What body part is affected by an ACL injury?

The anterior cruciate ligament (ACL) is one of the two major ligaments in the knee, the other being the posterior cruciate ligament (PCL).These ligaments perform the vital function of connecting the large femur bone of the thigh to the lower leg bone called the tibia.

The ACL’s main purpose is to maintain the overall stability and support of the knee, the largest joint in the body. The ligament is positioned just behind the kneecap and holds the leg and thigh bones in place preventing the leg bone from slipping forward and rotating during pivoting movements. The ACL is supported by the thigh, buttock and very importantly the hamstring muscle groups.

Ligaments are tough bands of tissue that connect various bones together within your bodies. Although they are very strong too much stress on them due to intensive sports or overloading during a sudden twisting movement can cause them to stretch too far, possibly even to snap. If the ligament snaps, that is a complete rupture, we use the technical term ‘’he did his ACL”.

A couple of weeks ago I wrote about my personal experience in how I recognised I was suffering from patellar tendonitis. I covered some technical points about who is at risk and what some of the contributing risk factors are for developing patellar tendonitis.

If you are considering whether your knee pain might be patellar tendonitis then be sure to read my initial blog post - What Is Patellar Tendonosis

In this part 2 follow-up I want to share some of the first stage rehabilitation activities that I have been doing to help my recovery.

After doing all the wrong things at first I sought advice from the Mount Merrion Physiotheray team who set me straight on what I should be doing. Having an inquisitive mind for the detail I asked for some evidence-based literature on the treatment of patellar tendonitis which I duly studied and supports my personal account here.

The first time I felt the sharp and stabbing front of left knee pain was a few months ago while enjoying my usual afternoon run with my dog. It was unlike the more familiar muscle aches and pains and there was no swelling present. I remember worrying this could be a potentially serious issue because this was a knee pain I had not felt before.

I was experiencing for the first time a condition which has since been diagnosed by my Chartered Physiotherapist as patellar tendinosis. After discussing my condition with my physiotherapist he directed me to various evidence-based online information resources as well as sending on relevant journal articles to help me understand the condition better. What follows is an account of a knee problem from a patients point of view.

This condition can become a more serious and chronic issue requiring many months of rest and rehabilitation if not appropriately cared for in the early stages. My knee pain started with repeated deep squat movements in the gym with a heavily weighted bar across my shoulders. Oddly the pain did not last more than a second during the exercise and almost no pain followed in the days after. Naturally I did not give it much more thought at the time until many weeks later when the pain returned, much more intensely and persistently, during a less than demanding run.

I now find myself in a delicate situation having to manage my knee pain very carefully indeed with fear of my condition becoming a much more difficult one to cure if I don’t give it the right attention.

Anterior knee pain or patellofemoral pain syndrome (PFPS) is a common complaint that we see in the clinic. What we are dealing with here is pain located to the front of the knee, usually over or around the kneecap. It can be vague and difficult to say exactly where it is sore. The pain may be constant and made worse by certain activities, otherwise only painful when doing certain things. The pain often starts gradually for no obvious reason and may be aggravated by walking, running, ascending or descending the stairs or prolonged sitting with the knee flexed. You may have severe difficulties continuing the activity that causes you pain and discomfort.

Who is likely to suffer from this condition?

PFPS is more prevalent in females, they are 1.5 to 3 times more likely to develop the condition than males in the athletic population. It can be a significant and debilitating complaint that can affect as many as 1 in 10 active adolescent girls.

What exactly causes PFPS remains a misunderstood and controversial topic. Knee muscle weakness especially of the vastus medialis obliquus (inner thigh muscles which supports the knee cap), abnormal foot biomechanics - in particular abnormal pronation, weakness of the hip stabilising muscles and poor functional control of the femur during weight bearing tasks can be common causes of the syndrome. So in other words if you have weak thighs and hips, wobbly knees, flat feet and generally poor balance you may be at risk.

The below statement was a recent message taken by our receptionist indicating a level of dissatisfaction from a client of ours, Mrs K. With the intention of resolving the client's concern as soon as possible I met with the attending Physiotherapist and together we reviewed the client case notes. This particular scenario has raised an important consideration about the healing process that I would like to share in this article for the benefit of our readers.

Can you call Mrs K back please, she is not happy that after 4 sessions she is still in pain and wants to know where she goes from here?

As human beings we are ambulatory creatures, that is we walk upright and are very reliant on our legs to move us about. How the foot strikes the ground and the knock on effect this has up the lower limbs to the knee, hips, pelvis and low back in particular has become a subject of much debate and controversy in recent years.

Lower limb biomechanics refers to a complex interplay between the joints, muscles and nervous system which results in a certain patterning of movement, often referred to as ‘alignment’.

Much of the debate centres around what is considered ‘normal’ and what is considered ‘abnormal’ in biomechanical terms as well as the extent to which we should intervene should abnormal findings be found on assessment.

There are common causes of knee pain in children but it can be difficult to determine which aches and pains need medical attention and which they may “grow out of”.

Osgood Schlatters

A common cause of knee pain, particularly in boys, is Osgood Schlatters. Your child may complain of pain and tenderness below their knee cap and could recently have had a growth spurt. The pain is due to irritation of a ligament, called the patellar ligament, which connects the kneecap to the shin bone. This is sensitive to touch and your child may have pain with walking or jumping activities or on the stairs.

The initial treatment for Osgood Schlatters is “RICE” Rest Ice Compress Elevate which can help ease pain symptoms. Symptoms usually subside when the growth spurt ends…unfortunately this could take 1-2 years! Gentle stretching of the quadriceps muscle is also advised as it can reduce the tension on the patellar tendon. It is also important to consider lower limb biomechanics and gluteal/ hip muscle strength and intervene with Physiotherapy treatment where necessary to help accelerate the healing process.

A recent 'twinge' in my left knee while jogging over some uneven turf in the park reminded me of these simple self treatment techniques and the vulnerability of our hard working knees.  

Did you know the knee is the largest joint in the body? It also has a pretty tough job and is prone to injury unfortunately. Our knees take the impact for pretty much everything we do on our feet. Being literally two bones, femur and tibia, joined together by ligaments with only a wedge of soft cartilage (meniscus) as a cushion between them - they do an amazing job on the whole.

It's not only athletes who risk injuring their knees but most of us in our day to day can suffer one of these common conditions. If we are aware of them and be more mindful during our daily movements we should be able to reduce the risk. Let's take a look... 

It may sound counter-intuitive when first telling someone suffering with arthritis of the knee that they should exercise to help relieve the pain. But, research suggests that some forms of aerobic, aquatic and strength training will ease pain and improve function.

But not every study is created equally and sometimes certain published claims don't stack up with what our daily hands-on experience is telling us. Some examples...

Otherwise known by the very medical term of ‘Hurty Knee’ (!) according to Paul Noonan, the lead singer of one of my favourite Irish bands - BellX1. Knee pain can be very debilitating as it can affect our mobility and independence not to mention being a darn nuisance possibly leading one to dread getting out of bed in the morning.