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Knee Injury Explained
Knee pain is a common problem for many sports people in Birmingham, Tamworth Staffordshire or Solihull, West Midlands. One of the more common Sports Injuries, you can usually divide knee injuries into either trauma or overuse injuries.
Trauma
As it suggests would be contact from something else such as a tackle, struck by a flying object, hitting the ground from a fall or indeed a road traffic accident.
Overuse
This would suggest repetitive stress on a muscle, ligament, tendon, cartilage, bone or joint.
Knee injuries can be either internal (within the joint) or external (outside the joint) In order to understand knee injuries we need first to have an appreciation of the anatomy and structures of the knee joint.
Basically the knee is a hinge joint and classified as a synovial joint, which means it has a capsule around it which is fluid filled. This fluid helps nourish and lubricate the structures within.
Generally knee injuries can be confined to either :
- Menisci tears ( cartilage )
- Ligament sprains or ruptures
- Articular cartilage damage or degeneration
- Loose bodies floating around the knee cavity
- Muscle or tendon strains and ruptures
The knee is put under a lot of weight bearing forces and does not cope with both weight bearing and twisting simultaneously which often occurs in sport. Anyone wearing long studs in boots will benefit from a better surface grip but this can hold the foot even when the player wants to change direction.
The compression and shearing forces can result in menisci tears, knee ligament sprain and ruptures.
Recently England soccer striker Michael Owen suffered an anterior cruciate ligament rupture of the knee during a World Cup Football Match which has resulted in surgery. Captured on World TV the knee gave way and it was obvious to the millions of viewers that something serious had occurred.
It is now a topic of conversation that, will he or wont he fully recover from this recent setback. Some schools of thought seem to think he will never play for his country again and others suggest that he is now finished playing at the top level and will be out for much of next season.
Not good news for Newcastle United Football fans who have seen very little of this expensive purchase and will have little opportunity to sell this once valuable player on to another club. This will be due to the history of injuries that Michael has sustained over the years. Michael has always relied on pace to help him achieve his status as a top striker but many hamstring injuries have left him a yard or so slower which allows defenders opportunity to catch him. This final knee injury may well be one injury too far for Michael, but all England fans would wish him a speedy recovery and thank him for his services to football.
There are a variety of tests designed for diagnosing injuries to knees but they are far from perfect and require much skill and experience from the therapist in order to be accurate. It may be advisable to have suspected internal knee damage checked out with an MRI scan or Arthroscopy which will give a more definitive answer.
Menisci
These are two “C” shaped cartilage washers that act as shock absorbers separating the two articulating bones of the knee joint. The Femur and the Tibia are fully weight bearing bones and are the principle bones of the knee joint. Menisci have virtually no means of repairing themselves due to the very poor blood supply, so if you sustain a menisci tear it may require surgery to trim the cartilage.
Cruciate Ligaments
These are two strong ligaments found inside the knee which help stability from anterior (forward) or posterior (backward) movement of the articulating bones of the knee joint. Due to biomechanics and the fact that the anterior cruciate ligament is smaller in diameter than the posterior cruciate ligament, the anterior cruciate is more commonly injured.
Often torn and damaged in skiing, snowsports and soccer where much twisting forces occur, the anterior cruciate ligament is often repaired with surgery. This may involve harvesting the hamstring and gracilis tendons and using them as a replacement ligament during surgery. The patella tendon is another option although it involves taking a slice of knee tendon from the patient which may then weaken this tendon.
Collateral Ligaments
These ligaments are found on the inside and outside of the knee joint and are involved with lateral (sidewards) stability of the knee. More commonly injured is the inside knee ligament called the Medial Collateral Ligament ( MCL ) because in trauma injuries the external forces strike from the outside and the resulting force is transferred internally to the inner knee which stretches the inner knee ligaments.
Treatment is straightforward as the ligament is superficial and has easy access, however ligaments are slow healers due to their poor blood supply and may take some time to fully heal. This ligament can be irritated in bed when turning over so a good idea is to wear a support knee bandage when in bed during sleep.
Patella Femoral Pain
Knee pain at the front of the knee, under the kneecap (patella) can be caused by degenerative changes to articular cartilage ( osteoarthritis) or a misaligned patella tracking situation which causes uneven abrasive forces at the underneath of the patella (kneecap) Mostly evident by clicking and cracking knees when squatting or bending knees or knee pain on climbing or descending stairs.
There are a variety of causes which include Q angle, especially on females with a wide pelvis and overpronated ankles which result in fallen arches and flatter feet.
Remedial work may be required or custom fitted orthotics which can be fitted at Atlas Pain Relief Centre in Tamworth www.atlaspainrelief.com
Ankle ligament sprains
The most common ligament damaged when you sustain an ankle sprain is the Anterior Talofibular Ligament. Most ankles are injured when you turn your ankle with the sole of your foot inwards, which is called an inversion sprain. In most cases the ankle is at more risk when walking downhill on uneven ground. Running sports where twisting and turning is required are high risk from ankle sprains. Snowsports such as skiing and snowboarding can also be responsible for ankle ligament sprains.
The mechanical design of the ankle joint gives it stability and mobility during different phases of gait.
The Talus bone sits between the 2 ankle bones of the Tibia and Fibula and when the foot is pulled upwards (dorsi-flexion) such as walking on your heels, the ankle benefits from more stability due to the wedge shaped Talus bone sitting tighter between the Tibia and Fibula. This restricts movement side to side and thus protects turning of the ankle.
When you walk on your toes the foot is in plantar-flexion and the thinner edge of the wedge shaped talus is now engaged. This allows side to side movement and it is in this state that more ankles are sprained.
The foot and ankle have very complex biomechanics and are too involved to discuss at this time however in simplistic terms, the foot needs to be both a rigid lever and a mobile adapter during different phases of the gait cycle. The ankle therefore needs to lock and unlock at various times to give both stability and mobility and is most at risk of injury during the mobility phase.
The anterior talofibular ligament is put on stretch during plantarflexion and inversion and any undue exaggeration of this movement will sprain fibres of this ligament and cause injury which is extremely painful. Swelling can occur if the capsule is damaged and bruising may follow if small blood vessels are damaged.
Ligaments are very slow to heal due to their poor blood supply. It is often said that a fracture to an ankle bone will be less painful and heal faster than a sprained ankle ligament. This is due to the contrasting blood supply to both structures. Bones have a very good supply of blood which carries all the repair materials and ligaments have by comparison a poor supply of blood.
During injury to the ankle, small sensory nerves called proprioceptors can be damaged and all good therapists should ensure that re-education of proprioceptors takes place as a part of the rehabilitation process. Ankle ligaments respond well to therapeutic ultrasound treatments and ice, contrast bathing and support strapping whilst waiting for nature to heal the injury will help.
When strapping the ankle, non stretch tape such as zinc oxide should be used, but be aware that some people can have allergies to this tape. The ankle should be taped in dorsiflexion and eversion to help prevent unwanted movement into inversion, which puts a strain on the lateral (outside) ankle ligaments.
Sports injuries are a speciality at the Atlas group of sports injury clinics which are located in Solihull, Birmingham, West Midlands and Tamworth, Staffordshire.
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