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Knee Sprain Treatment – Rehab Exercises to Heal Fast and Strong

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knee sprain treatmentManaging a knee sprain the right way, means faster healing, stronger healing and you get back to what you love faster – how could you say no to that!

Following on from the first post in this knee sprain series, where I outlined what you must do in the first 72 hours, I want to outline the knee sprain treatment and rehab exercises that will fully rehab your knee, the right way.

Knee Sprains Rehab with Non-Operative Treatments

Sprained knee, heal fast and strongThe medial collateral ligament (MCL) is the most frequently injured ligament of the knee, so it is important that YOU have the know-how, to rehabilitate it right from the start.

It is important for you to know and have peace of mind that knee sprains (when other structures aren’t also injured) do respond very well to non-operative treatment and rehab.

As Phisitkul et al state: “Nonoperative care has been proposed as the mainstay treatment for the majority of isolated MCL injuries regardless of severity”.

Treatment with early protected range of motion exercises and progressive strengthening has been shown to produce excellent results and a high rate of return to sports”

So let’s go through what your knee sprain (LCL or MCL) rehab involves and what the exercises are that will get you back faster and stronger.

Knee Sprain Treatment 

Effective knee sprain treatment must include:

  1. RICE – for the first 72 hours
  2. Brace (for high-grade tears)
  3. Proprioceptive re-training
  4. Range of motion exercises
  5. Strengthening exercises

If one of these aspects are missed or ignored, you could be left with ongoing, nagging pain or heal weaker, leading to future injury. Not ideal right?

Your rehab needs to be gradually progressed so that you body has time to adapt and get stronger. Our body is continually adapting to the forces that we put through it – So if you put the right controlled forces though your injured leg, it will get stronger and stronger.

We have talked about the first two components of sprained knee rehab and treatment in our earlier posts. For this post we will talk about the other three aspects, starting with Proprioception Re-Training.

1. Proprioception Re-Training:

Proprioception is the ability for you brain to know where you body is in space. If this is decreased, you have poor balance and increased chance of re-injury.

If you aren’t sure what proprioception is – extend one arm out to the side, close your eyes and mirror it exactly with the other arm – you could do this with your eyes closed because of proprioception.

Single leg standing (SLS):

Begin by standing on one leg on a solid surface (you can put one finger on the wall if you need to start with). When you can do this for 60 seconds, you can progress it by:

  • SLS on a folded up towel, layers of towels are great to use as you can easy progress this by adding layers and then finally rolling it up, tighter and tighter. Progressing each time when you can easily do it for 60 seconds. NOTE: Have a bench in front or to the side to grab onto if need be – but only if you have to!
  • You can also use Wobble boards, Bosu balls and balance boards when towels become to easy (or boring!) – Bosu ball are fantastic rehab tools if there is one available to you!

Continue to progress this through all phases.

2. Range of motion (ROM)

We recommend performing multiple exercises in a couple of phases to regain range of motion and  strengthening of muscles.

Phase one (first 1-2 weeks)

Due to pain, inflammation and limping, we lose range of motion (flexibility) very quickly and it is important to get this back as soon as possible to normalize movement and prevent secondary injury.

Note: continue to ice after use if there is pain, discomfort or swelling.

heel slides– Heel slides

  • Lying on your back or sitting
  • slide your heel up and down (bending knee up)
  • Do not push into pain
  • 3 sets, 10 reps
  • Do not push through pain

SLR-– Straight leg raise

  • Keeping leg straight
  • Lift leg 5-6 inches off the surface
  • 3 sets, 10 reps

inner range quads, quads setting for knee rehab– Quads setting

  • Roll a towel up and place under your knee
  • pushing your knee down into the towel
  • Lifting the feel up as shown
  • hold for 5 seconds, 10 reps

Progress to phase 2 when you can complete phase 1 exercises with little or no pain or swelling

Phase 2 of ROM and Strengthening:

*Continue to ice as needed

calf stretch , soleus, gastroc - self treatment for shin splints– Calf stretch

  • Hang your heel off the edge of a step, hold for 30 seconds
  • Do not push into knee pain – you should just feel a calf stretch

