The Anterior Cruciate Ligament (ACL) within the knee joint prevents anterior (forward) movement of the femur (thigh bone) on the tibia (shin bone). This is one of the more major stabilizing ligaments of the knee joint for this reason. This ligament can be injured in many different ways, but more commonly occurs after a force directs the knee joint in a quick movement. This usually occurs during contact sports. This is common to also occur in sports that involve cutting motions (I.E. Basketball, Jumping sports) even without contact. The injury can happen when your foot is firmly planted on the ground and a sudden force hits your knee while your leg is straight or slightly bent. As we age, the blood supply to these ligaments decreases, on top of chronic wear and tear over time, which can lead to injury
Athletes and non-athletes who sustain injury may recall feeling or hearing a pop or snap in the knee at the time of injury. This may be followed by severe pain, swelling, and discoloration of the knee. There may also be stiffness and an unstable feeling to the knee. It is best to try not to bear weight into the leg at this stage. Crutches and a knee immobilizer may prevent worsening of symptoms.
It is important that you see a musculoskeletal specialist (Physiatry, Sports Medicine, and Orthopedics) soon after injury to prevent a long lasting issue. Options for treatment may include, physical therapy and surgical treatment with subsequent therapy. The type of treatment needed will depend on what is revealed during Xray and MRI imaging, such as the degree of tear or avulsed fragments of bone. Other factors such as activity level, age, time frame, and overall health also play a role.
The Posterior Cruciate Ligament (PCL) keeps the shin from moving backwards too far. It is stronger than the anterior cruciate ligament and is injured less often. An injury to the posterior cruciate ligament typically requires a powerful force such as a direct blow to the front of the knee (such as a bent knee hitting a dashboard in a car crash, or a fall onto a bent knee in sports). Typically the PCL is injured in conjunction with other structures.
It is possible to have immediate pain with swelling that occurs after injury, swelling, difficulty walking, instability, and possible visual deformity as if the shin sits too deeply (backwards) within the knee joint as compared to the opposite knee. Immobilization and stabilization usually protect knee from further injury at this time.
It is important that you see a musculoskeletal specialist (Physiatry, Sports Medicine, and Orthopedics) for formal evaluation and management. Options for treatment may include, physical therapy or surgical treatment with subsequent therapy. The type of treatment needed will depend on what is revealed during Xray and MRI imaging, such as the degree of tear or avulsed fragments of bone. Other factors such as activity level, age, time frame, and overall health also play a role.
The medial collateral ligament (MCL) prevents medial valgus translation of the knee (inwards movement of inner knee). The MCL attaches to the inner lower portion femur (thigh bone) and the inner upper portion of the shin bone (Tibia). This assists in stability of the knee when active. An injury to the MCL commonly occurs with a force on the lateral portion (outside part) of the knee that causes overstretch to the medial portion (inner part) of the knee. This overstretch can typically cause a sprain of the ligament. This type of injury is common in contact sports. It’s usually the result of a hit or blow to the outer aspect of the knee, which stretches or tears the MCL.
The symptoms of an MCL injury may include a snapping or popping sound upon injury, pain and tenderness along the inner part of your knee, swelling of the knee joint, instability, locking, or catching in the knee joint. MRI imaging can formally diagnose level of injury to the knee. It is important that you see a musculoskeletal specialist (Physiatry, Sports Medicine, and Orthopedics) for formal evaluation and management. Options for treatment may include, physical therapy or surgical treatment with subsequent therapy.
The lateral collateral ligament (LCL) prevents lateral varus translation of the knee (outwards movement of outer knee). The LCL attaches to the outer lower portion femur (thigh bone) and the outer upper portion of the shin bone (Tibia). This assists in stability of the knee when active. An injury to the LCL commonly occurs with a force on the medial portion (inner part) of the knee that causes overstretch to the lateral portion (outer part) of the knee. This overstretch can typically cause a sprain of the ligament. This type of injury is common in contact sports, but can also occur in chronic fashion over time.
The symptoms of an LCL injury may include a snapping or popping sound upon injury, pain and tenderness along the outer part of your knee, swelling of the knee joint, instability, locking, or catching in the knee joint. MRI imaging can formally diagnose level of injury to the knee. It is important that you see a musculoskeletal specialist (Physiatry, Sports Medicine, and Orthopedics) for formal evaluation and management. Options for treatment may include, physical therapy or surgical treatment with subsequent therapy.
Sprains and strains are common injuries that share similar signs and symptoms, but involve different parts of the body.
A sprain is a stretch and/or tear of a ligament (a band of fibrous tissue that connects two or more bones at a joint). One or more ligaments can be injured at the same time. The severity of the injury will depend on the extent of the injury (whether a tear is partial or complete) and the number of ligaments involved.
A sprain can result from a fall, a sudden twist, or a blow to the body that forces a joint out of its normal position and stretches or tears the ligament supporting the joint. Although sprains can occur in both upper and lower parts of the body, the most common site is the ankle.
