Category Archives for "Knee Injuries, Pain"

Medial Collateral Ligament (MCL) Injuries

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. 

Injury severity?
Grade I

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.  

Grade II

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. 

Grade III

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. 

Prevention?

  • Improve patellofemoral alignment 
  • Improve your proprioception, agility and balance
  • Improve your walking, running, and squatting techniques 
  • Strengthen your knee, especially quadriceps and hamstrings

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

Knee ACL Injury: Squat Clock Reaches

This is a great exercise for developing strength, balance, and proprioception after you have sprained the ACL ligament in your knee.

Start with nice tall posture and engage your core muscles below the belly button by drawing the lower ab muscles inward toward the spine. Then, stand on one leg and hold a stick with the butt end about 2 and a half feet away. Bend down through the hips to touch the stick to the floor at the 9 O’Clock position like a grid on a clock. Come back up and then bend down to touch the end of the stick at the 10 O’Clock position.

Repeat this until you get to the 3 O’Clock position and then reverse coming back to the 9 O’Clock position again to complete the full set. When doing this exercise maintain your knee alignment with the second toe, the knee over the ankle and bend through the butt more. Do 2 full sets 2 times a day.

IT Band Syndrome

What is IT Band Syndrome?
Iliotibial Friction Syndrome is one of the most common causes of “Runner’s Knee” and can account for up to 22% of overuse injuries in runners (Worp et al., 2012). The ITB attaches to a bony protuberance on the outside of the knee, and slides back and forth across this point with movement. Repetitive sliding in this area can create excess friction, especially when the knee is bent at 30 degrees, which is the motion that commonly happens just as your foot strikes the ground while running. ITB Syndrome is typically caused by poor biomechanics due to underlying muscle imbalances, such as weak hip rotators, gluteal muscles, or core muscles. 

Symptoms of ITB Syndrome include sharp or burning pain right above the outer part of the knee, swelling over the outside of the knee, and pain during early knee bending. ITB Syndrome also worsens with continuance of running or other repetitive activities. If you detect any symptoms, the best way to get rid of ITB syndrome is to rest immediately, and take a break from running for a few days (Worp et al., 2012). 

Prevention?

  • Decrease your mileage or take a day off when you feel pain outside of your knee 
  • Walk as a warm up before you begin running
  • Replace shoes that are worn out along the outside of the sole 
  • Run on flat surfaces

Perform exercises or stretches such as the following:

Lateral Quad Stretch:

Rolling Out The IT Band:

If you have any pain during exercises, or are unsure about what you are doing, please consult your local physiotherapist before continuing.

Worp, M., Horst, N., Wijer, A., Bacx, F., & Sanden, M. (2012). Iliotibial band syndrome in runners: A systematic review. Sports Medicine. 42(11). doi:10.1007/BF03262306

Knee Sprain ACL, MCL: Bosu Ball Lateral Shuffle

One of the most common knee injuries is an anterior cruciate ligament sprain or tear.

Place your left foot onto the Bosu and push off on it shuffling it over to allow the right foot to land on the Bosu while you aim to place the left foot on the other side of the Bosu and then finish with both feet on the ground on the other side of the Bosu ball.

When you place your foot on the Bosu ball, keep your knee in line with your 2nd toe and bring your hip over the ankle so you can push off on your entire upper thigh so you avoid pushing off with just your foot. Repeat this going left to right for 1 minute for 3 sets in total.

This is great for strengthening the knee after post anterior cruciate ligament, or ACL surgery or after having sustained a minor strain to your anterior cruciate or medial collateral ligaments. If you have any pain during the exercise or are unsure about what you are doing, consult your local Physiotherapist before continuing. 

Knee Ligament Sprain: Lunge Squats

It’s important to retrain the pushing off dynamic strength in your core stability and lower quadrant after a knee ligament sprain. There are a few key points to keep in mind as you go through this exercise. First, start off with neutral posture and the core stability muscles of your lower back engaged. Then when you lunge forward you want to push off with the back leg as opposed to stepping forward with the front foot. This will allow you to work the dynamic push - off of the back leg and stabilizing aspect of the front leg to better strengthen your lower quadrant with your core stability, and to ultimately help you recover from your deficiencies so you can return to playing sports faster & doing the activities you love to do. Perform 10 reps on each side for 3 sets daily to start. If you have any pain during the exercise or are unsure about what you are doing, consult your local Physiotherapist before continuing. 

