ACL Injury Treatment
The Anterior Cruciate Ligament (ACL) is a major ligament of the knee that connects the femur to the tibia. The ACL’s main function is to prevent an anterior translation of the tibia on the femur, providing stability to the knee joint. ACL injuries are one of the most common sports injuries. They are most often seen in high impact sports such as football, basketball, soccer, gymnastics and skiing. The actions that can provoke an injury are sudden changes in direction, jumping, and a direct blow to the knee joint. Injuries can range from an overstretching or a sprain of the ligament to a complete tear of the ACL.
Symptoms of an ACL injury are swelling around the joint, pain and tenderness towards the outside of the knee, and instability or a feeling of the knee “giving way” with standing and walking. However, ACL injuries are best diagnosed with an MRI.
Physical therapy is needed for mild sprains of the ACL and complete tears to help restore the stability of the knee and return the patient to normal function. For a mild to moderate sprain, the course of physical therapy can last anywhere from 6-10 weeks and will initially include modalities such as ice and ultrasound to reduce pain and swelling, manual therapy techniques, range of motion exercises and stretching exercises. As the injury begins to heal, the therapist will incorporate progressive strengthening, balance and agility training. Physical therapists will also analyze a patient’s gait and body mechanics to ensure that the patient’s quality of movement is safe, and that they will be able to return to prior activities and sports without risk of re-injury to the knee.
In the event of a complete tear of the ACL, depending on a person’s level of activity, surgical reconstruction may be indicated. Post-surgically, the patient will then have to wear a knee brace when walking and undergo an extensive course of physical therapy to strengthen the knee and ensure that the reconstruction is a success.
ITB Pain Treatment
The Iliotibial Band (ITB) is a thick band of connective tissue running along your outer thigh from hip to knee. A tight ITB can cause pain on the outside of the knee and is usually very common in runners. A tight ITB may become inflamed with repetitive flexion of the knee. To alleviate pain, your physical therapist will introduce some stretching exercises to the muscles surrounding the ITB such as the glutes, hamstrings, hip rotators, and quads. Foam rolling the ITB is a self myofascial release, and is an effective way to decrease adhesions in the band, thus improving tissue mobility. Strengthening exercises will also be provided to increase strength of the surrounding musculature and improve functional ability.
MCL Injury Treatment
The Medial Collateral Ligament (MCL) is the largest and strongest of four major ligaments that are essential for the stability of the knee joint. It is named the MCL because it is located on the “medial” (middle) side of the knee joint. It is a “collateral ligament” because it connects the bottom of the femur (thigh bone) to the top of the tibia (shin bone). The MCL prevents excessive widening of the inside of the knee joint.
The MCL can be injured with a direct blow to the outside of the knee, or what is known as a “valgus force” injury. When the outside of the knee is struck, the outside of the joint buckles and causes the inside to widen and potentially over-stretches or tears the MCL.
Symptoms of an MCL injury include pain, swelling and sometimes bruising along the inside of the knee. Pain from an MCL injury can be reproduced by placing the knee in a “knock knee” position as this puts stress on the ligament.
Early treatment of MCL injuries involves the RICE regimen; Rest, Ice, Compression, and Elevation of the affected limb until swelling subsides. The knee loses strength and stability after an injury.
Progressive physical therapy addressing the strength and stability of the knee and entire lower extremity are critical to get the patient back on their feet and prevent further injury.
Meniscus Tear Treatment
A torn meniscus is one of the most common knee injuries. Any activity that causes you to forcefully twist or rotate your knee, especially when putting your full weight on it, can lead to a torn meniscus.
Each of your knees has two menisci, which act like cushions between your shinbone and your thigh bone.
Conservative treatment, such as rest, ice and medication, is sometimes enough to relieve the pain of a torn meniscus and give the injury time to heal on its own. In other cases, a torn meniscus requires surgical repair. Some symptoms of a meniscus tear may include pain, stiffness and swelling, catching or locking of your knee, the sensation of your knee “giving way” and decreased range of motion. Without treatment, a piece of meniscus may come loose and drift into the joint which can cause your knee to slip, pop, or lock. With proper diagnosis, treatment, and rehabilitation, patients often return to their pre-injury abilities.
Patellofemoral dysfunction is pain at the front of your knee, around your kneecap (patella). Sometimes called “runner’s knee,” it’s more common in people who participate in sports that involve running and jumping. The knee pain often increases when you run, walk up or down stairs, sit for long periods, or squat. Simple treatments such as rest and ice often help, but sometimes physical therapy is needed to ease patellofemoral pain.
Patellofemoral dysfunction can stem from any of the following:
- Overuse. Running or jumping sports puts repetitive stress on your knee joint, which can cause irritation under the kneecap.
- Muscle imbalances or weaknesses. Patellofemoral pain can occur when the muscles around your hip and knee don’t keep your kneecap properly aligned. Inward movement of the knee during a squat has been found to be associated with patellofemoral pain.
- Injury. Trauma to the kneecap, such as a dislocation or fracture, has been linked to patellofemoral pain syndrome.
- Surgery. Knee surgery, particularly repair to the anterior cruciate ligament using your own patellar tendon as a graft, increases the risk of patellofemoral pain.
Your physical therapist will work with you to maintain your strength and flexibility as well as optimize your movements with jumping, running and pivoting, all geared to help keep the patella track properly in its groove.