Knee Sports Injuries
You can injure a ligament through a sharp change in direction, landing wrong from a jump, or the most common a blunt force hit to the knee, such as in football tackle. The incident usually needs to happen at speed. Muscle weakness or incoordination predispose you to a ligament sprain or tear.
Major Knee Ligaments
ACL: anterior cruciate ligament
PCL: Posterior Cruciate Ligament
MCL: Medial Collateral Ligament
LCL: Lateral Collateral Ligament Coronary Ligament
Symptoms & Severity of Knee Ligament Injuries?
The severity and symptoms of a ligament sprain depends on the degree of stretching or tearing of the ligament.
In a mild grade I sprain, the ligaments may stretch, but they don’t actually tear. Although the joint may not hurt or swell very much, a mild sprain can increase the risk of a repeat injury. With a moderate grade II sprain, the ligament tears partially. Swelling and bruising are common, and use of the joint is usually painful and difficult. With a severe grade III sprain, a ligament tears completely, causing swelling and sometimes bleeding under the skin. As a result, the joint is unstable and unable to bear weight. Often there will be no pain following a grade 3 tear as all of the pain fibres are torn at the time of injury.
What’s the Healing Time of a Knee Ligament Injury?
Treatment of a ligament injury varies depending on it’s location and severity. Grade I sprains usually heal within a few weeks. Maximal ligament strength will occur after six weeks when the collagen fibres have matured. Resting from painful activity, icing the injury, and some anti-inflammatory medications are useful. Physiotherapy will help to hasten the healing process via electrical modalities, massage, strengthening and joint exercises to guide the direction that the ligament fibres heal. This helps to prevent a future tear.
When a grade II sprain occurs, use of a weight-bearing brace or some supportive taping is common in early treatment. This helps to ease the pain and avoid stretching of the healing ligament. After a grade II injury, you can usually return to activity once the joint is stable and you are no longer having pain. This may take up to six weeks. Physiotherapy helps to hasten the healing process via electrical modalities, massage, strengthening and joint exercises to guide the direction that the ligament fibres heal. This helps to prevent a future tear and quickly return you to your pre-injury status.
When a grade III injury occurs, you usually wear a hinged knee brace to protect the injury from weight-bearing stresses. The aim is to allow for ligament healing and gradually return to normal activities. These injuries are most successfully treated via physiotherapy and may not return to their full level of activity for 3 to 4 months. Definitely seek professional advice in these cases.
One of the most common problems involving the knee joint is an anterior cruciate ligament injury or ACL tear. Of the four major knee ligaments of the knee, an ACL injury or rupture is the most debilitating knee ligament injury.What Causes an ACL Injury?
An ACL injury is usually a sports-related knee injury. About 80% of sports-related ACL tears are “non-contact” injuries. This means that the injury occurs without the contact of another player, such as a tackle in football.
Most often ACL tears occur when pivoting or landing from a jump. Your knee gives-out from under you once you tear your ACL.
Female athletes are known to have a higher risk of an ACL tear, while participating in competitive sports. Unfortunately, understanding why women are more prone to ACL injury is unclear. There are some suggestions it is biomechanical, strength and hormonally related. In truth, it is probably a factor of all three.
What Sports have a High Incidence of ACL Injuries?
Many sports require a functioning ACL to perform common manoeuvers such as cutting, pivoting, and sudden turns.
These high demand sports include football, rugby, netball, touch, basketball, tennis, volleyball, hockey, dance, gymnastics and many more. You may be able to function in your normal daily activities without a normal ACL, but these high-demand sports may prove difficult.
Therefore, athletes are often faced with the decision to undergo surgery in order to return to their previous level of competition. ACL injuries have be known to curtail many promising sporting careers.
What are the Symptoms of an ACL Injury?
The diagnosis of an ACL tear is made by several methods. Patients who have an ACL tear commonly sustain a sports-related knee injury.
They may have felt or heard a “pop” in their knee, and the knee usually gives-out from under them. ACL tears cause significant knee swelling and pain.
How is an ACL Injury Diagnosed?
On clinical knee examination, your physiotherapist or sports doctor will look for signs of ACL ligament instability. These special ACL tests place stress on the anterior cruciate ligament, and can detect an ACL tear or rupture.
