Knee injuries are very common in both training and in competition, when you are putting your body through its paces.
Ground impact, load, twisting and change of direction forces, collision, stability, strength and biomechanics can all play a part no matter what the injury.
The older we get too, the more important it is to work on rehab exercises to help with injury prevention.
No matter whether it’s a niggling pain in your knee or post-operative rehab from a knee reconstruction, we have the right assessment, treatment and exercises to help you progress and achieve your goals in returning to training and sport.
ACL Tear and Surgical Reconstruction
An increasingly common sporting injury involving either a partial or full tear of the Anterior Cruciate Ligament (ACL) usually comes from an internally rotating movement.
The ACL plays a vital role in knee stability and control, acting to prevent excessive translation and movement of the tibia on the femur.
Most patients feel a ‘giving way’ of the knee, as well as an audible ‘pop’, sudden pain and a large amount of swelling.
There are three grades of ACL tear and when you suffer a complete tear (grade 3), generally surgery is indicated if the knee is unstable and the person is wanting to return to twisting and impact sport.
We have an extensive ACL rehabilitation program for pre-surgery, post-surgery and non-surgical cases that your Physio will guide you through week to week to enable you to fully recover and return to exercise and sport.
Collateral Ligament Tears
Other important supporting ligaments in the knee are the Medial Collateral Ligament (MCL) which is found on the inside of the knee and the Lateral Collateral Ligament (LCL), on the outside of the knee.
Both ligaments serve to protect the stability and movement of the knee side to side.
The MCL is more commonly injured when sidestepping, unstable surfaces and impact from the outside of the knee.
Pain and instability may be reproduced by manually stressing the ligament through a clinical valgus force test by the Physio during assessment and is used as part of the diagnosis to the grade of tear.
Most MCL and LCL tears do not go for surgery, and so are treated conservatively with Physio, rehab and taping as part of the return to activity.
Higher grade injuries may need a brace to limit movement of injury when there is a large gapping of the joint.
Meniscal Injuries
There is both a medial (inside) and lateral (outside) meniscus where both function as a shock absorber, cushioning the impact of the thigh bone on your lower leg.
Normally the surface of the meniscus is very smooth, occasionally however due to excessive weight bearing or twisting forces, the meniscus can be torn or damaged.
Meniscal injuries can occur in combination with other structures of the knee, such as with an ACL injury.
There will often be a sharp pain and block when bending the knee, general ache with loading and walking, a reduction in the range of movement, and sometimes locking, giving way or feeling of general instability.
We treat both non-surgical acute or degenerative tears as well as post-operatively for ones that go for surgery, by initially settling down the inflammation and swelling.
At the same time we work with you on improving the tone and strength of the quads and surround muscles to return function and reduce pain.
In many cases tears do NOT need to go for surgery but will then require a regimented regime of progressive strengthening exercises planned out to enable optimal recovery.
Patellofemoral Pain and Dysfunction
Patellofemoral pain is one of the most common complaints of knee pain. Injury can arise as a result of inflammation or tissue damage to the structures between the patella and its articulation with the femur.
This can come in the form of bursitis, fat pad impingement and ITB syndrome (‘runner’s knee’).
In assessment we will likely see biomechanical deficiencies in the tracking of the knee cap or control of the knee, with weakness in surrounding muscles such as the quadriceps and gluteals.
Symptoms are usually located at the front of the knee, the lateral or medial side or ‘underneath’ the patella, which is commonly aggravated with squatting on one leg, running, walking downstairs and jumping.
When the issue is chronic or has developed over time there can be cartilage and tendon changes which then lead to conditions such as Chondromalacia patella and quadricep or patella tendinopathies, with tendonitis (jumper’s knee) and Osgood Schlatter’s in young sportspeople and athletes.
A big focus for all patellofemoral pain injuries is not just the injury site or where the pain is, but looking further up and down the chain to the hip and the ankle.
Foot over-pronation and a lack of hip external rotation strength and knee control can be major causative factors and so are identified and addressed in our rehab programming.
Hamstring Tears and Tendinopathy
In many athletes and long distance runners we see injuries to the hamstring muscle, tendon as well as origin tendinopathy, sometimes called a high hamstring strain.
These types of injuries tend to be from overuse or incorrect training and usually involve muscle imbalances or biomechanical dysfunction.
Effective hamstring injury rehab requires specific rehabilitation exercises, like isometric and then eccentric movements to improve the pain and increase the strength progressively and carefully.
