A primer on knee injuries for the clinically inclined
Knee injuries have plagued athletes over the years, often hindering performance and sometimes ending careers. As if his woes on and off the links is not enough, Tiger Woods has had his share of knee problems. In June 2008, he underwent reconstructive knee surgery, which sidelined him for eight months. Last month, Tiger sprained his left medial collateral ligament (MCL) of the knee at the Masters. This injury, along with a sprained Achilles tendon, forced him out of the Players Championship last month.
Most knee ligament injuries result from the knee being struck from a specific direction. In sports such as football and basketball, agility and quickness is essential for success. The combination of running, jumping and changing directions quickly can put considerable stress on the knees.
Ligament stretching or tears are called sprains. In a first-degree sprain, the ligaments stretch but the fibres do not tear. In a second-degree sprain the fibres tear partially, but the ligament keeps some integrity. Second-degree sprains (grade 1) are similar to first-degree sprains, while the more severe second degree sprain (grade 2) is closer to a third-degree sprain. In a third-degree sprain, the ligament is completely ruptured.
Sometimes, the ligaments in the knee can get damaged without a blow to the knee. For instance, an athlete may change directions suddenly and hear a “pop” with their knee giving out. This is most likely an anterior cruciate ligament tear (ACL). ACL injuries occur more often in women than in men. One theory is women have a wider Q (Quadriceps)-angle. Basically this means that women have a wider pelvis which may put more stress on the knees. If you want to measure your own Q-angle, draw a straight from the Anterior Superior Iliac Spine (ASIS) – which is the bone in front of the hip, to the centre of the kneecap and then to the bump below it called the tibial tuberostity.
Medial collateral ligament (MCL) injuries are caused when the outside of the knee is struck while the foot is planted on the ground, pushing the knee inward. If the blow is vast enough the ACL and, or medial meniscus (cartilage that attaches to MCL) may also be torn. When all three structures are damaged, this is known as a terrible triad.
Lateral collateral ligament (LCL) injuries occur less often than MCL injuries. This is because the force is directed to the medial aspect of the knee, forcing the knee outward. The opposite leg is normally in the way, protecting the medial side of the knee.
Posterior cruciate ligament (PCL) can be injured by a forceful landing on the tibial tuberosity, while the knee is flexed at 90°. This may drive the tibia (bone in lower leg) backwards on the femur (thigh bone) rupturing the ligament. The PCL can also be injured in combination with either an MCL or LCL injury.
A first-degree sprain is treated with RICE (rest, ice, compression, and elevation), rehabilitative exercises and possibly protective bracing.
A second-degree sprain (grade 1) should be treated similarly to a first-degree sprain, except a knee support should be used until the condition improves. A second-degree sprain (grade 2) should be treated with PRICEM (protective bracing, ice, compression and elevation) to control any swelling. Pain-free range-of-motion exercise can be introduced immediately. Crutches should be used until the knee has healed back to full strength. Surgery is rarely necessary.
Third-degree sprains may require surgery if more than one ligament has been damaged ie. terrible triad.
Sports Injury Therapy treatments after a knee injury, will strengthen the muscles around the knee and support the joints by decreasing the load on it. A sound rehabilitation routine may consist the following:
- Proprioception: The ability of the body to determine joint position in space
- Electrical muscle stimulation: To re-educate malfunctioning muscles
- *Cold laser therapy - To increase the production of Adenosine Triphosphate (ATP), which is the body’s energy source. This encourages cell division which facilitates speedy healing of tissues
- Other modalities – Ultrasound, Transcutaneous Electrical Nerve Stimulation (TENS)
*Previously, cold laser therapy was only available to individuals in Europe and to elite athletes in North America. The Theralase laser is by far the most effective laser in the industry. Used by the Toronto Blue Jays, Major League Baseball pitcher Roy Halliday and tennis’s superstar William sisters, bphealth clinics utilize the Theralase laser as an integral part of our patient’s healing process.
So, will Tiger’s professional golf career be in jeopardy, because of chronic knee problems?
With technology where it is today, Woods will be part of the PGA tour for a long time. As long as his mental approach to the game improves.