An MRI may also be used to determine if you have an ACL tear. It will also look for signs of any associated injuries in the knee, such as bone bruising or meniscus damage, that regularly occur in combination with an ACL tear.
X-rays are of little clinical value in diagnosing an ACL tear.
How is an ACL Injury Treated?
Many patients with an ACL tear start to feel better within a few days or weeks of an ACL injury. These individuals may feel as though their knee is normal again, because their swelling has started to settle. However, this is when your problems with knee instability and giving way may start or worsen.
ACL tears do not necessarily require ACL reconstruction surgery. There are several important factors to consider before deciding to undergo ACL reconstruction surgery.
Do you regularly perform sports or activities that normally require a functional ACL?
Do you experience knee instability?
What are your plans for the future?
If you don’t participate in a multi-directional sport that requires a patent ACL, and you don’t have an unstable knee, then you may not need ACL surgery.
Physiotherapy & ACL Exercises
Your best way to avoid ACL reconstructive surgery is to undertake a comprehensive ACL-Deficient Knee Rehabilitation Program that involves leg strengthening, proprioception and high level balance retraining, plus sport-specific agility and functional enhancement. Your sports physiotherapist is an expert in the prescription of ACL tear exercises.
ACL Deficient Knee Rehabilitation Program
CARE Institute/Sabga Physiotherapy has developed a specific ACL Deficient Knee Rehabilitation Program to address ACL injuries for patient who wish to avoid or delay ACL reconstructive surgery.
Your physiotherapy treatment will aim to:
• Reduce pain and inflammation.
•Normalise your joint range of motion.
•Strengthen your knee: esp Quadriceps (esp VMO) and Hamstrings.
•Strengthen your lower limb: Calves, Hip and Pelvis muscles.
•Improve patellofemoral (knee cap) alignment
•Normalise your muscle lengths
•Improve your proprioception, agility and balance
•Improve your technique and function eg walking, running, squatting, hopping and landing.
•Minimise your chance of re-injury.
We strongly suggest that you discuss your knee injury after a thorough examination from a knee injury specialist such as a sports physiotherapist, sports physician or knee surgeon.
The usual surgery for an ACL tear is called an ACL reconstruction. A repair of the anterior cruciate ligament is rarely a possibility, and thus the ACL is reconstructedusing another tendon or ligament to substitute for the torn ligament. There are several options for how to perform ACL surgery.
The most significant choice is the type of graft used to reconstruct the torn ACL. There are also variations in the procedure, such as the new ‘double-bundle’ ACL reconstruction.
You may have heard of a Lars Procedure, which is a new ACL reconstruction procedure. In some, but certainly not all, ACL ruptures a stub of the old ligament can be used as a part of the repair procedure, which can hasten your recovery time. Your surgeon will know whether a Lars procedure is an option for you or not. There are higher re-rupture risks involved.
Risks of ACL surgery include:
• persistent instability and pain,
• knee stiffness, and
• difficulty returning to your previous level of activity.
The good news is that better than 90% of patients have no complications with ACL surgery.
Post-Surgical ACL Rehabilitation
Post-operative ACL rehabilitation is one of the most important, yet too often neglected, aspects of ACL reconstruction surgery. The most successful and quickest outcomes result from the guidance and supervision of an experienced Sports Physiotherapist.
Your rehabilitation following ACL surgery focuses on restoring full knee motion, strength, power and endurance. You’ll also require balance, proprioception and agility retraining that is individualise towards your specific sporting or functional needs.
Your sports physiotherapist is an expert in this field. We suggest that you contact them for the best advice in your circumstances.
ACL Injuries in Children
ACL reconstruction surgery is the standard treatment for young, active people who sustain an ACL tear. But what happens when you’re young and your bones are still growing?
Should ACL surgery be delayed until the child is older, or should ACL reconstruction be performed before skeletal maturity?
The concern of performing ACL surgery in children is that there is a risk of causing a growth disturbance in growing children. Growth plate problems as a result of ACL surgery could potentially lead to early growth plate closure or alignment deformities.
However, recent research is showing that the risk of growth plate problems is much less than the risk of permanent knee damage if the ACL is not fixed.
Your knee surgeon is the best person to discuss whether ACL reconstruction is advisable or not.
How to Prevent an ACL Injury?
