A Lateral Collateral ligament injury is when the varus force (bowing) on the knee is too great for the ligament to resist. This occurs during activities like a sudden change in direction, twisting your knee while your foot is fixed, when your knee hyperextends, or if there is a direct hit to your knee. A Lateral Collateral ligament tear usually occur at speed, and if it coincides with muscle weakness or knee instability, because it increases your risk. Just like a Medial Collateral ligament sprain on the inside of the knee, the Lateral Collateral ligament on the outside needs to be strong enough & able to withstand different forces to your knee. Let’s discuss this in more detail.
What is the Lateral Collateral Ligament made up of?
The Lateral Collateral ligament is a fibrous band on the outside of your knee. THe ligament is made up out of very strong cable-like collagen fibers. It originates from the lateral femoral epicondyle, this is the bony bump on the outside of your thigh just above the knee joint. It attaches to the head of the fibula which is the outside bone in your lower leg just below the knee joint.
It also forms part of the “posterolateral corner”. The biceps femoris tendon also anchors at this point.
What does Lateral Collateral Ligament do?
The Lateral Collateral ligament is one of the four ligaments that help stabilise your knee joint. Your Lateral Collateral ligament prevents excessive motion of your knee bowing inwards. While your knee is straight, your Lateral Collateral ligament stops our lower leg from collapsing inwards. It also prevents excessive outward rotation of the tibial bone. The ligament takes up slack when your foot is forced inwards in relation to the knee, or when the foot is planted and the knee is twisted outwards.
For example, when you play soccer and run towards the ball, someone kicks it to your left, you have to very suddenly change direction, your foot stays on the ground while your body starts turning outwards, and your knee twists outwards over your foot.
An Lateral Collateral ligament sprain only accounts for about 2% of all knee injuries. Sometimes it happens in conjunction with injury to the other structures on the outside of your knee, such as the lateral meniscus tears, Anterior Cruciate ligament tears or hamstring tears in the bip femoris muscle.
How does Lateral Collateral Ligament sprain happen?
A ligament sprain is a form of overstretching of the ligament. There are several classifications in which ligament sprains can be divided, depending on the severity (Degree or Grade 1, 2 or 3). The fibrous band is like a pulley, which prevents the joint moving into extreme ranges. But when the force is too big for the ligament to resist, the fibers will tear. Over stretching the Lateral Collateral ligament will result in tears & a sprain of your ligament.
It is very important to know and understand the difference and implications thereof. In the case of a tear, you may hear a snap or tearing sound. For example when a rugby player is tackled on his knee from the inside when his foot is firmly planted, the weight of the tackler will be in excess of what the Lateral Collateral ligament can resist. The force directed on the player’s knee is pushing his knee outwards. The Lateral Collateral ligament is at full stretch while a uncontrollable load is being forced on it, therefore this will thrust the ligament past its boundaries and cause the ligament to tear or completely rupture.
The collagen fibers tear like a rope. On a cellular level, injury will cause inflammation along the sheath of the ligament (a membrane that gives the ligament its nutrients – normal sustenance is disrupted). In turn, the inflammation causes swelling, pain and loss of function of the ligament, leaving the knee to buckle inwards. The swelling along the sheath contributes of loss of space around the ligament that restricts the normal slide of the ligament.
Ligament tears are indicated by Mucoid degeneration and fibrinoid necrosis (a type of cell death).
Causes of Lateral Collateral Ligament sprain
An Lateral Collateral ligament injury occurs mostly during sporting activities, but it doesn’t rule out the fact that it happen at work or just during a normal daily activity. For example, you are a soccer player, running towards the ball. An opponent comes from your left side, also running towards the ball, he collides with you and his knee hits you on the inside of your right knee. Your foot is planted in the ground at the time and thrusts your knee outwards. This puts the Lateral Collateral ligament at full strain. If the force exceeds the tension of the ligament the fibers start snapping & tearing, causing a Lateral Collateral ligament sprain.