Overuse Knee Pain: IT-Band / Lateral Quad Stretch

Start by lying on your good side with the tight Iliotibial Band or “IT-Band” facing up. Keep your inner core muscles below the belly button engaged while keeping your low back flat. Then, bring the bottom knee towards your chest and with your left hand, reach down and back for your other leg above the ankle. Pull the heel back towards the bum while keeping the core engaged and the low back flat. Keeping the top knee and ankle parallel and level with the floor, lift your bottom heel onto the top part of your knee. Next, guide your lower leg down toward the floor with your heel while keeping the top leg, knee and ankle parallel and level to the floor. As the top leg is lowered down, have the top knee and thigh pointed downwards so it’s in alignment with your whole spine. Hold this stretch for 30 seconds and repeat 3 sets 2 times daily. This “IT-Band” stretch is particularly helpful if it’s caused by tightness by an overly tight lateral quadriceps muscle. This type of overuse knee pain can be caused by excessive running, running sports, hill training, squats, hiking or cycling.

Functional Rehab for Hip, Knee and Ankle

This exercise is great for the functional rehab to strengthen your hip, knee and ankle with your core stability. Start by standing on your left leg with your lower abdominal muscles below your belly button drawn inwards toward your spine. Next lean your body weight forward onto the ball of your left foot and hop ten times forward… then switch to your right side. Repeat doing 3-5 sets on each side. Single leg forward hops is an excellent functional rehab exercise for running. It helps to retrain your balance, proprioception and neuromuscular system in the forward or “Sagittal” Plane.

Rolling Out the Ilio-Tibial Band (IT-Band)

Place the roller on the ground or your yoga mat and put your lateral thigh onto the roller. Gently roll up and down onto your IT-Band controlling the amount of pressure onto it with your hands. Find the sweet spot and continue to roll over onto this area for up to 3-4 minutes total. Do this 2 to 3 times per day. This self release technique is great for IT-Band syndrome caused by knee sprains, tight lateral quads, lateral tracking of the knee cap or any other acute or chronic knee pain. 

Knee ‘ACL’ Anterior Cruciate Ligament Injuries

Function of the ACL

The primary function of the ACL is to provide stability in the knee and restrain anterior displacement of the tibia relative to the femur. It also acts to restrain internal-external rotation and varus-valgus angulations and combinations of. Therefore an injury to the ACL causes a loss in stability in the knee joint.

Causes
  • Non-contact sudden deceleration force
  • Quick unopposed force of quadriceps
  • Contact force to posterior aspect of knee, but also to the sides is possible
What to Look For – Signs and Symptoms
  • 72% with apparent hemarthrosis (blood accumulated in joint)
  • “Pop” sound an time of injury
  • Feeling of instability (giving way)
  • High percent of ACL tears present with meniscal tears and collateral ligament injuries (Common is the Triad = ACL + MCL + Meniscus)
Classifications
  • Grade 1 = small partial tear / sprain
  • Grade 2 = moderate partial tear
  • Grade 3 = complete rupture
Treatment and management

Proper treatment can only be applied when a correct diagnosis can be made. A clinical examination will help to assist this.

Initial Stage of Rehabilitation Phase 1 (0- 6 weeks)
  • Swelling control: (PRICE) protect, rest, ice, compress, elevate
  • Counter-act protective muscle spasms
  • Restore pain free passive mobility (regaining full extension priority)
  • Restore pain free active mobility
Intermediate Stage of Rehabilitation Phase 2 (6 weeks to 4 months)
  • Continued increase in active and passive mobility of joint (regaining full range of mobility)
  • Begin strengthening / muscle balance of knee and core stability
  • Balance / proprioception
  • Begin cardiovascular strengthening
Progressive Stage of Rehabilitation Phase 3 (4 to 8 months)
  • Continued increase in active and passive mobility of joint
  • Progressive strengthening / muscle balance of knee, lower extremities and core stability
  • Progressive Balance / proprioception, exercise program
  • Dynamic functional strengthening program return to high level activity

Research studies reveals that ALC tears are problematic because of functional instability, which results in meniscal injuries, secondary instabilities, and early onset osteoarthritis. Incidence of meniscal tear in ACL deficient knee is 40% at year one, 60% at year five, 80% at year ten. Osteoarthritis occurs in 60%-90% by year 10-15. Surgical intervention may be an option depending on the your current situation.

For more information about knee ACL injuries please contact InSync Physio.