Preventing an ACL tear has been the focus of recent research, especially the prevention of ACL tears in female athletes. Numerous theories have been proposed to explain why people may tear their ACL, and how they can be prevented.
Current investigations have focused on neuromuscular training to prevent ACL tears. Just as we know that ACL reconstruction patients who have extensive post-operative physiotherapy to rebuild their strength, proprioception and agility we do know that similar ACL exercises can help prevent an ACL tear in the first place. For more advice, please consult with your sports physiotherapist.
Return to Sports with an ACL Injury
Athletes often have particular difficulty returning to sport once they have sustained an ACL injury, even if they are surgically reconstructed.
Researchers have found that your best chance of returning to your sport post-ACL tear is to have undertake both:
• ACL reconstruction surgery, and
• Intensive post-operative physiotherapy rehabilitation.
For more information, please ask the advice of your knee surgeon or sports physiotherapist.
Your knee meniscus have unique shapes. They are a wedged, kidney shape.
Your meniscus act like a wedge to assist with the rotational stability created by the anterior cruciate ligament. The meniscus also acts as a shock absorber. As we walk, run, and jump the knee absorbs tremendous forces. Your meniscus helps to absorb these forces so that the bone surfaces are not damaged.
The amount of force increases exponentially as the speed of movement increases from walking to running to jumping. Your meniscus helps to disperse the compressive forces over the entire knee rather than isolating them.What is a Meniscus Tear?
In the younger population, your knee meniscus is usually torn traumatically, by a twisting on a slightly flexed knee.
The traumatic type of meniscal injuries are most often sports-related. The meniscus can be torn anterior to posterior, radially (parrot beak), or can have a bucket handle appearance.
In the older adult, the tear may be due to a natural age-related degeneration of the meniscus or a rough arthritic femoral bone surface tearing into the softer meniscus. In this case, surgery may be required to attend to both the meniscal repair and to repair the damaged joint surface.
Depending on the type of meniscus tear, meniscus repair be complicated. A large meniscus tear that is inadequately treated may cause premature degenerative bony (arthritis) changes.
Signs and Symptoms of a Meniscus Tear
The history of a painful twist occurring on a slightly flexed knee will indicate the likelihood of a meniscus tear. You may also experience clicking, popping, or locking of the knee. These symptoms are usually accompanied by pain along the knee joint line and a joint swelling.
Clinical examination may reveal tenderness along the knee joint line. You will usually notice it is painful to squat.
Your physiotherapist or doctor will use McMurray’s test and other clinical tests to confirm a meniscus tear diagnosis.
X-rays or MRI?
A MRI scan is the most accurate non-invasive test to confirm a meniscus tear. X-rays do not show a meniscus tear.
Does a Meniscus Tear Heal?
Meniscal blood supply is limited: your meniscus receives its nutrition from blood and synovial fluid within the joint capsule. Your meniscus has two distinct regions that affect their ability to heal. We call these the Red Zone and the White Zone.
The red zone has blood supply, whereas the the white zone doesn’t have a blood supply and won’t heal naturally. The outside of the meniscus has a blood supply from the synovial capsule. Lateral meniscal tears may heal without the need for surgery.
The inside of the meniscus gets its nutrition from the synovial fluid. Due to this, tears of the inner meniscus do not usually heal due to a lack of blood supply to trigger an inflammatory response. These injuries often require surgery.Treatment Options for a Knee Meniscus Tear
A small meniscus tear, or a tear in the red zone, will usually respond quickly to physiotherapy treatment.
One of the major roles of your meniscus is shock-absorption. Luckily, the other vital shock absorbers around your knee are your muscles. Researchers have discovered that if you strengthening your leg muscles, your bone stresses will reduce as your muscle strength improves and your knee becomes more dynamically stable.
Your physiotherapy treatment will aim to:
• Reduce pain and inflammation.
• Normalise joint range of motion.
• Strengthen your knee: esp quadriceps (esp VMO) and hamstrings.
• Strengthen your lower limb: calves, hip and pelvis muscles.
• Improve patello-femoral (knee cap) alignment.
• Normalise your muscle lengths Improve your proprioception and balance Improve your technique and function eg walking, running, squatting, hopping and landing.
• Minimise your chance of re-injury.
• Meniscal injuries are commonly associated with other knee injuries, which need to be treated in conjunction with your meniscal tear.
