Knee pain - Sports Injury

ACL knee injury symptoms

by Pete Colagiuri - Sports Physiotherapist

If you’re looking up “ACL knee injury symptoms”, then chances are you’re worried about the dreaded ACL knee injury.

So what is an ACL, how does it happen and how can you tell if you’ve injured your ACL?

What is an ACL (Anterior Cruciate Ligament)?

The Anterior Cruciate Ligament is a thick band of connective tissue that joins the top of your shin bone (tibia) to your thigh bone (femur).

It is contained completely inside the knee joint and it has good blood supply – two important points for diagnosis.

The job of the ACL is to stop the tibia sliding forward off the femur and to resist rotation of the tibia as the foot twists outwards.

How does an ACL knee injury happen?

The ACL can be damaged in any situation when the movements it restrains are exposed to excessive loading.

The classic mechanism for ACL rupture (complete tear) is when a football boot digs in to the ground and the player twists against it.

ACL knee injury - Photo credit to AAP, via news.com.au — Jack Bird (Brisbane Broncos NRL) ACL injury – March 2020

The same mechanism can occur during snow skiing, when a skier loses balance and twists over their ski as the ski grips and doesn’t twist with them.

Another mechanism is a deceleration movement. This is typically associated with basketball when a player hits the brakes coming in to the basket and the knee collapses under them.

In this circumstance, the strong quads muscle at the front of the thigh pulls the shin forward and the ACL fails to resist the force and ruptures.

The final mechanism for ACL knee injury is a hyperextension movement, or the knee forcefully and excessively straightening to the point of bending back on itself.

In this situation, the simple leverage of the thigh and shin bones rolling too far forward can create enough force to rupture an ACL.

What are the ACL injury symptoms? How can you tell if you’ve ruptured your ACL?

Firstly, you need a mechanism of injury. An ACL rupture can’t occur gradually over time, it needs an excessive force to overload it.

The knee will typically swell up rapidly, due to the ACL’s good blood supply. It bleeds into the knee joint and inflates it within a few minutes.

The knee is no longer trustworthy. The injured person often describes that they don’t want to load the knee because it feels like it’ll collapse. (This is different from not loading it because it hurts too much, which happens with many different injuries).

The person can often walk with a bent knee but won’t be able to walk on their heels. As heel walking forces the knee straight, they’ll refuse because of the feeling that it’ll give way on them.

Pain is quite variable, so don’t assume that all ACL knee injuries are painful as a criteria. Some isolated ACL tears are almost pain free while others have numerous other structures damaged, like MCL tears and meniscal injury. Pain levels are not a good guide of injury type or severity.

Should you go to hospital for ACL scans?

If you had an incident, the knee swelled quickly and doesn’t feel trustworthy, there’s a strong potential for an ACL knee injury.

An ACL rupture is not a medical emergency, so no need to panic and rush to a hospital emergency department. The damage is done and getting quick assessment won’t change anything.

That said, don’t keep loading it if it’s giving way on you as the collapsing movement can cause damage to other structures.

For the ACL knee injury alone, get medical assessment the next day to confirm the diagnosis. If the pain is unbearable when it happens, you may want immediate medical assessment so they can provide some pain relief.

If surgery is on the table (pun intended), they need to wait for the knee swelling and reaction to settle. So regardless of immediate or delayed assessment, surgery won’t be done for a few weeks anyway.

Can I run with IT band injury?

by Pete Colagiuri - Sports Physiotherapist

As soon as runners feel that frustrating knee pain, the brain automatically asks “can I run with IT band injury?”

It doesn’t feel like the kind of injury that should stop you. Surely there’s no harm in pushing on, right?

But the harder you try to run, the more the pain seems to bite. Eventually it affects your running stride so much that you just can’t keep going.

So is there a way to run through IT band injury?

Understanding IT band injury

It helps to understand why the pain is occurring when you are trying to run through IT band issues (“IT” stands for Iliotibial, if you’re curious).

The issue occurs when the leg loses control of rotation at either hip or ankle or both.

There is a rotational load through the knee which pulls the IT band tight across the outside edge of the knee as the knee bends to 40 degrees.

The increasing band tension causes pain, not through friction as first thought, but through bony pressure or irritation of a small pad (called a bursa).

It’s important to note that there is no structural damage with an IT band injury. So pushing through doesn’t have any risk of long term damage to the body.

As you go to take your next step, the brain is expecting pain. So the leg tends to buckle slightly on landing, adding more rotation and further pain.

