Football and netball seasons are well and truly in full swing and so we continue to discuss those injuries associated with those sports. Today we focus on the different types of knee injuries that can occur in these sports, assessment and diagnosis and how Physiotherapy can help.
Why so many knee injuries in team ball sports?
Knee injuries are an unfortunate all too common occurrence in team ball sports such as netball, the different football codes, and basketball due to their fast pace, sudden change of direction and the possibility of body contact. The knee joint is also a major weight bearing joint meaning that it is subjected to significant loads in sports that require running, stopping and change of direction. This can at times place stress on all of the different tissues within the knee.
Knee injuries can be the result of falls or a direct blow from an object or an opponent, but quite often knee injuries can occur without any external contact at all. A very typical mechanism of injury is to plant the foot and to try and pivot or change direction suddenly. This can leave the joint at risk of twisting under load of multiple times the athlete’s body weight, which is at times too much for the tissues of the knee to cope with.
Knee anatomy
Bones
The knee joint is where the bottom end of the thigh bone (femur) meets the top part of the shin bone (tibia). The femur has two smooth, rounded ends on it where it meets the flattened top of the tibia. This arrangement is essentially a hinge joint with a small amount of rotation.
The other bone of the knee joint is the kneecap (patella). It is actually a bone that grows within the tendon of the quadriceps muscle. In fact, we are all born without patellas! They don’t start to grow until we are toddlers.
Acute forces on the knee joint can lead to bruising of bones, fractures and dislocation/subluxation of the patella.
Cartilage
Cartilage is a frictionless surface that appears in almost all of the joints of the body. It allows for smooth movement of the joint and also has a shock absorbing function which gets utilised with running, jumping and landing. Cartilage can at times become bruised, similar to bone, or even acutely torn making weight bearing and movement of the knee incredibly painful.
Ligaments
Ligaments are the main stabilising structures of the knee joint. They are designed like thick cords of connective tissue to prevent excessive side to side or rotational force within the knee. There are 4 main ligaments – 2 on either side of the knee joint (the one on the inside is called the Medial Collateral ligament or MCL and the one on the outside is called the Lateral Collateral ligament of LCL) and 2 inside the knee joint itself the Anterior Cruciate Ligament or ACL and the Posterior Cruciate Ligament or PCL.
Anyone who has followed football has probably heard of the dreaded “pop” that accompanies an ACL rupture, but injuries to the other ligaments can also cause great pain and a sense of instability in the joint which needs to be addressed.
Meniscus
Meniscus is a really interesting type of tissue and performs several functions. It is structured in a very similar way to the discs of our spine. It is thick and hard, a little bit like rubber, so it performs a similar shock absorbing role to that of cartilage. It is also shaped a little bit like two shallow bowls that sit on the top of the tibia. This provides additional stability for the rounded ends of the femur to sit in and on top of.
What are the first steps if I injure my knee?
Managing the pain and inflammation in the hours and few days and even weeks post knee injury is really important. The quicker an athlete can get on top of these two things the quicker they can start the process of rehabilitation with their Physiotherapist.
Some simple methods of reducing swelling and inflammation are:
Do’s
Protected weight bearing – It may be necessary to use crutches in the early stages of recovery in order to be non weight bearing or partially weight bearing. It may also be necessary to protect the joint by wearing a brace that limits movement or limits side to side force on the ligaments.
Ice – On the injury site for approximately 20 minutes every 2 hours for the first 48-72 hours
Compression – Such as a compression bandage or compression tubing
Elevation – Resting with the injured limb above the level of the heart will limit unnecessary bleeding
Book in to see your Physiotherapist as soon as possible for a thorough assessment and to develop a plan to help you return to sport safely and prevent recurrence of the injury
How does Physiotherapy help with recovery from knee injury?
Physiotherapists are experts in assessing, diagnosing and treating all joint injuries. Our Colac Physiotherapist has over a decade of experience dealing with knee injuries caused by local athletes playing sport.
Assessment and diagnosis
It’s important to properly assess and diagnose knee injuries accurately in order to provide a realistic time frame for a return to play and also to ensure that the right exercises and advice are provided at the right times.
Physiotherapists are skilled in their ability to assess injuries accurately, but often with serious knee injuries it is necessary to investigate further. MRI is often the most accurate method of imaging as it can show damage to all of the soft tissues (cartilage, meniscus, ligaments) as well as to the bones.
Treatment
Exercise prescription – Strengthening of the quadriceps, hamstrings, calves and gluteal muscles are a cornerstone of knee rehabilitation. It is essential that the muscles that control movement of the knee are well conditioned and able protect the knee joint from the high loads associated with dynamic ball sports such as football and netball.
Aerobic and anaerobic conditioning is also a key element in rehabilitation as fatigue can have a negative effect on muscle and joint control. This in turn can leave the knee vulnerable to reinjury.
Balance and joint sense awareness (proprioception) is also often a deficit found in athletes who suffer knee injuries. Exercises that not only challenge load capacity but also balance, control and change of direction are important for a successful transition back to sport.
Running loads often need to be monitored closely so that the knee joint doesn’t become unnecessarily sore and inflamed during rehabilitation.
Taping and bracing – If the knee joint has been left unstable by the injury it may be necessary to use tape or a brace to protect the joint while the injury heals.
Graduated return to loading, activity and a return to sport – Building and then crossing the bridge from rehabilitation to a safe return to sport can be tricky. Our Colac Physiotherapist has vast experience in prescribing the right exercises at the right time to help local athletes navigate this transition with confidence with a focus not only on recovery but also performance on the field.
Don’t let knee injuries prevent you from achieving your movement or sporting goals. Make an appointment with our experienced, local Physiotherapist, Grant Brauer by contacting us at Prosper Health Group Colac on (03) 5290 5238. Alternatively you can book online here.