The usual signs and symptoms include pain, swelling, bruising, instability, and loss of the ability to move and use the joint. The symptoms can vary in intensity, depending on the severity of the sprain. Sometimes, people feel a pop or tear when the injury happens.
A strain is an injury to either a muscle or a tendon (fibrous cords of tissue that connects muscle to bone). Depending on the severity of the injury, a strain may be a simple overstretch of the muscle or tendon, or can result from a partial or complete tear.
A strain is caused by twisting or pulling a muscle or tendon. Strains can be acute or chronic. An acute strain is associated with a recent trauma or injury. It also can occur after improperly lifting heavy objects or overstressing the muscles. Chronic strains are usually the result of overuse, prolonged repetitive movement of the muscles and tendons. The most common sites for a strain are in the back and in the hamstring muscles (located in the back of the thigh).
The usual signs and symptoms of a strain are pain, limited motion, muscle spasms, and possible muscle weakness. There can be localized swelling, cramping or inflammation and, with a minor or moderate strain, some loss of muscle function can occur.
Treatments for sprains and strains are similar having two specific stages. In the first stage, the goal is to reduce swelling and pain. Patients are advised to follow a formula of rest, ice, compression and elevation (RICE) for the first 24-48 hours after injury. In the second stage, the overall goal is to improve the condition of the injured area and restore its function.
Physical therapy is an effective choice of treatment during this stage. In therapy, a physical therapist will perform a thorough evaluation and design a program, specific to the patient’s findings and personal goals, to prevent stiffness, improve range of motion and restore the joints normal flexibility, strength, and stability. Therapists will apply a variety of manual techniques and, when necessary, use modalities (electrical stimulation, ultrasound and or heat/ice) to assist in the recovery process. A physical therapist plays a vital role in not only designing treatment programs and performing manual techniques but educating the patient on their injury, how to self manage their symptoms when not in therapy and how to prevent re-injury in the future.
The duration of physical therapy will depend on the severity of the injury, a person’s compliance with both therapy and their home program, and the activity level and or sport that person needs to return to.
Patellar tendinitis is one of the most common sources of knee pain in athletes. This condition is also known as "jumpers knee". Patellar tendinitis is an inflammation of the tendon that attaches the patella (kneecap) to the tibia (shin bone). This tendon works in conjunction with the quadriceps muscle to extend the knee.
Clinically, patellar tendinitis presents as localized pain and dysfunction in the patella tendon, which is just below your knee cap. While anyone can develop symptoms from common exercises like stair climbing and squatting, this particular tendinitis is most prevalent in athletes who play sports and do activities that involve a lot of jumping. Such sports and activities include; basketball, volleyball, distant running, long jumping, mountain climbing, figure skating, tennis or high-impact aerobics.
In many cases of patellar tendinitis, there is a sudden onset of aching and pain in the area just below the kneecap after a sport or recreational activity. You may notice pain when landing from a jump or when going up and down stairs. At times, there can be pain at rest, particularly just sitting with the knees bent for a period of time. Swelling and tenderness in the area just below the kneecap is common. When pain is present, a feeling of weakness in the knee can also occur.
Treatment has two objectives: to reduce the inflammation and to allow the tendon to heal. When the knee is painful and swollen, rest is needed. Avoid stair climbing and jumping sports. Keep your knees straight while sitting and avoid deep squatting. Let pain be your guide. You will aggravate the condition if you continue activity while experiencing pain. Mild discomfort or ache is not a problem but definitive pain is a cause for concern.
Patellar tendinitis is a condition that will resolve with rest, activity modification and physical therapy. Recurrence of the problem is common for patients who fail to let the patella tendon fully recover before resuming training or other aggravating activities. Rest is an important part of treatment of patella tendinitis. Depending on the severity of your symptoms, a physical therapist will advise a period of strict rest and possibly even a short time of immobilization in a brace to prevent any repetitive knee flexion/extension. When pain is no longer present at rest, then a gradual increase in activity is permitted as long as there is no return in resting pain.
Physical therapy will initially aim to decrease the inflammation and pain in the knee through modalities and most importantly, hands-on techniques. Once the initial pain and inflammation has calmed down, your physical therapist will focus on improving any flexibility, strength and alignment deficits found in and around the knee joint and entire lower extremity observed in your evaluation. In addition, specialty taping application to the knee has been very helpful in making exercises and activities less painful.
Proper alignment of your entire lower extremity is paramount to decreasing the overall stress that is placed on your patella tendon. Besides strengthening and stretching, foot orthotics may be very useful to correct any abnormal foot position, which in turn, encourages proper alignment up the lower extremity chain.
Arthritis is inflammation of one or more of your joints but it is particularly common in the knee. The most common types of arthritis are osteoarthritis and rheumatoid arthritis, but there are more than 100 different forms. Arthritis is mainly an adult disease but some forms affect children.
