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Knee and Leg

Common Knee and Leg Injuries

Click on the titles below for more information
Iliotibial Band Syndrome
Anterior Cruciate ligament (ACL) sprain
Posterior Cruciate ligament (PCL) sprain
Medial collateral ligament (MCL) sprain
Lateral collateral ligament (LCL) sprain
Meniscus Tear
Chondromalacia Patellae
Runner’s Knee
Knee Bursitis
Shin splints
Definition

Iliotibial band syndrome is inflammation of the iliotibial band where it attaches to the hip bone and/or outer surface of the knee.

Structure and function

The iliotibial band (ITB) runs from the outside of the thigh down to the knee. It is a thick and strong structure made up of a tissue known as fascia. The ITB aids associative hip muscles for movement and provides support to the outside of the knee.

Why does it occur?

The ITB is prone to injury in runners, suggested to affect 4-8% of those participating in long distance. This is due to the repetitive nature of movement causing the ITB to repeatedly create friction on the outer surface of the knee, resulting in pain and inflammation.

Symptoms

– Pain on the outside of the knee
– Pain on the outside of the hip
– Snapping sensation around the hip
– Pain that improves with rest
– Increased pain with downhill running

What to avoid

– running on tracks without banking
– Increasing your level of sport/activity (over training)
– Wearing shoes with poor shock absorption

Definition

Partial tearing of the anterior cruciate ligament

Structure and function

The ACL is located deep within the knee joint, attaching to the femur (upper leg) and tibia (lower leg) bone. Its primary function is to resist anterior translation (forward movement) of the tibia.

Why does it occur?

Any force that pushes the tibia anteriorly (forward) whether severe (being slide tackled from behind) or having to decelerate (slowing/halting running pace) will place stress on the ACL. The ACL may be predisposed to tearing if the surrounding muscles are weak or imbalanced; such as the hamstrings being too weak or the quadriceps being too strong in relation. Over pronation (foot falling inwards) will also place greater tension on the ACL by rotating the tibia internally.

Symptoms

-Feeling of instability or “giving way” when standing
-“Clicking/popping” sensation at time of injury
-Loss of range of motion, particularly extension (straightening the leg)
-Swelling

Treatment

Physical examination from a professional can help determine if the ACL is damaged and understand the severity of injury. Treatment will often focus on strengthening the surrounding muscles and ensuring proper balance. Alongside rehabilitative exercise, massage, acupuncture, electrostimulation, and other modalities have been found effective in treating ACL injury. The hip and foot may also need to be treated if predisposing factors are found that are contributing to dysfunction of the knee. In cases of severe partial tearing surgery may be advised.

What to avoid

– Plyometric (explosive movement) dominant exercise during recovery
– Prolonged crutch use or bracing

Definition

Partial tearing of the posterior cruciate ligament

Structure and function

The PCL is located deep inside the knee joint and primarily limits posterior translation of the tibia (the lower leg moving backward) on the femur (thigh bone). The PCL is approx. twice as strong as its counterpart the ACL and thus injury is much less common.

Why does it occur?

The PCL is placed under stress when the tibia is moved posteriorly (backward), therefore incidents such as impact trauma to the shin can cause injury. There might be predisposing factors to the injury occurring, such as muscular imbalance or weak quadriceps and/or popliteus muscle.

Symptoms

-Pain behind the knee, especially on bending
-Feeling as if the knee might “give way”
-Swelling

Treatment

A professional assessment will help determine an appropriate programme to help rehabilitate the injury. Crutches might be required initially leading toward the patient being encouraged to walk without aid. Often exercise will be focused on strengthening the quadriceps. Manual therapy can assist moving the joints through its range of motion to assist in recovery. Other treatment therapies such as taping, acupuncture, and manipulation may provide additional relief and promote the rate of healing.

What to avoid

-Plyometric (fast/explosive) exercises during recovery
-Heavy squatting too early

Definition

Partial tearing of the medial collateral ligament

Structure and function

The MCL attaches to the inner side of the femur (thigh bone) to the inner side of the tibia (leg bone) located externally from the joint. It is one of the strongest ligaments in the body yet the most commonly injured in the knee. The MCL helps to prevent valgus stress (the knee falling inward).

Why does it occur?

A blow to the outer side of the knee causing valgus stress can overstretch and tear the MCL. Over pronation and sudden sharp changes in direction may also cause injury to this ligament. Weak or imbalanced surrounding musculature might be causing a predisposition to this type of injury.

Symptoms

-Pain on the inside of the knee
-Swelling
-Tenderness to touch inside of the knee

Treatment

Most cases of MCL sprain respond excellent to conservative (non-surgical) intervention. In some cases bracing might be suggested during the acute phase of injury. A strengthening routine is often advised to enable better support from the muscles protecting the ligaments from excessive stress.

What to avoid

-Prolonged bracing/splinting in acute phase
-Sports involving excessive pivoting during recovery

Definition

Partial tearing of the lateral collateral ligament

Structure and function

The LCL supports the outer side of the knee joint and primarily resists varus stress (knee joint being forced outward). It attaches to the fibular head (top of the outer shin bone) and lateral femoral condyle (bony prominence on the outside of the thigh bone). Secondarily, it helps prevent too much internal rotation of the tibia (movement created by turning your foot inward)

Why does it occur?

Force to the inside of the side causing varus stress can overstretch and tear the LCL. Sharp changes in direction may also cause injury to this ligament. Weak or imbalanced surrounding musculature might be causing a predisposition to this type of injury. The ITB and short head of biceps femoris muscles assist the LCL is stabilisation and thus might be implicated. It is the least commonly sprained of the 4 major ligaments of the knee.

