Knee pain - collateral ligaments

ANATOMY

Ligaments are like strong ropes that help connect bones together and provide stability to joints. In the knee, there are four main ligaments. On the inner (medial) aspect of the knee is the medial collateral ligament (MCL) and on the outer (lateral) aspect of the the lateral collateral ligament (LCL). The other two main ligaments are found in the center of the knee. These paired ligaments are called the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). They are called cruciate ligaments because the ACL "crosses" in front of the PCL.

CAUSES OF INJURY

Trauma to the ligaments holding the knee can be caused by different things. However the most common causes of knee ligament injuries are.

Twisting injury (as happens in a skiing accident).

Deceleration injury. Often seen in football where the studs effectively "stop the lower leg" whilst the rest of the body continues its original path of motion.

Trauma. Seen in contact sports where contact with another player causes heavy forces on or around the knee.

The medial collateral ligament is usually injured by a "blow" to the outer side of the leg (valgus force). A "blow" to the inner side of the leg (varus force) may injure the Lateral collateral ligament. Medial collateral ligament injuries are far more common than lateral collateral ligament injuries injuries

SYMPTOMS

At the time of the injury there is often immediate pain and sometimes swelling can occur. A "pop" or "snap" may be felt or heard and the knee may feel "unstable" during certain movements.

Tears of the MCL or LCL may be mild (grade I), moderate (grade II) or severe (grade III). MCL and LCL injuries differ from anterior cruciate (ACL) and posterior cruciate (PCL) injuries in that mild to moderate tears have the ability to heal following injury.

Injuries to other structures inside the knee can occur when either the MCL or LCL are injured. The cartilage (menisci) inside the knee can be injured as can the ACL or PCL (the cruciate ligaments). Injuries to other structures are more likely if there was a significant force or if there was a rotational component at the time of injury. A bone injury or fracture can occur, particularly, in young growing athletes.

Examination techniques that detect side to side (valgus-varus) looseness in the knee are effective in detecting collateral ligament tears. Tests that detect forward-backward (anterior-posterior) or rotational looseness can help detect other ligament injuries. X-rays are often done at the time of injury to make sure the bones of the knee are not broken. Tests such as Magnetic Resonance Images (MRI) are rarely required for collateral ligament injuries but are occasionally used to rule out other injuries to the knee.

TREATMENT ACUTE PHASE

If traumatic injury of the knee occurs immediate medical attention should be sought.

P - R - I - C - E
Protection - Your knee may be splinted, taped or braced to prevent further injury.
Rest - You should rest from all activities that cause pain or limping. Use crutches/cane until you can walk without pain or limping.

Ice - Place a plastic bag with ice on the knee for 15-20 minutes, 3-5 times a day for the first 24-72 hours. Leave the ice off at least 1 1/2 hours between applications.

Compression - Wrap an elastic bandage from the toes to mid calf, using even pressure. Wear this until swelling decreases. Loosen the wrap if your toes start to turn blue or feel cold.
Elevate - Make sure to elevate the knee above heart level

TO RESTORE NORMAL FUNCTION

Exercises should not hurt, if they do stop!

Here are some exercises to help your knee pain. After you do all the exercises as shown in the drawings, reverse your position, and do the exercises with your other leg, so both knees get the benefit of stretching

STRETCHING EXERCISES

Technique:	Hold each exercise 30seconds at a gentle stretch. Do not bounce!
Frequency:	6-10 repetitions/exercise, 5-7 days per week

Iliotibial band and buttock stretch (right side shown)

Position yourself as shown above. Twist your trunk to the right and use your left arm to "push" your right leg. You should feel the stretch in your right buttock and the outer part of your right thigh. Hold the stretch for 30 seconds. Repeat on the other side.

Technique:	Hold each exercise 20 seconds at a gentle stretch. Do not bounce!
Frequency:	6-10 repetitions/exercise, 5-7 days per week

Iliotibial band stretch (left side shown).

Position yourself as shown above, with your right leg crossed in front of your left leg. Hold your hands together and move them toward the floor. You should feel a stretch in the outer part of your left thigh. Hold the stretch for 30 seconds. Relax then repeat on the other side

Technique:	Hold each exercise 20seconds at a gentle stretch. Do not bounce!
Frequency:	6-10 repetitions/exercise, 5-7 days per week

Hamstring stretch

Rest the leg to be stretched on a supporting surface while keeping the knee from bending. Lean forward toward your toes by bending at the waist and keeping your back straight. You should feel the stretch but it should not hurt.

Technique:	Hold each exercise 30 econds at a gentle stretch. Do not bounce!
Frequency:	6-10 repetitions/exercise, 5-7 days per week

Calf stretch

Foot alignment should be shoulder width apart, you can confirm this by standing either side of a straight line on the floor. When you take your rear foot back, it should not cross or move away from the midline, your foot should be pointing forward with your heel either flat on the floor, or raised if aiming to develop the stretch.

Your front leg should bend so that when you look down over your knee, you can see the tip of your toes. Lean forward aiming to keep a straight line with your heel, hip and head.

For best results, push against a wall.