When these mechanisms of injuries occur, they usually happen at speed, and if the knee stability muscles are not firing properly, the ligament will have to take up the slack, therefore it will increase your risk of an Lateral Collateral ligament sprain. If the ligament doesn’t get properly treated and rehabilitated, it could cause repetitive sprains.
A single, sudden, overload on the ligament will be classified as acute trauma, but repetitive straining of the ligament in excess of its abilities, will develop a persistent laxity of the ligament over and over again. The end result is a Chronic Lateral Collateral ligament injury. The ligament will end up in a cycle of constant damage leading from fatigue, strain and eventually tear or full rupture.
The Lateral Collateral ligament rarely ever gets injured in isolation, therefore it is important to consult with your physiotherapist in order to assess the surrounding structures as well.
How bad is it?
The symptoms of an Lateral Collateral ligament injury depend on the degree of stretch that is put on the ligament.
Grade 1 LCL sprain (mild)
Small amount of fibers torn, some discomfort and pain. The ligament only has a slight stretch. No swelling or much pain, but you may run into trouble if this starts happening over and over again. Recurrence of micro tears in the ligament could lead to more severe tears. You will have no loss of function or range of movement of your knee, but may be painful at some point during the movement. You will be able to continue playing.
Symptoms of a 1st degree LCL sprain
- Light stretch, no tear
- About 5/10 pain on the VAS scale
- Could get slightly swollen on the outside of the knee
- Mild tenderness over the area
- No instability/giving way of the knee
- No discolouration
Medical treatment
You will need to consult with a Physio to establish the extent of damage and accurate diagnosis. Physio treatment of a Gr 1 LCL sprain is very successful.
What you should do during this time:
- Rest from any activity that causes your pain
- Ice your knee
Grade 2 LCL tear (moderate)
Partial tear with some swelling and bruising. Pain level increases quite a bit from a grade I, and moving the knee will not occur without pain. It may feel uncomfortable to bend or straighten the knee and your knee may feel unstable and like it wants to “give way”. 20% to 80% of the fibers torn. You will not be able to put weight through the leg. Even if you try to continue playing, you will have considerable amount of pain and limping. The pain will not allow you to straighten your knee or lift your leg forward (knee to chest).
Symptoms of a 2nd degree LCL tear
- Partial tear of the ligament
- Swelling common
- Bruising (discolouration)
- High pain level
- Difficulty bending or straightening (flexing and extending) the knee
- Feeling of instability (giving way) when full weight bearing on injured side
- Fearful of putting full weight on affected side
Medical treatment
Contact us A.S.A.P. The faster we have a look at it before the swelling and bleeding sets in, the better. You have to consult with a Physio to establish the extent of damage and determine the most appropriate course of action. We can successfully restore your ligament without any surgical intervention.
- Use of a weight-bearing brace or supportive strapping will be used during this phase. This aids in avoiding overuse of the ligament and puts some pressure on the ligament to ease the pain.
- Physiotherapy management during this grade will be the same as with a grade I, progression will be expected to be slower.
- Comprehensive rehabilitation program addressing all the stages of recovery
- Expect return to activity to be no sooner than 6 weeks.
Grade 3 LCL tear (severe)
Complete tear. Swelling and discolouration (bleeding under the skin) is visible. The knee feels like it wants to give way completely. Bearing full weight is almost impossible. Bleeding and swelling will definitely be present.
The main concern with a Gr 3 tear, is the ligament’s ability to stabilize the knee joint, if the ligament tears into two separate flaps, there is no way the ligament can ‘heal’ or re-attach without surgery. A Sonar or Diagnostic Ultrasound will show the full extent of the damage. Surgery is the best option to re-connect the separated segments of the torn muscle.
Often there will be no pain, but the disfigurement is quite obvious, since all the fibers are torn. It is important to know that there could be other structures involved with such an injury, but we will discuss this in more detail with our differential diagnosis later.