– Quads stretch

  • Hold for 30 seconds
  • As pain allows

hamstrinhamstirng stretch, knee pain rehab stretch– Hamstring stretch

  • Hold for 30 seconds
  • A little pain is OK, no more

Single leg Squat, hip stability and strengthSingle leg squats

  • Quality, not quantity here – control it
  • 3 sets, 10 8 reps
  • Hold onto a pole/broomstick if needed
  • Don’t push into pain, just go down in a comfortable range

Bridge - increase leg strength, glute activationa dn decrease back pain. physiotherapy exercises for everyone

– Bridges

  • Bend your knees up, place feet on the ground
  • push through your heels and lift your bottom up
  • 3 sets, 12 reps

Progress this to single leg bridges when this is easy and pain-free:

Bridge 1 leg - glute activation, leg strength and core stability. the best exercise for hip stabiltiy, great for runners

  • 3 sets, 12 reps

– Begin walking/jogging program

Want more?

More more detailed information, advice and a step by step rehab guide that makes you your own Physical Therapist, check out our downloadable knee rehab guide HERE

Fore more detailed information, for those of you that enjoy research articles, have a read of this good review of anatomy, biomechanics and management

Persevere with this knee sprain treatment until your knee is 100% and remember, physio treatment can help speed up recovery by reducing swelling, muscle spasm and increasing ROM.

If you have any questions, make use of the comments section and don’t forget to like and share!


Health

Sprained knee – Heal Fast and Strong

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Sprained knee, heal fast and strongTreating a sprained knee the RIGHT way, from the start, means you heal faster, stronger and have less chance of re-injury. 

In this series I want to show you what a sprained knee is, the most effective initial treatment and the best rehab exercises to get you back to what you love.

Sprained knees are known by a few different names:

  • Medial collateral ligament sprain (MCL)
  • Lateral collateral ligament sprain (LCL)
  • Ligament Tear
  • Ligament Sprain

sprained knee heal fast How common are sprained knees?

Ligament injuries make up a huge 40% of all knee injuries, and given that there is a 30-40% re-injury rate, it is very important that you treat it right!(12, 3).

Now, to avoid confusion right from the start. As there are 4 main ligaments in the knee that are commonly sprained, I cannot generalize treatment and rehab exercises to them all in one post.

So, this post is about the collateral ligaments of the knee (LCL and MCL as shown in the image at the top) and not about the inner cruciate ligaments (ACL and PCL)

What and where are the Collateral Ligaments?

sprained knee - heal strong and fastThe collateral ligaments are on either side of the knee, as shown to the right and act to resist your knee bending too far in, or out.

As you can see by the pie chart above, the medial collateral ligament is far more commonly injured. There is a simple reason why the MCL is far more commonly injured too.

Not often does someone come from between your legs to impact on the inside of your knee – It is much easier and likely for the impact to occur on the outside of your knee (stretching and tearing the inside ligament).

The collateral ligaments are most often injured in sports that involved, twisting, side-stepping and contact such as skiing, hockey, football and rugby.

Generally, they are injured when landing and twisting with the foot planted or when the knee is forced in (MCL) or out (LCL).

What does a sprained knee feel like?

Signs and symptoms:

  • Localized tenderness on the inside (MCL) or outside of the knee (LCL)
  • Pain with weight-bearing and limping
  • The knee feels unstable
  • Muscle spasm
  • Swelling in around the knee-joint in moderate-severe cases

What else could it be other than a sprained knee?

  • ACL or PCL sprain – did you hear a pop?
  • Meniscal tear – is there clicking, catching or locking?
  • Medial plate fracture

It is important if any of these are suspected to get it checked out by your local Physio.

Surgery or conservative treatment?

sprained knee surgeryGood news. The treatment of sprained knees has evolved from aggressive surgical treatments to mostly non-operative management with surgery only for chronic MCL deficiency that failed non-operative treatment or more severe, complex injuries. (4

What is Typical Recovery Time for Sprained knee?

The general recovery time for a grade 1 and 2 sprain is 2-6 weeks (if looked after properly) and keep in mind, even if it feels bad now, if you do all the right things you will get a lot better, so persevere.

Not taking knee rehab seriously often leads to far too many chronic knees, long-term disability and other injuries so YOU NEED TO TAKE THIS SERIOUSLY!

