in organized and recreational athletics. With so many young athletes playing sports, it’s no wonder injuries are common. Half of all sports medicine injuries in children and teens are from overuse. The following is information from the American Academy of Pediatrics about overuse injuries and injury prevention tips.
What is an overuse injury?An overuse injury is damage to a bone, muscle, ligament, or tendon due to repetitive stress without allowing time for the body to heal. Shin splints are an example of an overuse injury.The following are the 4 stages of overuse injuries:
- Pain in the affected area after physical activity
- Pain during physical activity, not restricting performance
- Pain during physical activity, restricting performance
- Chronic, persistent pain even at rest
Who is at risk?Children and teens are at increased risk for overuse injuries because growing bones are less resilient to stress. Also, young athletes may not know that certain symptoms are signs of overuse (for example, worsening shoulder pain in swimmers). If you think your child has an overuse injury, talk with your child’s doctor. A treatment plan may include making changes in how often and when the athlete plays, controlling pain, and physical therapy.
How to prevent overuse injuriesAthletes should stay away from excessive training programs that could be harmful. The following are guidelines to help prevent overuse injuries by promoting a healthy balance of activities.
PrepareAthletes should have a preparticipation physical evaluation (PPE) to make sure they are ready to safely begin the sport. The best time for a PPE is about 4 to 6 weeks before the beginning of the season. Athletes also should see their doctors for regular health well child checkups.Athletes should maintain a good fitness level during the season and offseason. Preseason training should allow time for general conditioning and sportspecific conditioning. Also important are proper warmup and cooldown exercises.
Play smartAthletes should avoid specializing in one sport before they reach puberty. Child “superstars” are often injured or burned out prior to college. Children should be encouraged to try a variety of sports.Participation in a particular sport should be limited to 5 days per week.Athletes should sign up for one team and one sport per season.
Rest upAthletes should take at least 1 day off per week from organized activity to recover physically and mentally.Athletes should take a combined 2 to 3 months off per year from a specific sport (may be divided throughout the year [that is, 1 out of every 6 months off ]).
TrainingIncreases in weekly training time, mileage, or repetitions should be no more than 10% per week. For example, if running 10 miles this week, increase to 11 miles the next week.Crosstrain. Athletes should vary their endurance workouts to include multiple different activities like swimming, biking, or elliptical trainers.Perform sportspecific drills in different ways. For example, running in a swimming pool instead of only running on the road.
How to prevent burnoutBurnout (overtraining syndrome) includes mental, physical, and hormonal changes that can affect performance. To help prevent burnout in your child, follow the guidelines in this handout. Other suggestions includeKeep your child’s practice fun and ageappropriate.Focus on your child’s overall wellness, and teach them how to listen for problems with their bodies.
RememberParents: Your goal should be to promote a wellrounded athlete who can enjoy regular physical activity for a lifetime.