Symptoms

-locking or catching sensation in the knee when moving
-Tenderness when touching the outer surface of the knee
-Swelling

Treatment

The prognosis for LCL injury is good with surgical intervention rarely required. Conservative treatment may focus on strengthening muscles that help support that side of the joint and examining other structures that might be predisposing you to weakness in this area.

What to avoid

-Pivoting exercises during recovery
-Avoid prolonged bracing post-acute phase
-Avoid contact sports during where the inside of the knee/leg is likely to be struck

Definition

Tear to either the medial or lateral meniscus

Structure and function

The medial meniscus is located on the inner side of the knee and lateral meniscus on the outer side. Both menisci are located adjacent to each other in the superior surface (top of) of the tibia forming a connection with the femur (thigh) bone. Their primary function is to aid congruency between the femur and tibia and enable greater shock absorption. The medial meniscus has a greater function for stability whilst the lateral is more mobile. Approximately 75% of all meniscus tears are medial.

Why does it occur?

Tears to the meniscus can be degenerative meaning they occur insidiously with age related changes, or traumatic. Trauma to the menisci usually occurs from end of range movement such as forcing the knee into hyperflexion or hyperextension with or without rotation. The menisci injured and location of the tear will be dependent on the plane of force. It’s suggested People with ACL deficiency are 40% more likely to incur a meniscus tear due to instability.

Symptoms

– Pain on hyperflexion (maximal knee bending) and forced extension (maximal leg straightening
-Popping or clicking during movement
-Feeling the joint becoming locked in a certain position.
– Pain on twisting with the knees whilst standing.

Treatment

Rehabilitation is often focused around increasing knee joint stability by assessing and strengthening musculature to prevent reoccurrence of injury. Although most cases respond to conservative treatment tears can be progressive and may eventually require surgery.

What to avoid

-Contact sports

Definition

Damage and irritation to the articular surface of the patella (inside of the knee cap)

Structure and function

The patella enables greater forced to be generated from the quadriceps muscles improving knee extension power by 35-50%. The patella achieves this by increasing the leverage that the tendon can exert on the femur by increasing the angle at which it acts.

Why does it occur?

Damage to the articular surface of the patella may arise from overuse, trauma or be degenerative. There can be many contributing factors for this condition. Trauma that results in compression of the patella with translational force may cause frictional damage to the articular cartilage. This condition may arise more insidiously due to poor gait mechanics causing maltracking (incorrect movement) of the patella from muscular imbalance or anatomical predisposition (increased Q angle).

Symptoms

Pain usually begins insidiously and starts off mild, creating a vague dull intermittent ache on the anterior (front) of the knee. This may then progress to a sharp catching or grinding pain.

Treatment

Physical examination can assess how the patella tracks (moves) during activity and what may be causing dysfunctional movement predisposing to this condition. Corrective exercise and techniques such as massage and stretching can then be administered dependent upon the case.

What to avoid

-Incorrect/poorly fitting footwear
-Excessive patellofemoral contact force, i.e. jumping, walking downstairs

Definition

Degeneration of the infrapatellar tendon (tendon below the knee cap). Also known as patellofemoral pain syndrome and jumper’s knee.

Structure and function

The infrapatellar tendon attaches directly beneath the patella (knee cap). It is a continuation of the quadriceps tendon (muscles at the front of the thigh) that enable the leg to straighten.

Why does it occur?

Overuse and structural fault are common reasons for occurrence.

Symptoms

-Pain worsened with stairs (especially going down)
-Increased pain with prolonged sitting with the knees bent
-Knee pain around infrapatellar (but poorly localised)

Treatment

Significant improvement is expected in 2-3 weeks. Tends to be chronic and reoccurring. An elastic knee brace with horseshoe pad to counter pressure, especially if patella maltracking is apparent may be advised.

What to avoid

– Heavy deep squats
– Increasing training freq/intensity

Definition

Inflammation of one of the bursae of the knee.

Structure and function

There are 14 bursae surrounding the knee, of these 14, 5 are considered primary bursae that are more prone to injury. Bursae resemble sacs, or pocket like structures which contain synovial fluid – a clear viscous fluid that serves to reduce friction of joints and surrounding structures.

Why does it occur?

Bursae may become inflamed from direct trauma or friction/compression e.g. Prolonged kneeling. Other less common causes are infection or inflammatory arthrosis.

Symptoms

– Localised tenderness and pain pressing onto specific bursae.
– Swelling may be visible
– Area may feel warm to touch

Treatment

-Elastic sleeve (depending on bursae affected)

What to avoid

– Compression or activities causing friction to the area

Definition

Shin splints is a vague term for exercise induced leg pain, “shin splints” may be used to describe a symptom or a diagnosis.

Structure and Function

There are numerous causes of shin/leg pain, the 2 most common are Medial Tibial Stress Syndrome (Posterior shin splints) and Tibialis Anterior Strain (Anterior Shin Splints). These both relate to a strain or tendinopathy of muscles acting on the tibia (the larger of the 2 leg bones)

Why does it occur?

Repetitive impact e.g. running, endurance training, poor conditioning and over training play a key role in development. Muscle imbalance and over pronation (foot falling inwards) has also been known to contribute.

Symptoms

-Pain in the leg which increases with activity
-Small lumps/nodules may be felt along where the muscles attaches to the tibia
-Rarely, swelling or redness may be apparent.

Treatment

PRICE, gentle stretching and massage therapy to address tight/hypertonic muscles causing additional strain. Gait may be assessed to address any issues causing predisposition. Foot and ankle may require mobilisation.

What to avoid

-Improper/unsupportive footwear
-Limit avoid hard surfaces or hills
-Warm up adequately and avoid over training