By Physio Team Appointments & Fees, Exercises, knee pain, ligament damage, ligaments, Lockdown, lockdown wellbeing, MCL knee pain, MCL ligament, medial knee pain, muscles, online consultations, pain management, physical health, Physio, Sprain, surgery, Therapy #injury, #leginjury, #physio, #physiotherapy, #rehab, Blog, Clinic, evidence based, exercise, exercises, Injury, Knee exercises, Knee joint, Knee pain blog, Knee strengthening, MCL damage, MCL sprain, medial knee pain, online consultation, physiotherapy, rehabilitation, sporting injury, Therapy

Managing your Medial Knee Pain: MCL injuries

What is it?

Although your knee has free movement going forwards and backwards, its’ sideward movements are restricted by the robust collateral ligaments on either sides of your knee. The medial collateral ligament (MCL) is situated on the inner part of your knee, but on the outside of your joint. The MCL connects the top of your shinbone (tibia) to the bottom of your femur (thighbone). It helps hold your bones together, provides stability and prevents your knee from bending sideways away from your body.

Injuries to the MCL are from the result of a direct blow to the outer part of your knee- and is most commonly seen in contact sports such as football and soccer. These injures may either over-stretch or cause a tear in the ligament. Whilst surgery may be needed in some severe cases, it is not always the go-to form of management.

Read on to know how physiotherapy can help manage your MCL related-knee pain.

Mechanism of Injury

Injury to the MCL typically occurs when a force drives the lower leg in a sideward direction away from your upper leg and body. Awkwardly landing from a height, twisting of your knee with your foot fixated to the ground, or from a direct blow to the outer part of your knee- most commonly seen in contact sports, are frequent causes of injury to the MCL.

Grading of MCL Injuries

MCL injuries are often graded using the system below:

Grade 1: Regarded as a minor injury- means that the MCL has been overstretched but not torn

Grade 2: Regarded as a moderate injury- means that there is a partial tear in MCL, and presents with some degree of instability in the knee

Grade 3: Regarded as a severe injury- means that the MCL has completely ruptured/torn, and presents with noticeable joint instability

Often 3 MCL injuries are associated with concurrent medial meniscus and ACL ligament damage, which may need surgical intervention. But, the good news is that most MCL injuries may be treated well with conservative physiotherapy management. It usually takes between 2-8 weeks for Grade 1 and 2 MCL injuries to heal, and a graduated rehabilitation programme is highly commended for prevention of future injury.

Signs and Symptoms

Because injury to the MCL may present with similar symptoms as with other knee injuries such as ACL damage, it is vital to have a medical professional such as your physiotherapist evaluate your injury.

Common symptoms of an MCL injury may include:

Tenderness and pain along in the inner part of your knee
Swelling in the knee
Experience catching and locking sensations in the knee joint
A ‘pop’ sound at the time of injury
Actual or feeling of giving way of the knee (often indicate grade 2 or 3 injury)

Diagnosis

Your physiotherapist will discuss your injury and its presenting symptoms, past medical history (including a history of any prior knee injuries) and will also undertake a thorough physical examination. During the physical examination, your physiotherapist will assess the structures of your injured knee and compare them to the non-injured side. The range of motion, strength and stability of your knee will be assessed. You may be referred on for imaging such as X-rays and Ultrasounds to help aid the diagnosis. For more severe MCL injuries, and if your symptoms do not resolve with conservative physiotherapy management, you may be referred onto a specialist who may consider referring you for an MRI to get a deeper look at your knee.

Management

The management options for MCL injuries will be dependent on the severity of the injury. In the initial stages of injury, management is focused on controlling swelling and pain, whilst allowing your body to initiate healing processes via inflammation. This is typically achieved through the P.O.L.I.C.E. principles (Protect, Optimal Loading, Ice, Compression and Elevation).

Over the counter medication such as ibuprofen and paracetamol may be taken to reduce pain. Other stronger painkillers and NSAIDs may be prescribed by your doctor to help reduce swelling and inflammation as well.

After assessing your knee, your physiotherapist will frame a rehabilitation programme with exercises tailored to your needs. The purpose of physiotherapy is to help restore your knee’s range of motion, stability and strength, which in turn will then allow you to safely return to your usual day-to-day and sporting activities as soon as possible.

Management of most MCL injuries usually only involves knee bracing and physiotherapy treatment. However, in some cases, surgery may be recommended. Particularly if there is damage to more than one ligament or structure in your knee or if you continue to experience instability in spite of physiotherapy.