Symptoms of a 3rd degree LCL tear
- Complete ligament rupture
- Swelling
- Bleeding under skin (red and blue discolouration)
- Unstable joint
- Can’t bear full weight on affected side
- Feeling of knee wanting to give way
- Either no pain, or severe pain that subsides quickly
- This injury usually increase the risk of other structures being injured as well (ACL, meniscus)
Medical treatment
Contact us immediately! The faster we have a look at it before the swelling and bleeding sets in, the better.
You have to consult with a Physio to establish the extent of damage and determine the most appropriate course of action.
What you should do during this time:
- You will be on crutches for up to 6 weeks, during which
- You will wear a hinged brace up to 6 weeks
- It is essential to see your physiotherapist for full rehabilitation of the knee, as it will become a very unstable joint if left untreated.
Selftest
If this position is painful going into it, the test is positive meaning you may have some degree of Lateral Collateral ligament tear.
Standing
- Stand on one leg
- Do a small squat (bend the knee slowly)
- You will either feel pain on the outside of your knee, or you wouldn’t want to stand on one leg, depending on the severity of your sprain
Kneeling
- Kneel with both knees on a mat or on the ground.
- Sit back onto your heels, you may only feel the pain when all of your weight is shifted backwards.
Stepping
- Stand on a step
- Step down with the affected leg staying on the step
- Your knee will feel like it wants to give way outwards or you’d have pain if there is a sprain
- Gently repeat trying to hold your knee inwards, and then repeat holding it outwards. Any difference?
Twisting
- Stand on your affected leg
- Bend it slightly
- Twist your body towards your knee
- Then twist your body away from the knee
- Either direction of twisting may cause pain
- Pain and/or instability will indicate a possible sprain
Diagnosis
Our Physiotherapists diagnose a ligament tear and sprain by placing stress on each individual ligament during our testing. Our physiotherapists are experts at detecting a Lateral Collateral ligament tear because we develop a fine dexterity for this type of injury. We test it by doing a few specific stretch and stress tests, after which we test the knee’s ability to bear Weight, Balance, Range of movement, Stability and Endurance of your knee. Other diagnostic tests:
X-ray
In this case, it is unnecessary to perform an x-ray, as the ligament will not show up on an x-ray and pathology will go undetected.
MRI
An MRI may be useful to rule out other injuries to the knee, for example, a meniscus injury, bursitis, ACL, Tendonitis’. But when a pure Lateral Collateral ligament injury is suspected, it is an unnecessary and expensive thing to do an MRI.
Sonar (Diagnostic Ultrasound)
This is the most cost effective diagnostic tool to determine an LCL sprain. The width of the ligament can be compared to that of the opposite side, and the degree of the tear is determined through a diagnostic ultrasound. We refer mostly for this type of diagnostic tool when it comes to ligament sprains, however, we can usually tell through our clinical tests whether we suspect a ligament injury or not.
Why is my knee pain not going away?
Maximal ligament strength will only return after about 6 weeks, when the collagen fibers have rearranged and matured.
Before this, the ligament can be prone to re-occurring injury or progression of the injury from a grade I to II or III. For example, if you sustained a grade I injury this past weekend during a soccer match, you have rested and iced it well. It feels better this week, and now, a few days later, you run onto the field. A player from your team kicks the ball to you, but just a few meters too wide, and at speed. You have to suddenly change direction. Your knee twists outwards while your foot stays in the ground for that second. The ligament is not ready to handle the load at this stage. At this point, you may have overloaded and overstretched the ligament to worsen your condition from a sprain to a tear.
It is always better to allow the full time for a ligament to heal until it is back to its normal state before getting back onto the sports field. Your physiotherapist will be able to assess and tell you exactly when this moment of readiness is.
A big problem we see with a Lateral Collateral ligament injury these days:
If you are asking yourself ‘why is it taking so long for the pain to go away’ then you might want to consider the following.
When a ligament tears, the body reacts similar to repairing an open wound. Let’s say for example, you have a cut on your thumb, but you keep writing with that hand. At this rate you are shearing away the cells that are closing the wound. The same principle applies. The more you put strain on the ligament, the longer it takes to heal.