This is why IT band injury tends to feel worse the harder you try to push through. It’s a self-reinforcing pain and dysfunction cycle.

But it’s also the secret to breaking that cycle.

How to run through IT band injury

The pain is causing the dysfunction, which is causing the pain. We need to break that cycle.

Pushing through tends to only reinforce the pain and the brain’s expectation of more pain.

The best way to stop IT band pain mid run

To break that cycle, it’s as simple as stopping running momentarily and having a walk for 20 or 30 seconds.

As walking involves landing on a straighter knee, it won’t be in a position to cause IT band tension and pain. And so the cycle is broken.

Then when you begin to run again, the trick here is to ensure that the leg doesn’t buckle on impact.

The easiest way to ensure a firm drive and good muscle activation is to increase your pace slightly.

By increasing your pace you avoid those muscles switching off and allowing the rotation to occur.

Now if it was simple as just running a bit fast at the whole time, we’d all be finished races a whole lot quicker.

Obviously going faster means eventually you will start to slow down or fatigue and usually that’s when IT band injury pain will begin to kick back in.

You need to go back to a short walk before trying again with another burst of slightly faster running. You can repeat this cycle an indefinite number of times.

You may notice that as you fatigue the duration of running gets a little shorter. But it’s a small price to pay to be able to keep on running.

IT band pain on downhill running

The only exception to this is running downhill. Often IT band injury is worse when running downhill, but switching to a walk can still cause pain due to the knee bend required.

The only option is to go for a deliberately short stride when you walk. This ensures that the knee won’t bend past the magic 40 degree angle.

That should be enough to allow the pain to ease and off you go again.

Meniscus tear – exercises to avoid surgery

by Pete Colagiuri - Sports Physiotherapist

A tear in the knee’s meniscus causes localised pain and usually some swelling
Pain is often sharp or catching with a residual ache
The most common cause of tears and the trigger for further episodes is a compressive load with rotation (weight-bearing while twisting)

TIPS

Wearing supportive shoes will reduce twisting forces on the knee during the recovery phase
Avoid activities with excessive rotation thru the knee, such as walking on sand or agility sports in studded boots
Anti-inflammatory meds can potentially cause more swelling in the first few days after a tear as they increase bleeding

MYTHS

Elevation of the leg to reduce swelling is ineffective as the fluid is contained inside the joint capsule
Meniscus tears do not heal so you’ll be prone to further episodes if the knee is twisted while weight-bearing
Surgery for meniscal tears doesn’t improve your outcome and usually isn’t required unless your tear is causing locking of the knee or you’re not responding after a few months of a strength program

Medial collateral ligament (MCL) tear

by Pete Colagiuri - Sports Physiotherapist

Medial ligament tears occur due to a sudden overload of the ligament, usually associated with impact, twisting or a collision
The medial collateral ligament (MCL) is actually two ligaments – a long ligament and a shorter deeper ligament
As the MCL is located outside the knee joint, the injury isn’t associated with a large amount of visible swelling (as it doesn’t collect inside the joint)

TIPS

Anti-inflammatories are a bad idea as the MCL is very vascular and the medication only causes additional bleeding
The ligament has a great chance of healing due to excellent blood supply. Protecting the ligament from over-stretch with a lockable hinge knee during the recovery phase is vital.
- Braces need to be locked at 15-30° initially and progressively increase range towards 0-90° at around the six week mark
- Braces typically range in price from US$50-150 but you can pick up a cheap (but effective) brace online such as this one on eBay for around US$30
Rehab should gradually reintroduce loaded bending after 2 weeks and lateral movements after around 4-6 weeks. This progressively builds back to full loading after 6-8 weeks

MYTHS

Taping an MCL to protect it during the recovery and return to sport phases is useless. The skin and tape stretch further than the MCL itself so they are unable to restrain it effectively
You can’t return to straight line running until the ligament has sufficiently healed (~4 weeks). Although the MCL primarily restrains sideways movement, it is still under load as the knee bends and straightens
Ongoing protection of an MCL, in the form of bracing or taping, is not required after a successful rehab and recovery as the MCL regenerates to almost full capacity

WHAT ELSE COULD IT BE?

If your injury happened due to a twisting movement, it could be a Meniscal tear
If your pain came on gradually or without incident, it could be Knee Osteoarthritis
If your pain has gradually worsened and aches constantly, it could be a Bone Stress Reaction or subchondral cysts