August 28, 2021

By Physio Team Appointments & Fees, body parts, bones, Exercises, feet, flat feet, foot, Home exercises, Injury, ligaments, muscles, online consultations, orthotics, pain, Physio, rehabilitation, Sprain, tendon, Therapy #injury, #leginjury, #physiotherapy, #rehab, #runners, #runninginjuries, feet, feet correction, fix flat feet, flat feet, Injury, Knee strengthening, mental health, online consultation, pain, physical activity, rehabilitation

The myth about foot pronation (flat foot)

Myth: Foot pronation(flat foot) is the enemy.

Quest - Article - Surgery Sometimes, Bracing Often, Caution Always | Muscular Dystrophy Association

In the foot, pronation should occur naturally when the foot comes into contact with the ground. Pronation will appear as the foot rolling inward and the arch flattening.

What are the benefits?

Dissipates the force that the foot receives from the ground
Allows the foot to become a stable and mobile adaptor to enhance movement opportunity
Loads the muscles of the extensor chain (calf, quads, glutes) to convert ground reaction forces into forward momentum so we can propel efficiently.

So why have I been told this is bad?

So as you are now aware, pronation is very normal and a critical movement to ensure we move and propel ourselves forward efficiently.

What you may have heard someone say to you is that you ‘overpronate’?

Firstly, overpronation is subjective and not as black and white as it is sometimes made out to be. Overpronation has be defined as: ‘a foot that rolls inward toward the arch excessively’.

Foot Pronation: Underpronation & overpronation explained- The Foot Clinic

What we must understand is that a pronation can only happen when the foot has a stable tripod on the ground. This means that the calcaneus (heel bone), 1st metatarsal (big toe knuckle), 5th metatarsal (little toe knuckle) must all remain in contact when the foot rolls inwards and the arch flattens.

So, If you have been told you are ‘overpronated’ , it is most likely that your whole foot is ‘everting’ NOT ‘overpronating’.

What is Eversion?

Eversion can be defined as: ‘the process of turning inside-out’.

In pronation your heel must naturally ‘evert’ (sole of the heel will move away from the midline of the body) NOT your whole foot.

If your ‘whole foot’ everts (turns out) you will no longer have a stable foot tripod as the 5th metatarsal (little toe) will lose contact with the ground.

The key to ensuring this does not happen is to provide an environment for the bones of the midfoot (middle of the foot) and forefoot (toes) to experience the opposite motion to that of the heel. This will mean that the foot has an opportunity to truly pronate with a tripod on the ground.

So how can you help me do that?

At Physio fusion we can help you to bring your own body into alignment and create an environment in which the healing can begin
Foot strengthening exercises
Footwear advice
Referral to other healthcare specialists for further assistance (e.g. podiatrists)

To find your nearest Physio Fusion clinic and book an appointment call 09 6266186 or visit our website https://physiofusion.co.nz

August 5, 2021

By Physio Team Exercises, Injury, Physio, Sporting, Sprain, Therapy, Work Injury Knee exercises, Knee injury, Knee joint, Knee pain blog, Knee sprain, Knee strengthening, Physio for knee, physiotherapy

KNEE PAIN

Knee pain is one of the most common musculoskeletal complaints that affects peoples of all ages.
Knee pain can result from injuries of traumatic nature or due to complications from medical conditions.

Depending on the structures involved, pain can be localized to a specific area or be felt all
around the knee.

ANATOMY OF KNEE

The knee joint is a hinge joint. Other than bearing the weight of the body, it’s primary function is to bend, straighten and rotate to a small degree. To achieve this function, the knee joint relies on a number of structures.

Bones

Knee joint consists of four bones to provide structure and weight-bearing ability.

Lower end of thigh bone (femur)
Upper part of shin bone (tibia)
Knee cap (patella)
Fibula (not involved in weight-bearing, but provides attachments for ligaments and tendons)

Ligaments

Four important ligaments connect the two big bones, providing multi-directional stability.

Cruciate ligaments

Anterior cruciate ligament (ACL)

Posterior cruciate ligament (PCL)

Collateral ligaments

Medial collateral ligament (MCL)

Lateral collateral ligament (LCL)

Cartilage

Glossy cartilage lines the end of each bone to protect and allow smooth movements against each other with almost no friction.
Meniscus is another type of strong cartilage that lines the upper surface of the tibia bone to cushion and stabilize the knee.

Tendons

There are two important tendons located on the front of the knee joint.

Quadriceps tendon is a strong durable tissue that extends from the quadriceps muscle and connects it to the knee cap.
Patella tendon connects the knee cap to the tibia bone.

Bursa

Bursa are fluid filled sacs that are found in areas that require the most protection. They occur where ligaments, muscles, skins, tendons or bones rub together.