Patients generally start running again because the pain “feels better” within 3 days. However, within these three days, you are disrupting the most vital part of the healing when participating too soon again, because you are “ripping the wound right open again”. This causes even more damage and will take even longer to heal. This is also the most common reason why patients consult us.
What makes Lateral Collateral ligament injury worse
- Straightening the knee through the pain
- Bending or ‘forcing ‘ the knee to bend
- Running – especially trail running (uneven surfaces)
- Climbing stairs (up and down)
- Jumping – especially on the landing
- Kneeling to fix the sink or getting something from the bottom drawer
- In the gym: leg press, knee extensions, side leg raises, squats, lunges.
Anti-inflammatories: to take them or not to take them?
If you are taking anti-inflammatory medication for your ligament tear, STOP taking them. Inflammation is the body’s natural way of healing the injured collagen fibers. The medication is preventing this process from taking place, not to mention, masking the effect of the trauma on the tissue if you return to running while still taking anti-inflammatory medications.
This is a bit of a “catch-22” situation. During healing, inflammation is necessary for the healing process to take place. But inflammation causes swelling, pain and discomfort in the joint. If your goal is to just have less pain, take the anti-inflammatories. If the goal is to heal the ligament quicker, leave the anti-inflammatories and allow the natural process of healing to take place.
Physio treatment for a LCL tear
Grade 1 Lateral Collateral Ligament sprain
Phase 1 (Week1)
Goals:
- To reduce swelling
- To get the knee to fully extend (straighten)
- To get the knee flexed (bent) more than 90 degrees
- Start pain free strengthening exercises
Rehabilitation:
- Pain free Passive stretches of the quads and hamstring muscles
- Static quad and hamstring strengthening exercises
- Isometric quad, hamstring, glute and calf exercises.
- Examples: calf raises, quads contractions on pillow, theraband resistance exercises- but come see us for a more specific exercise protocol and put us to the test!
Phase 2 (Week 1-2)
Goals:
- Get rid of swelling completely
- Restore full range of motion (ROM)
- Start jogging
Rehabilitation:
- Dynamic strengthening exercises introduced here
- Examples: knee flexions, extensions, step ups, half squats, single leg calf raises, bridging exercises
Phase 3 (Week 2-4)
Goals:
- Regain full strength
- Maintain Full ROM
- Introduce sport specific exercises/ exercises that allow you to get back to your daily activities completely like driving, climbing stairs and running
Rehabilitation:
- Adding more load/weight to activities
- Increasing the speed and agility of movements
- Examples: weighted squats, leg presses, plyometrics, sideways running drills
Phase 4 (week 3-6)
Goals:
- Maintaining full ROM, strength, agility, speed
- Adding endurance
- Performance based when dealing with a sports person (full time training and competition based)
Rehabilitation:
- Finally hopping, bouncing or jumping activities can be included here
Grade 2 or 3 Medial Collateral Ligament tear
Phase 1 (Week 1-4)
Goals:
- Control swelling
- Maintain full extension of knee
- Gain range to more than 90 degrees flexion
- Introduce strengthening exercises
- Maintain fitness (best suggestion would be a stationary bike).
Rehabilitation:
- Non weight bearing week 1-2 (use crutches)
- Partial weight bearing week 3-4
- Full weight bearing week 4 onwards
- Wear a brace that is set at 30 degrees
- Stretching, strengthening and mobility exercises will be done in the brace (knee extension should not be more than 30 degrees)
- Examples of exercises: static quads, hamstrings, calf raises, hip abductions
Phase 2 (Week 4-6)
Goals:
- Completely eliminate swelling
- Full weight bearing
- Full ROM
- Injured leg as strong as uninjured leg
Rehabilitation:
- Week 5: Knee brace set to 60 degrees
- Week 6: Remove knee brace (other knee support can be used at this time for compression, for example a knee guard, only to support knee during this transition phase for a week, no longer than that because we don’t want the knee to become dependent on external support)
- Examples of exercises: Quads and hamstring stretches, along with static and isometric quad exercises: leg presses, hamstring curls, step ups, calf raises. Upper body strength and endurance should be maintained, and general fitness kept by swimming or stationary bike. No breastroke though!