Knee arthritis can make it hard to do many everyday activities such as walking and climbing stairs. It frequently causes lost time at work and serious disability. Pain, swelling, and stiffness are the primary symptoms of arthritis. Typically when the knee joint becomes stiff and swollen it is difficult to bend and straighten the knee. Pain may cause a feeling of weakness or buckling of the leg. The symptoms are usually worse in the morning, after sitting or resting and after vigorous activity, sports or exercise. Loose fragments of cartilage and other tissue can interfere with the smooth motion of the knee. You may notice a "locking" during movement, creaking, clicking, snapping or a grinding noise. Many people with arthritis note increased joint pain with rainy weather.
Your doctor will most likely use an x-ray to diagnose arthritis. X-rays create a detailed picture of the dense tissue in the knee such as bone. They can also help to determine between the various forms of arthritis. X-rays of an arthritic knee typically show a narrowing of the joint space, changes in the bones and the formation of bone spurs. Other tests such as a magnetic resonance imaging (MRI) scan, a computed tomography (CT) scan, or a bone scan may be needed to further determine the condition of the bone and surrounding soft tissues of your knee.
Patellofemoral Pain Syndrome (PFPS) describes pain in the patellofemoral joint (kneecap and front part of the femur) that is due to overuse rather than traumatic injury. Although this pain may become apparent during athletic activities such as running, it is also evident with everyday activities. The individual will often notice symptoms when; going up and down stairs, after sitting for long periods of time, when transitioning from sit to stand, squatting deeply, kneeling, lunging and when wearing high heels.
PFPS, as well as other problems with the patella, are seen more frequently in women than men. Women actually stand in a more "knock-kneed" position, a posture that automatically pulls the patella towards the outside of the leg and places the knee at risk for an uneven stress distribution.
Overly tight muscles and soft tissue that support the knee, including the hamstring muscles and the Iliotibial band (the connective tissue which runs down the outside of leg to the lateral side of the kneecap), can lead to this condition. Conversely, women with "hypermobility", present with muscle weaknesses and imbalances which cause abnormal load to the kneecap.
The most common complaint with PFPS is pain, located on the sides and under the kneecap. There may be a grinding feeling or an occasional popping in the knee as well. Swelling is not very common with this syndrome, however, it can occur.
There are many different causes of PFPS, and it is difficult to pinpoint a single cause in every person. Four main contributing factors are; structural alignment, mobility and flexibility, muscle activation and strength, and movement patterns.
Structural mal-alignments focus on the way your body is built. The alignment, or direction of pull of the muscles on the bones, determines how your body moves, and how efficient you are with your movements. Two examples of structural alignments in the knee that can contribute to PFPS include a shallow femoral groove or a small patella. Other structural factors can include foot mechanics. Pronation and supination at the foot can often contribute to problems in the knee.
Mobility and flexibility determine how much motion is available in joints throughout the body. Mobility is different from flexibility, in that it involves the joints, rather than muscles, causing the restrictions. Mobility in PFPS is often focused on how much the patella moves, and in what direction. While this is important, what we often fail to realize is that it isn’t the mobility of the patella that is the problem, but rather the mobility of the joints above and below the knee that contribute to this syndrome. Mobility restrictions at the hips and lumbar spine, specially hip rotation, are now being looked at as a major contributing factor to anterior knee pain.
Weakness has long been, and continues to be, the number one contributing factor the medical profession points to for the cause of PFPS. Recent studies have pointed towards biomechanical problems associated with patella femoral pain syndrome as coming from weakness at the hips. Hip weakness creates an inability to adequately control movements of the femur during activities. Instead of maintaining normal, good alignment, the femur collapses in towards the midline of the body. When the femur collapses in, it causes the femoral groove to shift and rotate under the patella, resulting in over stress of the patella femoral joint. This will also result in a “lateral riding” patella, a common factor that is given for PFPS. Strengthening of the hip muscles helps to control this motion, providing a more stable femur during activity.
The final contributing factor that plays a role in patella femoral pain syndrome is fundamental movement patterns. Mobility, flexibility, muscle strength and activation, and even structural alignment, contribute to normal movement patterns. There are some fundamental patterns that we tend to lose as we get older and less active, and some that we lose because we are active. Movement patterns center around the brains ability to coordinate the right muscles to contract at the right time, and play a role in keeping the body and joints stable.
Rest is the first step in treating this syndrome. Rest from aggravating activities reduce the stress on the area and allows for recovery. But remember, you must fix the underlying problem in order to recover completely. Patella femoral pain syndrome is a complex and common knee injury. It is best treated with a physician evaluation followed by a thorough physical therapist’s assessment. The therapist will understand the complexity of the injury and the proper ways of addressing the many different causes. In summary, proper warm-up and stretching, as well as a conditioning and comprehensive strengthening program for the hips, core, and quads, along with mobility and flexibility exercises is the key to treating this condition affectively.
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