Avoiding ACL Re-Rupture

I find that the main reasons why people re-rupture or injure their old ACL knee is because they simply take their eye off the ball and stop doing their prehab or gym based rehab.

A knee that has been reconstructed in the past needs constant maintenance and reviews to make sure it is not getting weaker over time without the person knowing.

Weakness leads to muscle wasting which can lead to altered landing and running mechanics which can lead to injury.

I would advise people who have have an old ACL reconstructed knee to get it reviewed every year to avoid major issues in the future.

Joey Boland


Acute or Chronic Pain? Recognise the Differences

In dealing with injury and pain, a lot of people are not receiving the right treatment because they do not describe the pain they feel correctly to their doctor. It may not seem like a big deal – pain is pain, after all – but it is. There are different kinds of pain, and each of them has a different underlying cause.

Acute or Chronic Pain - Recognise the Differences

Basically there are two types of pain: acute and chronic. There is no telling which one of them is worse than the other, because there is equality among sufferers, but while one type will go away in a rather simple manner, the other will stick around for the long term.


So, without prolonging the suspense, here is what you need to know about acute pain and chronic pain so that you can tell the doctor exactly how bad it hurts.


Acute Pain


Acute pain has its onset right after an accident or injury. It is the way your body tells you that something was hurt and you should seek treatment. Acute pain will appear after a sprain, after you fall down, or after your muscles and ligaments are inflamed. You cannot ignore this type of pain, as it prevents you from exercising further and, in some cases, even walking properly.


Direct and Associated Symptoms

Acute pain is sharp, sudden and increases in intensity over a short period of time. It may be accompanied by:

  • Bruising
  • Swelling
  • Inflammation
  • The painful area feeling warmer than the rest


There is not a specific intensity of acute pain – for example, if you misstep and fall down, pain will be bearable; however if you suffer a fracture or a sprain, it can exceed your tolerance threshold.


Treatment and Prognosis

Acute pain is treated with ice packs and over-the-counter pain medication. For professional athletes, doctors will typically prescribe NSAIDs (non-steroidal anti-inflammatory drugs) to avoid any future problems during random drug testing.


Acute pain will usually go away in a few weeks (in case of serious injuries). It is actually one of the first important signs of recovery – the disappearance of pain in the injured area.


Chronic Pain


Chronic pain is the sign of an incompletely cured injury. It may be caused, for example, by a faulty alignment of the bones after a fracture or a sprain, or by the constant pressure applied on the nerve. It can be caused by internal scar tissue which has not healed completely.


Direct and Associated Symptoms

Chronic pain is continuous, over a long period of time (months, even years). It is either constant or intermittent, and it takes a great toll on the sufferer’s life. Over time, people with chronic pain experience:

  • Reduced mobility or stiffness in the affected area
  • Lack of energy and zest for life
  • Depression
  • Insomnia


The most common types of chronic pain are headaches, lower back pain, arthritic pain and psychogenic pain (pain which is not caused by physical injury in the past, but as a result of ongoing psychological stress and duress).


Treatment and Prognosis

Unfortunately, pain medication does not help in the case of chronic pain. People who do not realise that their pain is no longer acute but chronic, may end up developing an addiction to pain medication. The correct treatment of chronic pain is multi-disciplinary, and may include massage, kinesiotherapy, acupuncture, relaxation techniques and even psychological counselling.

As you can see, there are two completely different approaches in treating these two types of pain. This is why it is important to know what kind of pain you suffer from, so that you receive adequate treatment for it.

Anterior Knee Pain

Anterior knee pain is one of the most frequently seen symptoms in the clinic at Sports Physio Ireland. Common causes of this pain in athletes and the general population is patellofemoral pain syndrome. Another common cause mainly in sportspeople is patellar tendinopathy (injury to the tendon running from your knee cap to the front of your shin). Osgood Schlatter’s disease is often the cause of anterior knee pain in young athletes. If a sudden growth spurt occurs the plate can overgrow and cause irritation of the insertion of the patellar tendon.


Patellofemeral syndrome is generally the result of a movement or mechanical abnormality. Whereas patellar tendinopathy is generally caused by overuse but mechanical abnormalities may predispose the tendon to being stressed excessively.