Grade 3 sprains (high-grade tears) often need to be in a brace for 4-6 weeks to allow the ligament to heal up well first, so if you have a lot of laxity in your knee and very poor movement, it would be worth checking out a good brace like this one.

Self – treatment – Initial management:

In the first 72 hours it is very important to follow the RICE and HARM principles – This can take weeks off your recovery.

Ice bath - sprained knee treatmentDo: RICE

  • Rest – From running etc.
  • Ice – 10 minutes at a time, no more, every hour you are awake.
  • Compression – Eg Tubigrip.
  • Elevation – Get your knee above your heart when possible.

Don’t: HARM

  • Heat
  • Alcohol
  • Running
  • Massage

HARM increases blood flow to the area, worsening inflammation and so causing more secondary damage and a longer healing time.

Keep moving

Within reason of course!! It is important not to baby sprained knees and start weight-bearing through them as soon as possible to normalize movement and decrease loss of muscle activity.

If necessary, you may need to be on crutches for the first 24 hours (if very painful and you really have tried to walk on it) then move to partial weight-bearing and then full weight-bearing.

Footwear

Wearing good supportive footwear with heel and arch support (such as your runners) is great as this aligns the knee correctly, takes the pressure off the injured ligaments and lets them heal well.

AND THEN:

Click over to the next post in this series: Rehabilitation exercises or give your knee the best chance at full recovery and download our comprehensive, step by step knee rehab guide HERE

Check out this quick balance and stability test when healing well to check if your hip strength is holding you back (especially if you have had a lot of lower limb injuries lately).

Don’t forget to favorite this page so you can find is easily when needed 🙂


Health, Knee pain

ACL Injury: Strengthening and Rehab Rules

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acl mechanismInjured your ACL? Strengthening and rehabilitating the right way after ACL injury means less arthritis, faster return to sport and a more stable knee – So why wouldn’t you?

First and foremost, an ACL injury needs to be confirmed and then you need to ask yourself: Do you really need surgery?

Most likely, you won’t need surgery unless you are a high-level athlete or want to return to pivoting and high demand sports – the above post explains this in more detail and will help explain your options.

 

Why does a knee need to be strengthened following ACL injury?

acl anatomuThe ACL is right in the middle of the knee and prevents the tibia sliding forward on the femur and prevents excessive rotation. It is one of the four main  ligaments in the knee that give passive stability

So, simply, if you have an ACL injury – you have less passive stability in the knee and need to make up for this. This is done by improving the active stabilizers – Your muscles.

This is the same whether you have done a partial or full rupture – If partial, you need to unload the ACL and support the knee while it is healing. If you have ruptured it, then you need to replace this loss with increased muscle supports.

 

Why hamstrings are your savior:

hamstrings action in protecting the aclTo better understand a few of the below rules of rehab, it is important to know about the role of the hamstrings. The ACL works to prevent your tibia (the shin bone) sliding forward, when landing, kicking, twisting etc. Luckily the hamstring also does a similar job – they travel down the

 

ACL Injury Rehab Rules:

1. Closed-chain before open-chain exercises

Why: First of all a quick explanation of open and closed chain exercises for those of you who don’t yet know:

open and closed chainOpen chain: Simply, your hand or foot is free to move in the air while doing open chain exercises – the chain is not continuous. Such as bench press, biceps curls, and hamstring curls.

Closed chain: This is when your hands or feet and planted, in constant contact with a surface. Such as a push-up, squat or leg press.

A study investigating the tensile forces placed on the ACL during a range of exercises found that there is significantly less force through the ACL during weight-bearing (closed chain) exercises when compared to open chain exercises – hence unloading the ACL and putting less forward pull on the tibia.

For example:

  • 0 Newtons of ACL loading during barbell squat, leg press, wall squat, front or side lunge (closed chain)
  • 59 Newtons of ACL loading during single leg squat (closed chain)
  • Seated knee extension (open chain): 396 newtons

The exception of this is seated knee flexion (hamstring curl) this is an open chain exercise but produces 0 ACL loading – this is because as discussed earlier, the hamstrings support the ACL by holding the tibia back in place.

