Ligaments are short bands of tough fibrous connective tissue that connect bones to other bones in and around joints. A knee ligament sprain occurs when there is damage to one of these ligaments. The role of ligaments is to limit the amount of mobility of a joint, or prevent certain movements altogether. They allow the knee to function as an effective hinge of the thigh bone (femur) on the shin bones (tibia and fibula). Any disturbance to the normal function of this hinge (such as a knock from the side, or a twist on a fixed foot) can cause damage to these ligaments, known as a knee ligament sprain.
What causes Knee Ligament sprain?
You can injure a ligament through a sharp change in direction with a fixed foot. Another common mechanism is landing poorly from a jump – common in netball, basketball and football. A blunt force hit to the knee, such as in football tackle, is probably the most common cause. The incident usually needs to happen with some amount of speed and/or force. Muscle weakness or incoordination predispose you to a ligament sprain or tear.
Major Knee Ligaments
ACL: Anterior Cruciate Ligament
PCL: Posterior Cruciate Ligament
MCL: Medial Collateral Ligament
LCL: Lateral Collateral Ligament
What do Knee Ligament injuries feel like?
Ligament injuries generally result in pain and instability, which is the feeling of the joint “giving way”. The amount of pain and instability of a ligament sprain depends on the degree (or amount) of stretching or tearing of the ligament.
In a mild (grade 1) sprain, the ligaments may stretch, but they don’t actually tear. Grade 1 sprains tend to hurt, but have little instability as the main structural integrity of the ligament remains intact. Although the joint may not hurt or swell very much, a mild sprain can increase the risk of a repeat injury.
With a moderate (grade 2) sprain, the ligament tears partially. This is the situation where there is usually quite a bit of pain at the time of injury, and moderate instability – the patient will complain of the leg “giving way”. Swelling and bruising are common, and use of the joint is usually painful and difficult.
With a severe (grade 3) sprain, a ligament tears completely – otherwise known as a rupture. The main symptom with this grade of injury is instability. Initially there is pain with the ligament tearing, but then it can cause minimal pain as all of the pain fibres are torn at the time of injury. There is often swelling and sometimes bleeding under the skin. As a result, the joint is unstable and unable to bear weight.
How long does a Ligament take to heal?
The treatment of ligament injuries varies depending on the ligament injuries and the severity of injury.
Grade 1 sprains usually heal within a few weeks. Maximal ligament strength will occur after six weeks when the fibres have fully matured and healed. The best strategies are to rest from activities that are painful, icing the injury, and some anti-inflammatory medications are useful. Physiotherapy will help to speed up the healing process using techniques such as taping, electrical modalities, massage, strengthening and joint exercises to guide the direction that the ligament fibres heal. This helps to prevent a future tear.
When Grade 2 sprains occur, it is important to support the healing ligament fibres with a brace or tape early on. This helps to reduce the pain caused by stretching of the healing ligament. You can return to sport once the joint is stable and you are no longer having pain. This may take up to six weeks. Physiotherapy helps to hasten the healing process using techniques such as taping, electrical modalities, massage, strengthening and joint exercises to guide the direction that the ligament fibres heal. This helps to prevent a future tear and quickly return you to your pre-injury status.
When a Grade 3 injury occurs, the knee needs to be supported with an external brace, as the knee is no longer functioning as a hinge. Depending on the ligament injured, there is a chance that the ligament may not heal – leading to surgery. The aim of conservative treatment (when appropriate) is to allow for ligament healing and gradually return to normal activities. This level of injury can result in a minimum of 2 to 3 months out of sport, up to 12 months if reconstructive surgery is required. Definitely seek professional advice in these cases.
How physiotherapy can help
Your Leading Edge physiotherapist will examine your knee to determine the type, extent and cause of your knee injury, and can refer you on to a sports physician or GP for scans or medication if needed.
Early treatment will reduce any pain or swelling. This treatment could include:
- Massage and Mobilisation techniques to improve the movement of your knee joint
- Exercises to improve the strength of the knee and other lower limb muscles that may be contributing to your problem
- Taping to improve the stability of the knee joint or improve the function of the muscles that support the knee
- Dry Needling to reduce pain and muscle tightness around the knee joint
I think I have injured my Knee Ligament, what do I do now?
As soon as possible, and for 72 hours after injury, use the RICE method:
- Rest – Take it easy and only move within your limit of pain.
- Ice – As soon as possible, and for 20 minutes every two hours, apply ice or a frozen gel pack wrapped in a damp towel. This helps to control bleeding and pain and reduces secondary tissue damage.
- Compression – Firmly bandage the injury. This helps to control swelling.
- Elevation – As much as possible, elevate your injury higher than