Phase 3 (Week 6-10)
Goals:
- Full ROM
- Strength
- Return to light jogging
- Return to sport specific exercises at week 10
- Return to full activities of daily living (walking, driving, getting in and out of bed without pain)
Rehabilitation:
- Light jogging after week 6
- Sideways running after week 8
Phase 4 (Week 10+)
Goals:
- Performance based when dealing with a sports person (full time training and competition based)
Rehabilitation:
- Plyometrics, hopping, jumping, agility, speed by week 10
What else could the condition be?
- ITB syndrome – Its a sharper pain that only comes on during running, and subsides.
- Pesa serines Bursitis – Pain on the insertion site of the Bicep Femoris muscle
- Lateral meniscus tear – This involves the disc on the outside of the knee joint.
- Peroneal nerve entrapment – nerve type pain radiating down the outside of the lower leg.
- Tibial plateau fracture – Fractures or avution may happen with a direct impact to your knee
- Head of fibula immobility – Superior Tibiofibular joint that helps turning the lower leg outwards.
- Popliteal muscle strain – A muscle controlling the knee to lock and unlock at the back of your knee.
- Peroneal sprain or tendinitis – A muscle in the lower leg that controls the foot movement anchors on the outside of your knee.
Lateral Collateral ligament injury, Lateral Collateral ligament sprain, Lateral Collateral ligament tear, knee LCL injury
This is the introduction to your article topic
- Use your key phrase in the first paragraph
- Bold your message take-away
- Capture your audience attention with a stats or interesting fact
The Anatomy of your
The Lateral Collateral Ligament (LCL)
Imagine a strong, slender rope on the outer side of your knee, connecting your thigh bone to a smaller leg bone (the fibula). This is the Lateral Collateral Ligament, or LCL for short. It acts like a stabilizer, preventing your knee from moving too much side-to-side, especially from bending outwards. Think of it as a security guard, ensuring your knee only moves in the directions it should.
Muscles Around the Knee
Around your knee, there are several powerful muscles. The most well-known are the quadriceps at the front of your thigh and the hamstrings at the back. These muscles are like the engine and brakes for your knee, helping you to move, bend, and straighten your leg. They work together to keep your knee stable and strong, especially when you’re walking, running, or jumping.
Other Ligaments in the Knee
Besides the LCL, your knee has three more main ligaments. On the inside, there’s the Medial Collateral Ligament (MCL), which works with the LCL to stop your knee from moving too far in or out. Deep in the center, the Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL) cross each other, controlling the forward and backward movements of your knee. These ligaments are like internal ropes, holding the knee joint tightly in place.
Menisci: The Knee’s Shock Absorbers
Inside your knee, you have two special, C-shaped pads called menisci. These act like cushions or shock absorbers between your thigh bone and shinbone. They help spread out the force when you walk or run, protecting your knee from stress. They also make sure your knee moves smoothly, a bit like jelly pads ensuring everything glides without any trouble.
The Full Picture: Your Knee Joint
All these parts — the LCL, muscles, other ligaments, and menisci — work together in the knee, one of your body’s most complex joints. It’s where your thigh bone meets your shinbone, with the kneecap in front as a shield
What does it do?
The Knee’s Side Guard
Think of the Lateral Collateral Ligament (LCL) as a guard standing on the side of your knee. Its job is to stop your knee from moving too much to the side, especially outward. It’s like having a friend who keeps you from stumbling sideways while you’re walking on a narrow path.
The Team Player
The LCL isn’t working alone; it’s part of a team. With buddies like the MCL on the inside and the ACL and PCL deep inside the knee, they all work together. This teamwork is what keeps your knee strong and stable, no matter if you’re running, jumping, or just walking around.