How Long Does Meniscal Healing Take?
Your meniscal tear will commonly take up to six or eight weeks to fully heal. As mentioned previously, some meniscal tears will require surgery.
Your physiotherapist will guide you as to what is most likely for your knee injury.
It is important to avoid activities and exercises that place excessive stress through your meniscus and further delay your healing. In some cases, your physiotherapist may advise you to keep weight off your knee. In this instances, crutches may be recommended.
Everyone is different, so be guided by your physiotherapist.
Will You Require Surgery for a Meniscus Injury?
Most surgeons will recommend a few weeks of physiotherapy treatment prior to contemplating surgery.
Pre-operative physiotherapy has two main benefits:
• Successfully rehabilitating your knee injury without the need for surgery.
• Strengthening your knee to better prepare you for your post-operative rehabilitation.
If surgery is required, surgery is usually performed arthroscopically (via a fibre-optic camera about the size of a pencil) to either resect (remove) the torn fragment or repair (stitch) a tear in the outer zone.
Generally, the best treatment option is to repair the torn meniscus and save as much of the shock absorber as possible. This will leave you with near “normal” structures and decrease the likelihood of degenerative arthritic changes in later life.
Post-Surgical Physiotherapy for Meniscal Injuries
Resected Meniscal Tears
Physiotherapy rehabilitation for resected meniscal tears can normally be reasonably aggressive, targeting early return to function. You will be progressed through rehabilitation as your pain and swelling allow. Most arthroscopic patients can return to normal function within 3 to 6 weeks.
Rehabilitation after a meniscus repair is usually different than a resection due to healing time require where a meniscus has been stitched. Most surgeons will have you non-weight bearing for 4 to 8 weeks to allow the meniscus to heal before commencing weight-bearing exercises.
Physiotherapy rehabilitation should focus on early mobilisation of the knee (tibiofemoral) and kneecap (patellofemoral) joints, plus strengthening of your quadriceps, hamstrings and leg muscles.
Your treatment guidelines will be similar to the nonoperative approach taking into consideration the findings and operative procedures performed. For more specific information, please ask your physiotherapist.
In other words, any sport that involves running, jumping,squatting and landing.
Plus, the non-sporting person can even experience kneecap pain when descending or ascending stairs.
The condition usually results from either acute injury to the patella joint surface or from chronic friction between the patella and the groove in the femur (thigh bone) through which it passes as the knee bends.
Potential causes include a tight lateral knee structures such as the ITB, weak medial quadriceps (vastus medialis oblique – VMO), overpronating feet and weak lateral hip rotator muscles. These muscle imbalances result in a rotational instability that causes the patella to be laterally aligned in the femoral groove, which causes pain for the malalignment.
The good news is that patellar maltracking is very quickly fixed with physiotherapy assessment and intervention. Commonly, patients can leave the clinic pain-free after just one treatment session.
A contusion is very common in contact sports. In simple teams, your thigh muscles are usually “kneed” by an opponent during a tackle or similar impact. The muscle is crushed against the underlying bone. The impact to the muscles causes significant bruising and bleeding both intramuscularly and also between the muscle and your femur (thigh bone).
It’s damage can often be much more than you might expect for such a simple cause and these injuries should be treated with respect. If not treated correctly or if treated too aggressively then myositis ossificans may result.There are Two Types of Contusion
This is a tearing of the muscle within the sheath that surrounds it. This means that the initial bleeding may stop early (within hours) because of increased pressure within the muscle. However, the fluid is unable to escape as the muscle sheath prevents it. The result is considerable loss of muscle function, power and pain which can take days or weeks to recover. You are not likely to see any bruising come out with this type – especially in the early stages. Physiotherapy and carefully performed Massage Therapy are highly recommended for a speedy recovery. These interventions are important to prevent functional morbidity related to the large compression issues and myositis ossificans.
This is a tearing of the muscle and part of the sheath surrounding it. This means that the initial bleeding will take longer to stop especially if you do not ice it. However recovery is often faster than intramuscular as the blood and fluids can flow away from the site of injury. You are more likely to see bruising come out with this one. These injuries respond very well to physiotherapy and massage.
What are the Symptoms of a Contusion?
Pain after being whacked in the leg.
You might get swelling or bruising.
Restricted movement and reduced power.