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References
  1. Eitzen I, Moksnes H, Snyder-Mackler L, Risberg M. A progressive 5-week exercise therapy program leads to significant improvement in knee function early after anterior cruciate ligament injury. JOPST. 2010; (40) 11, 705-721.
  2. Fitzgerald GK, Axe MJ, Snyder-Mackler L. A decision-making scheme for returning patients to high-level activity with nonoperative treatment after anterior cruciate rupture. Knee Surg Sports Traumatolog Arthros. 2000; 8:76-82.
  3. Hurd WJ, Axe MJ, Snyder-Mackler L. A 10 – year prospective trial of a patient management algorithm and screening examination for highly active individuals with anterior cruciate ligament injury, Part 1 Outcomes. Am J Sports Med. 2008; 36:40-47.
  4. Ibid, 48-56.
  5. Silvers H, Mandelbaum B. Prevention of anterior cruciate ligament injury in the female athlete. Br J Sports Med. 2007; 41: 152-159.

Knee Injury Prevention Guideline

Knee and ACL injuries commonly occur in sports such as soccer, ultimate, and rugby. Athletes may require months to even more than a year to recover and to be able to return to play. There is a vast amount of literature describing a number of ways on how to prevent knee and ACL injuries. However, the most effective prevention strategies are the ones that are based on scientific evidence, a thorough assessment made by the coach and medical team, and the individual’s input.

Strongly suggested by research, programs most beneficial in preventing injuries consist of flexibility drills, running drills, strength training, core strength, and plyometrics. Each session should last approximately 20 minutes with a goal of exercising a minimum of 30 minutes per week. Programs should be implemented through out the year from preseason to regular season. Although most research studies focused on athletes between the ages of 12 and 25 years, these programs may benefit older individuals.

Recommended Exercises

Dynamic Stretches:

1) Toe Taps: Standing tall, kick one leg up and touch your toes to the palm of your hand. Alternate legs. Repeat 10 times on each side.

2) Reverse Lunge & Hop: Step back with one leg until you get into a lunge position. Swing the back leg forward until your knee is bent at a right angle by your chest. Maintain an upright body and repeat on the other side. Perform 10 repetitions on each side.

3) Calf Stretch: Standing tall on one leg, extend the other leg forward with only the heel in contact with the floor. Gently bend forward at the hips and feel a stretch along the front leg. Hold for 30 seconds and repeat on other leg. Perform 3 times on each side.

Running Drills: 

Perform running drills such as forward and backward running or bounding. Watch Physiotherapist Claire lead two athletes through a series of running and other dynamic drills below.

Strength Training: 

Two-legged Squat:

Starting with tall posture, engage your core below the belly button by drawing the inner core muscles towards the spine without arching the low back. With arms in a ready position do a two legged squat with your body weight distributed equally over both feet. Don’t go any lower than a ninety degree bend in the knees, keeping your knees in alignment with your second toe and over your heels as much as possible. Hold for a good long second and then straighten back up with your butt muscles to the start. Do three sets of fifteen repetitions daily.

Advanced Superman Deadlifts:

Start by holding on to a 5 pound dumbbell on the same side as the leg that you are going to extend back on. With nice tall posture, engage your core below the belly button. Keeping your spine flat, bend forward at the hips while you extend the leg back and reaching forward with the opposite arm and holding onto the 5 pound dumbbell with the other hand. Remember to keep that hip down on the side you’re extending the leg back on. Do 3 sets, 10 repetitions, holding for 3 seconds.

Split Squat Jumps:

Start with a nice tall posture and your inner core pulled in to keep your low back flat. Engage your back leg into extension by pushing the back forefoot into a solid bench or a chair supported against a wall. With your arms in the ready position bend the knee to 90 degrees by bringing the butt down and then jump back up. Keep your thigh strong by preventing the knee from buckling inwards. Keep your knee over the heel and don’t let it go over your toes. Do 3 sets of 10 on each side.

Core Strength Exercises:

1) Planks: Begin on the floor resting on your forearms and knees. Extend both legs until your whole body forms a straight line from the top of your head to your feet. Engage the core and glute muscles. Begin by holding this position for 30 seconds. Progress to 60 seconds or more to increase difficulty.

2) Glute Bridge: Begin on the floor with your back flat, legs bent at approximately 90 degrees and both feet on the ground. Place both arms to the side then engage your core as you lift your hips up. Hold for a second or two at the top as you squeeze your glute muscles.

Plyometrics

1) Box Jumps: Use a box that is around your knee height or higher. Stand in front of the box with your feet shoulder-width apart. Bend slightly downwards, swing your arms back, then swing them forward and explode up off the ground onto the box. Repeat 10 times.

2) Lateral Skater Jumps: Begin by standing on one leg and bend the other leg. Jump sidewards and land on the leg that was bent. Then switch sides. Repeat 10 on each side.

References:
https://www.ufvcascades.ca/2018/01/cascades-mens-soccer-program-to-host-id-camp/
https://www.jospt.org/doi/full/10.2519/jospt.2018.0509
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