The Knee’s Safety Belt
When you’re playing sports or running around, the LCL is like a safety belt for your knee. It holds everything in place, especially on the outer side, making sure your knee doesn’t bend in ways it shouldn’t. It’s always there, working quietly to keep you safe while you’re having fun.
The Knee’s Feedback Friend
The LCL is also kind of like a messenger. It helps your knee sense where it is and what it’s doing, which is super important for moving smoothly. It’s like having a sixth sense for your knee, so you can move without having to think about every step.
The Balance Keeper
When you’re doing things like dancing, playing sports, or even just turning quickly, the LCL is like the balance keeper in your knee. It works with other parts of your knee to make sure everything stays aligned and balanced, helping you move confidently and gracefully.
I have a … How did it happen?
The Side Swipe
Imagine you’re playing a sport or simply walking, and suddenly you bump your knee’s outer side hard against something, or someone hits it from the side. This kind of hit is what usually causes an LCL injury. It’s like someone pushing you sideways when you’re not expecting it, and your knee takes the brunt of it.
Twist and Shout
Another way the LCL can get hurt is if your knee gets twisted while your foot is planted firmly on the ground. It’s like trying to turn quickly while your foot is stuck, and your knee feels the twist. This sudden twist can stretch the LCL too much or even tear it.
Overstretching
Sometimes, if you move your leg too far outward, the LCL can get overstretched. Think of it like pulling a rubber band too far – it can strain or even snap. This happens to the LCL when the knee is forced to bend in a way it’s not meant to.
The Breakdown
When the LCL gets hurt, it might just stretch too much, get partially torn, or in severe cases, completely tear apart. The severity depends on how much force your knee faced. It’s like a rope that’s frayed or snapped depending on how much pressure it’s under.
The Aftermath
Once the LCL is injured, your knee might feel wobbly or unstable, especially when you try to move sideways or do activities that need a lot of knee movement. Without the right care and rest, this injury can make simple things like walking or climbing stairs tough and painful. It’s important to take care of it so your knee can get back to being the strong and stable part of your leg it usually is.
Causes of
- Direct Blow to the Inner Knee: Imagine someone bumping into the inner side of your knee, or your knee hitting the ground or a hard object on that side. This kind of direct hit can strain or tear the LCL, which is on the outer side of your knee. It’s like pushing a door at its hinges, causing the opposite side to stretch too far.
- Twisting Movements: Picture twisting your lower leg outward while your foot is stuck in place. This twisting can pull and harm the LCL. It often happens in sports when you quickly turn or pivot.
- Hyperextension: Think about straightening your leg too much, more than it normally would. This over-straightening, or hyperextension, can also injure the LCL. It’s like bending a ruler backward until it starts to strain.
- Excessive Varus Stress: Imagine applying a force that pushes your knee inward, towards your other knee. This inward push puts stress on the LCL on the outside, potentially causing injury. It’s like bending a twig inwards until it snaps on the outer side.
This is the core message I want you to understand, think about after you’ve read this article
Stating something is in a bad state is Information.
Explaining the influence of a bad state is Knowledge.
Symptoms of
Symptoms are the words your patient will use – in a subjective assessment.
Try to resonate the exact words used by your patients to describe it to you. Then Read your symptoms again and imagine a patient reading it to you… (Does it fit into the Title Diagnosis) can you describe it even better (signs they haven’t even noticed yet)
How severe is the muscle spasm in my lower back?
Mild LCL Injury (Grade I)
In a mild LCL injury, you might feel some pain and tenderness on the outer side of your knee, but it’s not too bad. Usually, your knee won’t swell up much. When you move your knee in certain ways, like bending it sideways (what doctors call a varus test), it might hurt, but your knee won’t feel loose or unstable. This is the least severe type of LCL injury and generally means your ligament is strained but not torn.
Moderate LCL Injury (Grade II)
With a moderate LCL injury, things get a bit more painful. You’ll probably feel more soreness and pain on the outer side of your knee, and you might notice some swelling there too. When you do that bending test (the varus test), it’ll hurt, and your knee might feel a bit loose, but not too much. This means your ligament is partially torn, which is more serious than just being strained.