Seek professional help quickly if you can. Otherwise implement a RICE regime until you can be assessed.
After two to three days check:
If the swelling has not gone then you probably have an intramuscular injury.
If the bleeding has spread and caused bruising away from the site of the injury then you probably have an intermuscular injury.
If you are more able to contract the muscle you probably have an intermuscular injury.
Can you feel a deformation in the muscle or a gap? If so, please seek professional assessment.
It is important the correct diagnosis is made. If you try to exercise on a complete rupture, or a bad intramuscular injury you can inhibit healing, make things worse or cause permanent disability.
If you apply heat and massage in the early stages then you could get myositis ossificans(or bone forming within the muscle), then you are in trouble. Myositis ossificans can result in months or years away from sport.
Contusions are Graded 1, 2 or 3 depending on the Severity.
What does it feel like?
Tightness in the thigh.
Unable to walk properly.
Probably not much swelling.
Trying to straighten the knee against resistance probably won’t produce much pain.
Lying on front and bending the knee should allow you nearly a full range of motion.
What does it feel like?
Probably cannot walk properly.
Occasional sudden twinges of pain during activity.
Pressing in causes pain.
Straightening the knee against resistance causes pain.
Unable to fully bend the knee.
What does it feel like?
You will be unable to walk properly without the aid of crutches.
You will be in severe pain.
You will have bad swelling appear immediately.
A static contraction will be painful and might produce a bulge in the muscle.
Expect to be out of competition for 3 to twelve weeks.
What Can the Athlete Do?
Seek medical attention immediately. R.I.C.E. (Rest, Ice, Compress, Elevate.) Use crutches.
A thigh strain refers to an injury where the fibres in a quadriceps muscles are overstretched. Once the fibers are overstretched to a certain point, muscle tears occur. These can vary from a minor strain to a full thickness muscle tear.What Causes a Thigh Strain?
There are a number of factors which can increase your risk of straining your thigh muscles.
The most common include:
• Muscle tightness
• Muscle fatigue
• Muscle imbalances
• Incorrect exercise technique
• Inadequate warm up period
• History of thigh strain/tear without adequate rehabilitation
What are the Symptoms of a Thigh Strain?
Pain during activities which engage the affected thigh muscle, e.g. walking, going up/down stairs, sit to stand, kicking.
“Pulling pain” or a tugging sensation with stretching of the affected muscle eg heel to bottom.
Swelling, bruising or thigh tenderness.
Audible “pop” or snapping sensation at the time of injury, which may indicate a major tear or rupture.
How is a Thigh Strain Diagnosed?
On examination, your physiotherapist will look for signs of a thigh strain. If further assessment is required, an ultrasound or MRI may be used to confirm the location and severity of the injury.
What is the Treatment for a Thigh Strain?
Your physiotherapy treatment will aim to:
Reduce pain and inflammation.
Protect your injury.
Normalise joint range of motion.
Strengthen your knee and leg: esp quadriceps (esp VMO) and hamstrings.
Monitor patellofemoral (knee cap) alignment.
Normalise your muscle lengths and neurodynamics.
Improve your proprioception, agility and balance.
Improve your technique and function eg walking, running, squatting, hopping and landing.
Minimise your chance of re-injury.
Depending on the severity of your thigh strain, the rehabilitation process generally take up to six weeks. It is important to complete the full treatment plan as directed by your physiotherapist to reduce the risk of re-injury or ongoing thigh problems.
How to Prevent a Thigh Strain
There are a number of things you can do to reduce your risk of developing a thigh strain. These include:
Adequate warm up and stretching prior to exercise or post-exercise.
Gradual increase in your exercise intensity or volume.
Monitor your athletic technique.
Benefit from regular leg massages.
Complete full rehabilitation programs following any injury to the lower limb.
For more advice, please consult with your sports physiotherapist.
Return to Sport with a Thigh Strain
The majority of patients generally make a full recovery post-thigh strain and are able to return to their previous sporting activities. The time frame for returning to sport is dependent on the degree of your injury. It is very important to complete your full rehabilitation program as prescribed by your physiotherapist to reduce your risk of complications when you return to your chosen sport and re-injury.
Surgery is rarely required except where major thigh muscle rupture occurs.
For more information, please ask the advice of your physiotherapist.
