Sports knee injury
SPORTS FOR ALL!
With an increase in knowledge of the importance of healthy lifestyle, more of us take up sports. Unfortunately this increases the incidence of injuries.
Knee pain can be the result of overworked knees in activities like cycling or running. It can also be due to overworking a joint, which lacks flexibility. This causes anterior knee pain. Trivial injury like twisting can cause degenerate meniscal tear in middle age or older people. In younger patients in can cause deep medial collateral ligament (AKA MCL) sprain. A valgus injury (leg being pushed out) in contact sports like football, rugby, netball or handball can sometimes cause MCL sprain.
MAJOR INJURIES
With an increase in knowledge of the importance of healthy lifestyle, more of us take up sports. Unfortunately this increases the incidence of injuries.
Knee pain can be the result of overworked knees in activities like cycling or running. It can also be due to overworking a joint, which lacks flexibility. This causes anterior knee pain. Trivial injury like twisting can cause degenerate meniscal tear in middle age or older people. In younger patients in can cause deep medial collateral ligament (AKA MCL) sprain. A valgus injury (leg being pushed out) in contact sports like football, rugby, netball or handball can sometimes cause MCL sprain.
TENDON INJURIES
Occasionally patients on certain antibiotics, statins or steroids have weaker tendons like patella tendon or quadriceps tendon. These can rupture on sudden loading even without contact or tackle. These patients can not weight bear. The knee is swollen, it buckles and gives way. X-ray does not show any fractures.
TREATMENT OF KNEE INJURIES
Treatment of knee injuries will depend on diagnosis and exact injury sustained. However it is important to keep quads (quadriceps muscles) active. Perform inner range quads and static quads exercises.
I will arrange x-ray and MRI scan (if needed). MRI scan is especially useful in significant knee injuries, cartilage damage, bone bruising and to check kneecap alignment.
MCL SPRAIN
The medial collateral ligament runs on inside of the knee and is attached to thigh bone and shin bone. It provides support on inside of the knee. It is typically injured when patient is tackled from the side. Minor sprains of this ligament are perhaps one of the commonest injuries and patient may not present to hospital.
I find that taking both a patient history and examination is adequate to diagnose injury.
In minor sprains with minimal or no opening of joint on sideways loading; tear is incomplete. I treat these without operation. Rest, ice, crutches, painkillers is all that is needed. I will encourage you to continue with quadriceps exercises and range of motion exercises. You can gradually progress with strengthening exercises and increased weight bearing. Most patients are back to normal activities and sport in two to three weeks with full movement, function and strength.
MCL injuries with high grade of instability need early evaluation by specialist as these may have associated injuries like cruciate ligament injury. Consult early!
Sometimes MCL injuries from its attachment to shin bone may not heal and these need early operation.
I tend to treat isolated significant MCL tears in special brace for a few weeks. I will encourage you to remove brace and perform physiotherapy for quadriceps and range of movements. You may need crutches till you can weight bear without pain. At this stage we can discard the brace. You can continue further rahab with exercise bike..
If a patient has MCL and ACL injury, I tend to treat MCL as above and then reconstruct ACL at a later date.
CYCLING INJURIES
Cycling like running, is prone to overuse knee injuries. These happen when the bone and soft tissues are loaded frequently without adequate recovery time. Other factors which may come in play are:
- Fitness level
- Endurance
- Muscle imbalance
- Limb alignment
- Training routine
- Equipment, bike fit, riding position
- Stretching of hamstrings, quads and calf muscles as well as core flexibility can avoid significant injuries.
Get a proper bike fit, good position of saddle, maintain cadence (number of pedal revolutions) of 70-90 per minute and ride in lower gear. You will avoid anterior knee pain!
COMPARTMENT SYNDROME
Chronic compartment syndrome is uncommon cause of calf pain in runner or cyclist. Leg has four different compartments for muscles to work in. If there is swelling in the compartment, blood flow to the muscle reduces. This leads to gradual damage to all contents (muscles, nerves, blood vessels) of the compartment.
You may notice pain after starting exercise. But pain can continue for several minutes after activity has stopped. You may have numbness, cramp and weakness.
You may need measurement of compartment pressures before and after activity. If your pain is not controlled with modification of activity, you may need operation. The procedure involves cut in the tight lining of compartment to reduce pressure on muscles.
RUNNERS KNEE (ITB SYNDROME)
The IT band is a thick, fibrous band originating from pelvis, running across hip and knee. It inserts on the outside of shin bone. Repetitive knee movement cause ITB to rub on outside of kneeleading to friction and irritation. This typically occurs when the knee is within last 30 degrees of full extension.
Increased tension in ITB may be due to tightness in the band or from abnormal position of leg while running.
You may have sharp pain on outside of the knee. You may need rest, anti-inflammatory medication, physiotherapy and activity modification.