Severe LCL Injury (Grade III)
In a severe LCL injury, the ligament is completely torn. Interestingly, sometimes the pain might not be as bad as with a moderate injury, but the problems are more serious. You’ll still feel pain and tenderness on the outside of your knee, and there will be a lot of swelling. When you test your knee by bending it sideways, it will feel very loose, showing that the ligament isn’t holding things together like it should. This type of injury can make your knee feel really unstable.
Other Injuries that come with LCL Injuries
It’s pretty common for other parts of your knee to get hurt when your LCL is injured. You might also have problems with other ligaments in your knee, like the ACL or PCL, or something called the PLC, which is a group of structures at the back of your knee. Sometimes, the injury can be bad enough to cause your knee to dislocate, which means the bones are out of place. Less often, you might also hurt the cushiony stuff (menisci) inside your knee. Other things to watch out for include injuries to the back of your thigh (hamstring) or the side of your thigh (Iliotibial Band Syndrome).
Diagnosis
Physiotherapy diagnosis
As experienced physiotherapists, we want to assure you that we use a thorough and systematic approach to diagnose your Patella Fracture. Our goal is to accurately identify the source of your knee pain and create a treatment plan to fit in with your lifestyle.
To begin the diagnostic process, we take a detailed history of your symptoms, including the onset, severity, and aggravating or relieving factors. Next, we do a comprehensive physical examination of your knee. This includes:
- Palpation: Carefully examining the area around your knee to identify tenderness, swelling, or warmth. This can help to differentiate between inflammatory pain, muscle pain, tendon pain or joint pain.
- Range of motion assessment: Measuring the mobility of your knee joint, as well as the flexibility of the muscles and tendons surrounding the knee and hip.
- Muscle Strength testing: Testing for muscle imbalances by measuring the strength of your knee muscles – especially your hamstrings and quad muscles.
- Special tests: Using specific clinical tests designed to provoke your symptoms. This is helpful to confirm the diagnosis of Patella Fracture as well differentiating between other conditions.
- Further Imaging: If the diagnosis of your injury is correct, imaging such as X-ray’s and MRI’s will allow us to determine the real extent of your condition and allow us to manage it in the most effective way possible.
Throughout the evaluation process, your physiotherapist will share all the findings and discuss the most appropriate treatment plan to effectively manage your Patella Fracture. At Well Health Pro, we are committed to help you recover successfully and return to your daily life pain-free.
X-rays
Muscles cannot be seen on an x-ray, so it will not be effective to diagnose a muscle spasm. X-rays will however show the integrity and alignment of joints in your spine. This will enable us to see if something is wrong with the structure of the bones in your spine or if there is a loss of disc space.
Your physiotherapist can refer you to get x-rays taken if necessary.
Diagnostic ultrasound
Diagnostic ultrasound can be used to show the presence of a muscle tear (muscle strains), inflammation, swelling or simply increased contraction of a muscle (muscle spasms).
If you need an ultrasound, your physio will refer you.
MRI
An MRI scan can image all of the structures in your lower back, including soft tissue, discs, nerves and bones. However, for a muscle spasm an image like this is unnecessary and very expensive. If your physiotherapist suspects anything more than just a muscle spasm, you will be referred to the right specialist.
Why is the pain not going away?
Discuss why the pain does not improve
You become stuck in a cycle of pain, not knowing if it is safe to move or not.
- Make sure you are getting the right treatment from the start
- Without intervention, or treatment why is the tissue state not improving.
- There is a risk of more critical and possibly irreversible damage if you don’t take the warning signs seriously.
Why will this condition NOT resolve or recover on it’s own
Problems we see when patients come to us with …
One concept per paragraph. Explain What resistance or problems can you encounter during the treatment process. Stay to the core message.
Speak to your patient as if each of these are happening to them.