Muscles

Many muscles cross the knee joint, some of which cross from the hip or ankle joints. Due to this, some people may experience knee pain as a result of muscle imbalances such as weakness, poor flexibility and or dynamic control.

CAUSE OF PAIN

Some of the common causes of knee pain include:

Ligamentous sprain
Meniscus injuries (bulge or tears)
Fracture or dislocation
Tendinitis, Sprains
Bursitis
Calcification
Baker’s cyst
Arthritis (osteoarthritis)
Overuse syndromes (patella-femoral syndrome, chondromalacia)
Autoimmune conditions (Infection, Gout, Lupus, rheumatoid arthritis)

WHEN TO SEEK HELP

Consult your doctor or physiotherapist if your symptoms have not subsided after one-week of consistent self-management (RICE, pain medications or alternative pain-relieving modalities), or if your knee pain is stopping you from managing your hobbies or day to day activities.

Immediate medical attention:

Knee pain from with the following signs and symptoms may require immediate attention:

Severe pain
Pain that does not resolve with rest
Sudden swelling or bruising
Clicking or locking of the knee
Inability to bend or straighten the knee
Inability to weight bear

SIGNS AND SYMPTOMS

Pain
Swelling
Bruising
Stiffness
Clicking, locking
Redness

DIAGNOSIS:

Treatment of your knee pain will depend on its underlying cause. So, it is all about the diagnosis.

A focused subjective and physical examination of your knee will be performed by your physiotherapist.

Subjective

Your physiotherapist will ask a range of questions

Location of pain – front or behind the knee
Description of pain – dull ache or sharp
The behavior of pain – constant or intermittent
Aggravating and easing factors
General health
Goals of treatment

Physical assessment

Your physiotherapist will inspect your knee joint to diagnose the source and the potential underlying cause(s) of pain.

You may be referred to have radiological Imaging to make or confirm the diagnosis.

Radiology

TREATMENT

In most cases, individuals suffering from knee pain respond well to conservative modes of treatment (pain relief, physiotherapy, acupuncture, etc). Surgical intervention may be required where conservative management has failed to optimize function and reduce pain.

CONSERVATIVE MANAGEMENT

A self-management remedy to control inflammation (pain and swelling) in acute or chronic knee pain is using the ‘RICE’ principle (rest, ice, compress, elevate)

Rest – refrain from activities that impose repetitive strain or aggravation of knee pain
Ice – use an ice pack for 10-15 minutes, 2 to 3 times per day (with care)
Compress – use a compression bandage to reduce swelling (not to be worn when sleeping)
Elevate – using pillows elevate injured leg. This works best when the leg is higher than the level of heart, to use gravity to help facilitate the circulation of fluid.

Pain medications

Over the counter pain relievers such as non-steroidal anti-inflammatory medications (ibuprofen, celecoxib) play an important role in reducing inflammation and pain.

(Note: If you have problems with bleeding, stomach ulcers or other liver, kidney conditions, anti-inflammatory medications MUST NOT be consumed without consulting your doctor.

Visit your general practitioner for more information on what medications are right for you.

Physiotherapy

After establishing your diagnostic findings, your physiotherapist will devise a tailored recovery programme to help you manage your pain, improve strength and flexibility.

Your physiotherapist will work with you to advance your understanding of your symptoms and provide a range of exercises, stretches and self-managing strategies that will help you be in control of your recovery.

As required, your therapist may liaise with your doctor or other health professionals (acupuncturist, podiatrist, knee specialists) to facilitate your progress.

Acupuncture/Acupressure

Acupuncture and acupressure are two different options available for individuals suffering from pain and swelling. While both aim to help control inflammation and fasten healing and recovery, acupuncture involves inserting thin needles into the body, whereas acupressure relies on hand pressure and some forms of massage.

Steroid Injection

In some instances, knee injections are recommended by your physiotherapist or doctor to reduce inflammation and relieve pain.

SURGERY

Surgical intervention may be required where conservative management has failed to optimize function and reduce pain. In this case your physiotherapist will refer you to a surgeon for the opinion of care.

EXERCISES FOR KNEE PAIN

The thought of exercise when you have knee pain can be daunting. However, your trusted physiotherapist will work with you to provide specific ‘pain-free’ exercises to get you started on effective strengthening.

Alternatively, low-impact activities such as cycling or elliptical machines are great. Notice what feels right for you. Swimming, jogging in water, or water aerobics may be appropriate if skin integrity is maintained.

Note: muscle soreness after a hard workout is normal.

If you experience sharp, shooting, or sudden knee pain you must consult your physiotherapist or doctor.

Tag: Knee strengthening