Knee

1. Anterior cruciate ligament sprain

The anterior cruciate ligament, or ACL, is like a strong elastic band inside the knee which helps to stabilise the knee joint on many movements. The most common way of spraining or tearing this ligament is through twisting and is why it is more prevalent in sports that involve a lot of changes of direction such as football, rugby and skiing. Completely ruptured ligaments often require surgery followed by an extensive rehabilitation period. However, if there is a smaller tear or mild sprain, conservative treatment such as physiotherapy can often be successful. It will generally require a lot of stability work, involving balance and strengthening exercises. However, improving the strength and stability of the ACL and surrounding knee structures prior to injury means you are less likely to injure it in the first place!

This short video shows a good visual demonstration of an ACL injury, and this one shows a common surgical method using a hamstring tendon graft.

2. Runner’s knee

Runner’s knee is not exclusive to runners. Also known as patello-femoral joint syndrome (PFJS) or patellar-femoral pain syndrome (PFPS), it is where pain results from inflammation behind the knee cap (patella) when it rubs against the bottom of your thigh bone (femur). Pain can be felt behind the knee cap, but it can also refer to the inside or outside of it (as well as above or sometimes below).

The inflammation tends to happen as a result of direct trauma (such as falling on your knee), prolonged kneeling over a period of time and frequently due to muscle imbalances. Normally the bottom of the femur has a groove that the knee cap fits into like a jigsaw in order to prevent it rubbing too much on one side of the joint. However, if muscles are too tight and strong on one side compared to the relatively weak ones on the opposite side it can cause the knee cap to get pulled slightly towards the tighter side causing friction and inflammation on one side of the joint. The most common presentation of muscle imbalance is strong and tight structures on the outside of your knee, such as the illiotibial band and lateral quadriceps muscle, and weaker, dysfunctional muscles on the inside of your knee so the knee cap can get pulled towards the outside of the patella-femoral joint.

Following diagnosis of Runner’s knee, the pain is initially alleviated by a combination of methods such as rest, ice and taping, and acupuncture is also very effective for this type of pain. Specific strengthening is required in order to correct the muscle imbalances, and tight areas are released by stretching along with soft tissue release techniques. Once the pain has subsided, functional rehabilitation takes place in order to prevent it troubling you again. This, as with all our treatments, will be tailored to your goals whether that involves running a marathon or walking up the stairs in your house pain-free.

3. ITB syndrome

ITB syndrome is a fairly common problem, often associated with running. “ITB” stands for “illiotibial band”, which is a band of fibrous tissue that runs from the illium (on the outside of your hip) to the outer part of the knee joint at the top of the shin bone (tibia). The mechanics of the muscles inserting into the ITB means it is susceptible to overuse injuries, particularly if there are any weaknesses or faulty movement patterns involved. Pain will often present towards the outside of the knee where the band can rub over a small sack of fluid, called a bursa. Both the tendon and the bursa can get inflamed and cause pain, and this is frequently noticed towards the end of a run and after completing the run.

Treatment initially involves rest, ice, possibly accompanied by soft tissue release and/or acupuncture. This will quickly progress onto strengthening, stretching and functional training to ensure any underlying causes are addressed. Remember, do not run through the pain as it will only get worse. A little rest and treatment as soon as you feel it can get you back on track with your training as soon as possible.