It has also been shown that closed chain exercises recruit important stabilizing muscle groups of the hip which play a big part in knee alignment and proprioception.

hamstirngs squat2. Lean forward at the hips

Why: Because the hamstrings originate from your sitting bones (ischial tuberosities) at the back of your pelvis – If you tilt forward at the pelvis more as shown here it acts to lengthen out the hamstrings. Thus increasing hamstring tension. As we now know that the hamstrings are important in stabilizing an ACL deficient or injured knee – this is what we want! So don’t try to keep your body straight up and down (it is pretty hard to squat like that anyway). Actually, the optimal forward trunk tilt was shown to be 30 degrees as this increases hamstring muscle activity and force – Ideal!

Don’t stretch your hammies

3. Balance it out: Don’t stretch your hamstrings or idolize your quads

Why: Your quadriceps and hamstrings play a tug-of-war on the knee – the quads pulling the tibia forward (increasing ACL tension) and the hamstrings pull the tibia backward (decreasing ACL tension). You need to make sure there is a balance here by making sure your hamstrings stay tight and strong and when strengthening your quads – only do this in closed chain exercises in order to get co-activation of the hamstrings and hip stabilizers.

4. Keep your heels down

Squatting with your heels off the ground causes 3 times more ACL loading compared to squatting with your heels flat – so when possible (ie if you haven’t got incredibly tight calves) keep your heels flat on the ground. This is because having the heels raised up increases how far forward the knees go during a squat. As your knees go further forward the top of the tibia/ shin bone slopes down more – increasing the force on the ACL.

Note: This also applies to your shoes – If your wear shoes with big fat cushioned heels when working out – this can increase the shear force on your knee also.

5. Do not do resisted knee extensions

This is a pet hate of mine as it puts a huge amount of force through the the ACL and increases anterior tibial shear. The reason for this is because as an open chain exercise, it is working the quadriceps muscles in near-isolation, pulling the tibia forward and increasing ACL strain – Not what we want.

There are a lot of other exercises that would be far better to do such as leg presses, various forms of squats, lunges etc – these all have better co-contraction of knee stabilisers and importantly the hamstrings, leading to great ACL protection. When you are stronger and healing nicely it is important to do sports specific and functional rehab and so open chain exercises will be needed to have a strong knee – your Physio can progress you and guide you on to this as every knee is different.

 

For more specific information and data on ACL tensile forces during exercises, see this great paper by Escamilla et al.

Thanks for reading and good luck strengthening your knee!

Remember this is just a guideline to help your achieve your best and nothing is better than getting hands on input from your local Physio.


Health, Knee pain

ACL tear – Do you really need surgery?

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ACL tear non contact
When can I play again? Do I need surgery? These are the questions emotionally asked after anterior cruciate ligament injury. In this post i am going to answer these questions and more!

Torn your ACL and now wondering, do you really need surgery? The simple answer is: No – Only if you are a high level athlete, wish to return to pivoting/high demand sports OR have an unstable knee.

In this first post we will explore the difference in outcomes between surgery and conservative treatment and what that means for you: 

How do you know if you have an ACL tear?

If you heard a pop, snap or tear, the injury should be suspected as a ACL tear until proven otherwise. You may have felt something pop out or move  in the knee, this is sometimes confused for patella/knee cap dislocation but is most often an ACL tear.

You may or may not also feel clicking and locking which would indicate meniscal damage. Meniscal injury occurs in at least 40% of all meniscal tears(1).

Swelling will occur within an hour of injury, if swelling occurs a few hours later it points more towards meniscal tear.

But it is always best to get it thoroughly assessed by your local Sports Physiotherapist – It is not worth relying on Doctor Google or hoping it will go away!

Brief anatomy:

acl anatomuThe knee is formed by three bones, making up two joints. One joint is where the patella (knee cap) glides on the femur as you bend your knee. The other is formed by the tibia and the femur – This is the main joint that the ACL is in the middle of.

There are four main ligament that connect the femur and the tibia together and form this large hinge-like joint. These are the medial collateral(MCL), lateral collateral(LCL), anterior cruciate(ACL) and posterior cruciate(PCL) ligaments.

The ACL is right in the middle of the knee and prevents the tibia sliding forward on the femur and prevents excessive rotation.