Explain the WHY it’s a problem, not only state “it’s a problem”, but why…
- Waiting too long – longer you wait, the bigger your chances of causing permanent damage
- Not getting a proper diagnosis – Don’t get a proper diagnosis from the start, it wastes time.
- Trying out, but not completing different forms of treatment
- ‘stretching” because it feels stiff
- Medication only mask the pain – not addressing the root of the problem
- Wearing a brace to ‘support’ – Braces & guards.
- Resting too much or too little – finding the balance between resting and doing safe movements is key
- Braces & guards
- Crutches
- Too much rest will not solve the problem
- Pain medication (how long is normal/ acceptable)
- Misconceptions about treatment
Physiotherapy treatment
Please inspire confidence in your ability to test, identify, diagnose and treat/ deal with this.
Patient asks you:
“So why should I come see you for … ?”
Your answer is…
We can provide the best treatment for
- provide guidance and answers.
- Implement a very effective and structured plan of action like
Use the antonyms of the words the patient complains of.
Instibility – stability/stable
Fear – confidence
worried – calm/carefree
anxiety – serenity
And we will also look at
- muscle strength,
- joint range of motion
- flexibility
- ligament stability
- nerve control.
Gradual strengthening, control and conditioning.
Phases of rehabilitation
As long as I can see progression & functional expectations changing , Example:
- crutches
- 20% Weight (limited ROM)
- 50% weight (FROM)
- 100% weight with concentric & eccentric contractions
- Speed & Power (Jump)
Please work the PEACE & LOVE protocol into the Plan of Action (Not all in the first phase)
- Balance on one leg
Perform a lunge
Squat to 90 degrees
Balance reactions (stepping out sideways, forwards & backwards)
Jump & Land from a step
Do a Single leg jump
Sit in a crouched position & get up
Jump over a hurdle
1st Phase: What you want to achieve (Week 0 – 1)
Functional expectation, what we’ll do.
To progress to the next stage you should be able to …
2nd Phase: What you want to achieve in Week 1 – 2
What needs to happen in the tissue/ pathology to fix it
This is the thing you should be able to do by now
3rd Phase: What you want to achieve in Week 2 -3
Treatment elaborated
This is what you need to be able to do with ease so we can progress to the next phase of treatment.
4th Phase: What you want to achieve in Week 3 – 4
Re-inforce, strengthen, guide,
What you should be able to do by this stage is ….
5th Phase: Test return to normal life Week 4 – 6
To makes sure you’re safe to turn to
- Driving you should be able to
- Jogging you should be able to
- Run you should be able to
- Work
6th Phase: Final medical clearance tests (Week
By now you should be able to jump, throw, but there’s some specific stress tests that you should be able to do
This allows us to make sure the structure of the tissue (muscle, ligament, tendon) is able to handle stretch stress, max load, compressive forces.
So we can sign off on your recovery, knowing you’re safe.
Healing time
Physio protocol time frame for healing (weeks / months)
- You will need physiotherapy treatment twice a week for the first two weeks.
- After this, your treatment sessions can be …
- How fast you recover will greatly be up to you.
- Remember: “Non-operative Treatment” or Non- Surgical Not
conservative - A full recovery and return to sport will take longer and should not be confused with the healing period.
Other forms of treatment
- Your doctor (GP) will probably
- Pain meds, injections,
- Getting your back or neck ‘aligned’ or ‘clicked’ in the hopes of improving the … will not improve the state of the muscle or change your pain. It could even worsen or trigger a muscle spasm. You need to look at the bigger picture.
- A biokineticist will be able to help you in the final stages of your rehabilitation and get you back to training for your sport.
- Wearing a back brace won’t be the solution to your problem.
- Stretching or foam-rolling might ease your pain temporarily, but
Is surgery an option?
Surgery is necessary when …
- These are the surgical checkboxes that must be ticked before surgery is even considered.
- Surgery is only Halfway mark for a successful surgery, the rest is the reintegration, strengthening and adapting your body to the change.
- Types of surgeries that can be done.
- Why is rehab important after surgery?