You have four hamstring muscles: semimembranosus and semitendinosus (medially) and biceps femoris – short and long heads (laterally). What Causes a Hamstring Strain?
Common reasons for hamstring strain or injury can be categorised as primary or secondary.
Poor timing-intermuscular coordination and eccentric strength in the hamstring muscles during the switch between late leg recovery and initial leg approach in the swing phase of sprinting Lack of “stiffness” and eccentric strength in the hamstring muscles during the ground contact phase of running “Stiffness” refers to the ability of the hamstring muscle to absorb shock and rebound. Dropping a golf ball onto concrete is an example of stiffness, it immediately rebounds off the surface.
Previous hamstring strain is a very good indicator of potential for future injury
Poor running mechanics. This consists primarily of overstriding or poor pelvic control, which puts the hamstrings in a vulnerable position at ground contact.
Improper warm-up. Your warm-up must be active and dynamic to prepare the hamstring muscles for the forces involved. Passive stretching is only one segment of warm-up.
Inappropriate training loads. Your hamstrings are primarily fast twitch Type II fibres that fatigue quickly. High speed work should be done early in workout, as close to warm-up as possible to avoid fatigue.
Fatigue (neural and local muscle).
Lower back pathology. Abnormalities of the lumbar spine or poor pelvic control that can cause nerve dysfunction and subsequent muscle weakness can predispose you to injury.
Playing surfaces. A wet slippery surface will put more strain on the hamstring due to slipping.
What are the Symptoms of a Hamstring Strain?
Mild hamstring strains may feel more like a tightness or low grade ache in your hamstring. Severe hamstring strains can be extremely painful, making it impossible to walk or even stand.
Other possible symptoms of a hamstring strain are:
• Sudden and severe pain during exercise, along with a snapping or popping feeling.
• Pain in the back of the thigh and lower buttock when walking, straightening the leg, or bending over.
• Hamstring tenderness.
How is a Hamstring Strain Diagnosed?
On examination, your physiotherapist or sports doctor will look for signs of pain on hamstring contraction, reduced hamstring flexibility, tenderness or a palpable lump or gap within the hamstring muscle bulk. Pulled hamstrings are graded 1, 2 or 3 depending on severity.
Grade 1 Hamstring Strain
With a grade 1 hamstring strain you may have tightness in back of the thigh but will be able to walk normally. You will be aware of some hamstring discomfort and unable to run at full speed. There will be mild swelling and spasm. Bend your knee against resistance is unlikely to reproduce much pain.
Grade 2 Hamstring Strain
With a grade 2 hamstring strain your walking pattern will be affected and you will most likely be limping. Sudden twinges of hamstring pain during activity will be present. You may notice some hamstring muscle swelling and your hamstring will be tender to palpate. It will also be painful for you to bend your knee against resistance.
Grade 3 Hamstring Strain
A grade 3 hamstring strain is a severe injury involving a tear to half or all of the hamstring muscle. You may need crutches to walk and will feel severe pain and weakness in the muscle. Swelling will be noticeable immediately and bruising will usually appear within 24 hours.
Diagnostic MRI may also be used to specifically identify the grade of hamstring tear and its exact location.
Beware of Referred Hamstring Pain!
Due to your sciatic nerve passing through the hamstring muscle group, a lower back injury or some other injury that pinches the sciatic nerve can replicate the symptoms. It is therefore vital that you seek a professional diagnosis from an expert in hamstring and back injuries.
Hamstring Strain Treatment
Many patients with a hamstring start to feel better within a few days of the injury. However, there is an extremely high hamstring re-injury rate due to a poor rehabilitation process.
Hamstring strains are one injury that professional guidance is highly recommended for both an accurate diagnosis but also provide you with the best chance of avoiding repeat hamstring injuries.
Repeat hamstring injuries have unfortunately curtailed many a bidding athlete’s career.
Hamstring Physiotherapy Treatment
Your physiotherapy treatment will aim to:
Reduce hamstring pain and inflammation.
Normalise your muscle range of motion and extensibility.
Strengthen your knee muscles and hamstrings.
Strengthen your lower limb muscles: calves, hip and pelvis muscles.
Normalise lumbo-pelvic control and stability – a co-factor in many hamstring strains.
Normalise your neurodynamics to enable your sciatic nerve to pass freely without scar adhesions.
