Knee injuries

Knee Ligament and meniscus (cartilage) injuries

 

Knee ligament injuries  

Whilst knee ligaments are commonly injured during sport it is quite uncommon to injure a ligament during everyday activities. A significant degree of trauma is required to injure a ligament and this specific trigger/ injury will most certainly be remembered. Knee ligaments are not usually injured by swinging your legs out of bed or getting up from a chair. 

 

Cartilage (meniscal) Injuries 

Your knee is a hinge joint with cartilage covering the ends of the bones, to allow smooth movement when you bend or straighten it. It also contains a different type of cartilage called the “meniscus”. The meniscus are 2 separate cusps of cartilage that act as shock absorbers within the knee joint. 

Cartilage tears are often heard to occur within professional sportsmen and women. Younger patients will however need to sustain a significant force to injure the meniscus. If this has occurred, then surgery is often required to allow a person to return to their sport.  Strengthening exercises before, after or in place of surgery is highly advisable.

Once over the age of 45 years however a different type of meniscal tear is far more common. This is more likely to be a “degenerative tear” and related to a fragile meniscus that has occurred overtime with early stages of osteoarthritis. It is well accepted nowadays however that unless the tear in a degenerative meniscus is causing the knee to lock or give way, then surgery to remove the cartilage will be avoided to preserve the cartilage as much as possible. Strengthening the knee as much as possible can help reduce symptoms experienced.

Managing Cartilage (Meniscal) injuries

In the early stages after a meniscal injury, it is important to reduce both the initial pain and swelling. This is a very important aspect of recovery as both the pain and swelling naturally irritate nerve endings which can cause more pain. Secondly, both pain and swelling cause the muscles around the knee to  ‘switch off’, resulting in them becoming weaker very quickly and losing muscle bulk.
When the muscles around the knee start to become weakened, there is less support for the joint which increases the strain on the joint and the meniscus.

To help the knee to settle in the early stages it is important to use the PRICE
Early stages:

P – Protect: Reduce the amount of activities you engage in.
R – Rest: Take time to rest the knee more than usual.
I – Ice: 10-15 mins every 4 hours.
C – Mild compression: Gentle compression with ice can be effective.
E – Elevate: Elevate the leg in a straight position without a pillow under the knee.

Once the initial pain starts to settles (Typically 48-72 hours), it is then important to start working on activating the muscles around the knee and hip.

Early exercises include basic exercises such as gentle straightening and bending of the knee,  static muscle contractions and leg lifts (Click here to see Level 1 knee Exercises).

Once you are able to walk more comfortably and are able to fully straighten the knee, it is then important to start progressively improve the control around the knee and hip as well as also the general muscle strength and bulk. This will involve more weight bearing exercises and strengthening.  For the majority of the population, these exercises will be sufficient to regain normal day to day function. (Click here to see Level 2 Knee exercises)

It is very natural to experience some discomfort when starting new exercises. We would suggest  discomfort is ok to experience but if you describe it as pain, then it may be beneficial to reduce the number of repetitions or reduce the range of movements you are undertaking. For example,  when completing squats, only go down as far down as is uncomfortable but not too far that is painful.

In order to prepare the knee to tolerate higher level activities such as running or sports, you need to ensure that you have a high level of “dynamic control” around the knee and hip. This will enable the knee to be able to tolerate greater impact and change of direction stresses.  If you have not improved the overall strength and control of the knee prior to returning to sport, then you will have a greater risk of recurrent injuries.

We would aim so that once  you have completed the following rehab programme, you will be able to return to pain free day to day activities but also sporting activities. Please follow the following Rehab programme (Level 3a, b, c) for higher level activity and exercises.

Please start with Level 3a exercises, once you can complete these over at least 3 sessions without any adverse reaction, then progress to Level 3b and then finally Level 3c.

Meniscal exercises Level 3A
Meniscal exercises Level 3B
Meniscal exercises Level 3C