Distinguishing between the two is sometimes difficult as the clinical signs and symptoms can be similar. Running downhill, steps and repetitive activities like distance running are the common aggravating activities at the onset of pain in patellofemoral syndrome, although it may present in the sedentary population with gradual onset or after a dramatic episode such as falling on the knee. Patellar tendinopathy is mainly brought on by a history of repeated loading of the patellar tendon such as jumping and landing. The specific location of the pain is the main determining factor between the two injuries.


Knee injury associated with pain and or swelling may result in the quads not firing correctly. This can set up imbalances on the forces acting on the knee cap, with a tendency to patellofemoral pain. The same is true with excessive tightness of the IT band and hip muscles that could also cause your knee cap to be pulled outwards. More commonly, it’s weakness in the glutes that results in your hip and knee dropping in. Causing the structures on the outside of the knee to be in a lengthened position and pull on the knee cap.


The majority of the client’s that come in with knee pain tend to be knee and quad dominant which means they load these structures excessively during everyday movements. If the glutes are not activated then there can be excessive force through the knee, creating irritation at the back of the knee cap on the thigh bone. This is purely due to overuse and degeneration of the structures. If the knees are painful, using the glutes to offload them is a key component of retraining movement patterns.


Examination will include a thorough history taking, observation, palpation, special tests and functional tests to determine the cause of the client’s pain. For an example a squat done on a decline will stress the patellar tendon more and is therefore more specific to patellar tendinopathy.


Treatment will depend on the underlying cause of the pain and may focus on lengthening structures in one person and strengthening of the quads or glutes in another. One of the main components of the treatment is looking at how the individual naturally moves and ensuring they are not loading their knees excessively.


Catherine Simpson

MISCP, MSc. Sports Medicine


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Iliotibial Band Syndrome-Lateral Knee Pain

Iliotibial (IT) Band Syndrome, or Lateral Knee Pain is an overuse injury caused by friction and compression of the structures between the IT band and the outside of the knee. Training errors and biomechanical abnormalities are some of the factors that predispose to IT band syndrome.

It is commonly an issue seen in cyclists, runners, army recruits and endurance athletes. IT band syndrome accounts for 15- 24% of overuse injuries in cyclists and 1.6 – 12% in runners. Pain generally worsens the longer the person persists with the sporting activity and may be associated with local swelling and inflammation of structures between the band and the inside of the knee.

A full assessment should be carried out to rule out other causes of lateral knee pain such as lateral hamstring tendinopathy, degeneration of the lateral meniscus of the knee, osteoarthritis of the lateral compartment of the knee or referred pain from the low back.

A general misconception is that the IT band can be stretched; when in fact it is just a thickening of the fibrous tissue that surrounds the thigh like a stocking and is restricted by strong attachments to the lateral side of the knee. The TFL (tensor Fascia lata) and ¾ of the gluteus maximus muscles insert into the IT band and it is these muscle that should be targeted to reduce the tension in the IT band and therefore leads to compression of the inside of the knee.

Manual soft tissue therapy through foam rolling, stretching and trigger point release of the hip musculature are useful techniques to reduce the tension through the IT band and relieve the irritation of IT band syndrome.

Catherine Simpson

MISCP MSc. Sports Medicine


MCL Injuries

We recently seen Karl Lacy tog out and play against Mayo with heavy taping on his leg to protect a recent Medial Collateral ligament (MCL) injury.

The medial collateral ligament is a band of tissue that connects the thighbone to the lower leg and helps prevent the knee from buckiling inwards. It can be injured when twisting or landing or when a standing leg is tackled from the outside forcing it to buckle inwards.

Initial management should be

  • Compress with a bandage
  • Use crutches to take the weight off
  • Apply ice pack

What are the symptoms?

  • Swelling.
  • Pain.
  • Local tenderness on the inside of the joint.
  • Bruising.

Specific tests and scans can diagnose the extent of the damage and the length of time the player will be out of action for. In Karl’s case, he obviously needed more time to regain 100% confidence in his ability the twist and turn to make those turn overs he has been famous for over the past few seasons.

Mild or Grade 1 injuries usually get better in 1 to 3 weeks and may only needhome treatment along with using crutches for a short time.

Moderate or Grade 2 injuries usually get better in about a month. You may need to wear a hinged knee brace and limit how much weight you put on your leg.

Severe or grade 3 injuries may require wearing a hinged brace for a few months, and limiting weight on the leg for 4 to 6 weeks.


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