STRENGTHENING EXERCISES

Technique:	Hold each exercise 30 seconds at a gentle stretch.
Frequency:	2-3 repetitions/exercise, 5-7 days per week

Quadriceps strengthening: straight leg

Position yourself as shown above. Hold your right leg straight for 30 seconds and then relax.

Technique:	Hold each exercise 5-10 seconds at a gentle stretch.
Frequency:	6-10 repetitions/exercise, 5-7 days per week

Quadriceps strengthening: straight leg lift.

Position yourself as shown above. Raise your right leg several inches, and hold it up for 5 to 10 seconds. Then lower your leg to the floor slowly over a few seconds. Then repeat the exercise

Technique:	Hold each exercise 5-10 seconds.
Frequency:	5-10 repetitions/exercise, 5-7 days per week

Hip adductor strengthening.

While sitting, squeeze a rubber ball between your knees. Hold the squeeze for 5 to 10 seconds. (If you don't have a ball, put your hands or fists between your knees and then squeeze.)

Technique:	Hold each exercise for 5-10 seconds
Frequency:	10 repetitions/exercise, 5-7 days per week

Hip abductor strengthening (left side shown, front and side views)

Position yourself as shown above, standing on your left leg with the knee slightly bent. Slowly raise your right foot about 30 degrees, hold for a few seconds, and then slowly lower the foot and straighten both legs. Don't let your pelvis tilt (be crooked), and don't let your knees turn inward during bending.

Repeat the exercises below several times with each leg on a daily basis. Over several weeks, increase the resistance by adding ankle weights or by looping purse straps or the handle of a weighted pail over your ankle. Start with one or two pounds, adding one-half pound at a time as you build strength.

Bent-Leg Raises

This strengthens the inner thigh muscle to balance the pull on the knee joint from the outer thigh, which is often stronger.

Sit on a chair and straighten one leg.
Hold for one minute.
Bend your knee to lower that leg about halfway to the floor (a 45-degree angle).
Hold for 30 seconds.
Return to starting position and rest for one minute.
Repeat.
Work up to four repetitions for each leg.

Straight-Leg Raises

This strengthens the thigh muscles to help support the knee joint.

Sit in a chair with one leg extended, resting your foot on a chair.
Lift that foot a few inches while keeping your leg straight.
Hold for 10 seconds.
Return to resting position for 10 seconds.
Repeat.
Work up to three minutes of lifting for each leg.

TO HELP PREVENT RE-INJURY

Remember, many patello-femoral problems occur at contact phase of gait (when the foot hits the ground) due to increased biomechanical stress at this point. It is therefore vital to improve your biomechanics with orthotics designed for you chosen sport.

Golden rule- Don't ignore the problem, it won't go away!

The way we function biomechanically is predominantly controlled by genetics, its hereditary (runs in the family). The way you function is set and cannot be cured.

What you can do however is control lower limb biomechanics by altering foot position during the contact phase of gait. This can only be done by wearing a good shoe (see our shoe guide) and with orthotics (foot beds). This is the cheapest and most cost effective way for any athlete to reduce the risks of injury from occurring and from helping to prevent re-injury. Overall costs for the average athlete will run into pennies per mile/hour of sport.

Orthotics are designed to alter the biomechanics during the time the foot is on the ground. They are also used to provide increased shock absorbency working in harmony with the sport shoe worn.

Consider purchasing a knee brace . This device provides extra stability to the knee when playing sports. The material also causes localised vaso-dilation (opening of the blood vessels) increasing circulation to the area. This is vital as all ligaments have a notoriously poor blood supply. Increasing circulation to the ligaments can reduce the chance of injury. Have a look at the knee brace information page in our online store.

Wobble boards- Designed to improve proprioception these devices used as per the manufacturers instructions will improve the connection between the brain and the nerve fibres in the leg. Have a look at the wobble board information page in our online store.

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Check your running shoes, are they worn, how long have you had them? Trainers used for running are designed to last at most about 750 miles. If you think you have done more mileage then replace them with a new pair. Read the running shoe page to get practical advice on running shoes.

RETURNING TO SPORTING ACTIVITY

The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your knee recovers, not by how many days or weeks it has been since your injury occurred.

You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:

You have full range of motion in the injured leg compared to the uninjured leg.

You have full strength of the injured leg compared to the uninjured leg.

You can jog straight ahead without pain or limping.

You can sprint straight ahead without pain or limping.

You can do 45-degree cuts, first at half-speed, then at full-speed.

You can do 20-yard figures-of-eight, first at half-speed, then at full-speed.

You can do 90-degree cuts, first at half-speed, then at full-speed.

You can do 10-yard figures-of-eight, first at half-speed, then at full-speed.

You can jump on both legs without pain and you can jump on the injured leg without pain.

disclaimer please read

Protection - Your knee may be splinted, taped or braced to prevent further injury.
Rest - You should rest from all activities that cause pain or limping. Use crutches/cane until you can walk without pain or limping.
	Ice - Place a plastic bag with ice on the knee for 15-20 minutes, 3-5 times a day for the first 24-72 hours. Leave the ice off at least 1 1/2 hours between applications.
	Compression - Wrap an elastic bandage from the toes to mid calf, using even pressure. Wear this until swelling decreases. Loosen the wrap if your toes start to turn blue or feel cold.
Elevate - Make sure to elevate the knee above heart level