Improve your game speed, proprioception, agility and balance.
Improve your technique and function eg running, sprinting, jumping, hopping and landing.
Minimise your chance of hamstring re-injury.
Kinesio Taping for a Hamstring Strain
Many patients will try a thigh support or kinesio taping for hamstring strains. They provide confidence, warmth and proprioceptive feedback, which should reduce your likelihood of hamstring re-injury.
Hamstring surgery is rarely required. It appears limited to complete ruptures or to remove scar tissue from chronic hamstring tears.
Hamstring Strain Recovery Times
While every hamstring injury and the demands of your sport differ, here are some general hamstring strain recovery times when you follow an optimal physiotherapist-guided rehabilitation program.
Grade 1 – 1 to 3 weeks
Grade 2 – 4 to 8 weeks
Grade 3 – 3 to 6 months. These may also require surgery.
For more information, please ask the advice of your physiotherapist.
The ITB attaches to a bony protuberance (femoral condyle) on the outside of the knee. It slides forwards and backwards across this bony point with movement. This repetitive sliding can create excess friction, especially when the knee is bent at 30 degrees, which commonly happens just as your foot strikes the ground in running. This region of 30 degrees of knee flexion is called an “Impingement Zone” or pinching of irritated structures over the outside of the knee, thereby producing ITB Friction Syndrome.What is the Iliotibial Band?
The ITB, or iliotibial band, is a long, thin band of fascia that runs down the outside of your thigh. At the top of your thigh it is attached to your Tensor Fascia Latae (TFL) muscle, and Gluteus Maximus and at the bottom it attaches to your tibia (lower leg bone) and femoral condyle on lower outside portion of the thigh bone.
What Causes ITB Syndrome?
Essentially ITB friction syndrome is caused by altered running biomechanics due to underlying muscular imbalances.Your biomechanics can alter due to a muscle imbalance (weakness or tightness), fatigue and ground impact issues.
The most common causes include:
Poor biomechanics (running technique); particularly inwards rolling knees and hips
Weak hip / gluteal muscles
Weak hip rotators
Weak inner quadriceps
Weak core muscles
Poor foot arch control
Worn out or unsuitable runners
Sudden increase in mileage for training
Excessive hill training (particularly downhill)
Endurance running (training for ½. and full marathons, ultra-marathons)
What are the Symptoms of ITB Syndrome?
There are varying degrees of severity of ITB Friction Syndrome. The most common symptoms include:
• Sharp or burning pain just above the outer part of the knee
• Pain that worsens with continuance of running or other repetitive activities
• Swelling over the outside of the knee.
• Pain during early knee bending
• Gradual onset of symptoms which if they persist for greater than 4 weeks can cause major sport or activity interference.
How is ITB Syndrome Diagnosed?
On examination, your physiotherapist or sports doctor will look for signs of ITB Friction Syndrome. The important diagnosis is discovering “what is causing” the problem. If this isn’t determined ITB friction syndrome will persist on a return to running.
With a thorough assessment, further investigations, such as scans are not required.
ITB Syndrome Treatment
Many patients with ITB Friction Syndrome start to feel better within a few weeks of the injury. Your physiotherapy treatment will aim to:
• Diagnosis the actual cause of your ITB friction syndrome.
• Reduce acute pain and inflammation.
• Deload your IT band.
• Assist you with modifying your exercise or training regime to reduce pain and prevent recurrence.
• Normalise joint range of motion or your hip.
• Strengthen your knee, hip and leg muscles
• Normalise your lower limb muscle lengths.
• Improve your proprioception, agility and balance.
• Correct your running and landing technique and function.
In severe cases, some patients choose to undergo a surgical release of the iliotibial band which is called a Z-lengthening procedure. It entails removal of the irritating piece of structure that overlies the femoral condyle on the outside of the knee. This is a last resort as most cases respond well to conservative treatment or physiotherapy.
Post-operative rehabilitation is one of the most important, yet too often neglected, aspects of surgery. The most successful and quickest outcomes result from the guidance and supervision of an experienced Sports Physiotherapist. Risks of surgery include infection, persistent instability and pain, stiffness, and difficulty returning to your previous level of activity.
For more information, please ask the advice of your physiotherapist.
For any of these injuries or conditions, contact us for an assessment