Between the smooth articular surfaces of the tibia and femur and the menisci – the lateral and medial meniscus act as the shock absorber of the knee to prevent body injury, absorb shock and offer a smooth, rounded surface to move on.

Causes of ACL tear:

ACL injuries occur when the bones of the leg twist in opposite directions under full body weight, either during contact, or non-contact:

Non-contact ACL injury makes up about 70% of all ACL injuries, The two main mechanisms of non-contact injury are:

  • acl mechanismHigh impact jump-landing with a under-flexed (too straight) knee or valgus position (knee going laterally)

 

 

 

 

 

 

  • acl non contact 2Forceful rotation of the knee with the foot planted on the ground. This often happens when turning, side-stepping, pivoting etc.

 

 

 

 

 

acl tear contact

Contact ACL injuries:

The other 30% of ACL tears are due to contact and so are more random and due to a less preventable mechanism – There are often just plain unlucky.

 

 

 

 

Risk factors for ACL injury:

  • Poor sports specific conditioning
  • Muscle imbalance – The main one here is a low hamstrings-to-quadriceps strength ratio
  • Poor technique and awkward body movement
  • Poor neuromuscular coordination and balance

Risk factors that are hard to change:

  • Female gender
  • Joint laxity
  • Reduced ACL size and strength
  • Increased female sex hormones

 

Prevalence:

In the USA alone, about 250 000 ACL injuries occur annually. This translates into a 1 in 3000 chance that a member of the general population will injure their ACL.(2)

And over half of these injuries are full ruptures of the ACL!

So that means an estimated 175 000 ACL reconstructions costing over US$2 billion each year.(3) That is a huge cost – especially if extrapolated world-wide! Unfortunately I can’t get a number on this but I’m sure you can appreciate that it is absolutely gargantuan.

This represents a huge financial cost for the health system AND for you with nearly half of ACL injuries undergoing surgery!

So imagine if it was found that there was no significant difference in outcome between surgery and conservative rehab?

Conservative rehab Vs Surgery – What are the outcomes? 

Re-Injury rate after reconstruction:

One of the big concerns following surgery is re-injuring the ACL or surrounding structures (e.g. meniscus or cartilage) upon returning to sport. This is because the re-injury rate IS HIGH – studies looking into this have found it can vary from 2.3% to 13%.(4) The reason for the reasonably large range here is because it does depend on the sport or activity that the player returns to.

The re-injury rate is in the higher spectrum if playing a pivoting sport. The re-injury rate is 12% when playing a pivoting sport such as rugby and football/soccer – This is an unacceptably high rate giving an almost 1 in 8 chance of re-injury!

Risk of Osteoarthritis:

Often patients are recommended surgery so that the risk of osteoarthritis (OA) is reduced, but this is simply not true.

The rate of return to sport, treatment method or how much loading the knee takes in the years after injury are not the main factors contributing to OA – The initial injury itself is the important factor contributing to OA. This is due to bleeding within and inflammation of the joint after injury that, although your symptoms resolve gradually (pain, limited range etc) and tears can be repaired surgically, trigger a remodeling process. This chronic remodeling triggered in the cartilage and other tissues in the joint leads to OA in the majority of cases.(7)

This results in roughly half of all ACL inured knees showing OA after 10 years and nearly 100% after 15-20 years.

Some studies have actually found that following re-construction there is more OA. Kessler et al 2008 found that although there was better knee stability after a re-con, there was significantly more OA when compared to conservative treatment (42% vs 25%).(6)

It is also worth mentioning that sports participation itself – without prior injury moderately increases the risk of hip or knee OA.

Conclusion: There is NO evidence to suggest that ACL repair prevents future arthritis.

So when is surgery called for?

People who SHOULD under-go reconstruction are those that:

  • Have on-going symptomatic instability, eg knee giving out
  • Are elite athletes

Or

  • Wish to return to high-risk sports (pivoting sports)

The main reason for ACL reconstruction is to give an athlete a stable knee – So do not rush off to the surgeon if you do not have an unstable knee!

Follow this link for great information on:

 

Please Like, Share and Comment to let me know how you go and check out the below link to check your hip stability! Your hip controls the knee so this is very important!

 

 


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