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

 


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

www.sportsphysioireland.com

Check out our social media

https://www.facebook.com/sportsphysioireland

https://twitter.com/sportsphyirl


What are Shin Splints?

 

What are Shin Splints? Shin Splints is a common term used among people to describe a pain in the leg in and around the area of their shin bone. A more specific diagnosis must be made however to successfully treat the symptoms. The traditional clinical use of the term shin splints is to describe medial tibial stress syndrome, pain on the lower inside of the leg. Often people use it as a term to describe pain and swelling of the muscles to the outside of the shin (anterior compartment syndrome) as well.

 

Chronic symptoms of shin splints may lead to stress fractures so symptoms must not be ignored if they continue to persist. Abnormal biomechanics may lead to a greater risk of pain around the shin bone. A high rigid arch effects shock absorption increasing the forces on the bone. In individuals whose arches fall from normal into a flattened position (excessive pronation) overuse, fatigue and excessive pull of the muscles that support the arch can lead to medial tibial stress syndrome, otherwise known as ‘shin splints.’

 

Weakness of the tendons or ankle instability from previous sprains may also contribute to overuse of muscular and tendinous structures leading to shin splints. Tight calf muscles can also lead to shin pain, excessive tightness can prevent normal ankle movement increasing the load on muscles surrounding the shin.

 

A full history and physical examination including biomechanical assessment with reproduction of symptoms is needed to find the true cause of the symptoms, so a progressive rehabilitation programme can be implemented.

 

Treatment may consist of reducing the repetitive training load, stretching and loosening out tight muscles such as the calves and improving strength. If it is a chronic issue, training to improve shock absorption will be required through altering running mechanics. Assessing and treating the origin of the problem is the key to full recovery.

 

Catherine Simpson

MISCP, MSc. Sports Medicine

www.sportsphysioireland.com

Check out our social media

https://www.facebook.com/sportsphysioireland

https://twitter.com/sportsphyirl


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

 


Major Injuries in Female Athletes Part 1 – The ACL

The most common cause of prolonged absence from sport is anterior cruciate ligament (ACL) injuries. Although ACL injuries occur in males and female, the incidence within female athletes is much higher.

The ACL is an important ligament within the knee and controls rotational movement. Most ACL tears occur when a person is landing from a jump, pivoting or decelerating suddenly. These non-contact ACL injuries generally occur because of insufficient control around the hip, knee and ankle. ACL tears rarely occur in isolation and there is often associated injury to other structures in the knee.

Lower limb injuries are the most common type of injury in running sports. In these sporting populations muscular injuries are more likely in male athletes, whereas female athletes have a higher incidence of ligament injuries. Possible reasons for higher levels of ACL injuries in females are that:

  1. Females have a wider pelvis creating greater angles of stress between the knee and the hip.
  2. Females tend to have a higher level of flexibility and ligament laxity then male (this is especially true at certain times of the month due to hormone changes).

This results in the joints having the ability to move through a greater range of motion, placing the ligaments under more stress. The muscles around these joints need to be strong enough to control this range of motion during rapid activities and changes in direction.

Looking at this hypothesis, do females need to have more muscular control then males to prevent serious ligament injuries; the answer is most likely yes!

We are now living in an era of injury prevention not just injury management. Basic conditioning programmes such as the FIFA 11+ has been implemented into warmup routines in many different sports. Research is showing that training and improvement of muscle control and joint proprioception is reducing the incidence of ligament injuries most notable ACL injuries in female athletes.

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.

 


Phase One Meniscal Tear Rehabilitation

 

When the knee suffers a meniscal and osteochondral fracture injury, it’s ability to absorb forces produced from stepping, running and cutting is diminshed. It’s essential to slowly and progressively load bear the joint in movements that simulate and compliment the movement patterns of the sport.

See the video of Sports Physio Ireland client, Ciaran, week one with Thomas, one of our Physiotherapists and Strength and Conditioning Specialists going through his initial rehabilitation.

 

 

 

 


Book Appointment