ANATOMY AND MECHANISM

A meniscus is a C-shaped piece of cartilage that acts as a shock absorber of the knee, protecting the bones from wear and tear. There are 2 menisci in each knee joint, 1 one either side. Meniscal tears usually occur as a result of twisting movements, where the foot remains planted on the ground, and are common in sports such as volleyball, netball, basketball, soccer and rugby.

SIGNS AND SYMPTOMS

• Pain, particularly with activities that involve twisting or bending the knee
• Clicking and/or locking
• Swelling – usually 24 hours following injury
• Difficulty bending and fully straightening knee

The extent of the signs and symptoms will depend on the severity of the tear. With larger tears generally more pain is felt. Also, with certain types of tears, flaps can lift up and cause the knee to lock which is usually very painful.

TREATMENT

Immediate treatment, and within the first 3 days, consists of the RICE principles:

Rest – Rest your knee, avoid too much walking and refrain from playing sport.

Ice  – Every 2 hours apply ice, this will help with the pain and swelling.

If using an ice pack (or frozen peas), leave it on for 10-20 minutes, using a tea towel or similar between the pack and skin to prevent ice burn.

If using an ice cube, “massage” your knee with the ice, gently rubbing it over the skin. Keep the ice cube moving to prevent ice burn and do this for no longer than 5 minutes.

Compression – Use Tubigrip (or a stretchy bandage) on the knee to apply some compression to the joint. This will help to alleviate swelling.

Elevation – Prop your leg up so that your knee is elevated above the level of your heart. This will help to minimise the swelling.

Initial physiotherapy treatment will include gentle joint range of motion and strength exercises aimed at preserving movement and muscle strength. It will also focus on reducing swelling, managing pain and restoring a normal walking pattern. You should do light pedalling on an exercycle with little resistance as this will keep your knee moving with minimal to no pain as it is not having to support your bodyweight.

As pain and swelling decreases your physio will progress your exercise programme, eventually introducing agility and impact exercises. The last phase of rehab will be focusing on sports-specific exercises (if the aim is return to sport).

ANATOMY, MECHANISM AND SIGNS & SYMPTOMS

The plantar fascia is a thick sheet of connective tissue (ligament) that supports the arch of the foot. It attaches from the heel bone to the base of the toes. There is a fat pad under the heel where the plantar fascia attaches, and this helps to dampen the load through that insertion point.

Plantar fasciopathy is a general term that describes heel or arch pain as a result of an overuse problem of the plantar fascia.

Initially, in the few days following the original injury, this is inflammatory in nature (plantar fasciitis) and symptoms include intense pain (particularly at the end of the day), heat and swelling. The inflammatory phase usually lasts a few days, unless repetitive loading and overuse of the plantar fascia continue, in which case it may last longer.

If repetitive stress of the plantar fascia continues degeneration usually occurs, including calcification of the plantar fascia near the insertion at the heel. In this case the condition is no longer inflammatory. Pain is likely to be worse when putting weight on your foot after a period of rest (e.g. in the morning) and usually eases after the first few steps.

TREATMENT

Treatment will likely include:

• RICE after injury (Rest, Ice, Compression, Elevation)
• Strapping
• Soft orthotics
• Use of night splints
• Stretches
• Exercises
• Ice
• Massage
• Replacing footwear if necessary
• Acupuncture
• Activity modification

ANATOMY & MECHANISM

The most common type of sprain to the ankle occurs when the foot rolls inwards. When this happens, one or more of the ligaments on the outside of the ankle get stretched or, if the force is great enough, tear.

There are 3 ligaments on the outside of your ankle, called the anterior talofibular ligament, posterior talofibular ligament and the calcaneofibular ligament:

This type of injury, called an inversion ankle sprain, is common  in sports such as netball, basketball, soccer and running. Simply stepping off a curb awkwardly or twisting your foot on uneven ground can also result in an inversion ankle sprain.

SIGNS AND SYMPTOMS

• Pain and swelling around the outside of the foot
• Difficulty and pain with walking
• Pain particularly when turning the foot in

The extent of the signs and symptoms will depend on the severity of the sprain and the number of ligaments involved.

Grade 1 – Only a few of the ligament fibers are torn

Grade 2 – Roughly 50% of the ligament fibers are torn

Grade 3 – The ligament has ruptured (torn through completely)

TREATMENT

Immediate treatment, and within the first 3 days, consists of the RICE principles:

Rest – rest the ankle, avoid too much walking and refrain from playing sport.

Ice  – Every 2 hours apply ice, this will help with the pain and swelling.

If using an ice pack (or frozen peas), leave it on for 10-20 minutes, using a tea towel or similar between the pack and skin to prevent ice burn.

If using an ice cube, “massage” the outside of your ankle with the ice, gently rubbing it over the skin. Keep the ice cube moving to prevent ice burn and do this for no longer than 5 minutes.

Compression – Use an ankle brace or slightly tight sock, or even better Tubigrip, on the ankle to apply some compression, this will help to alleviate the swelling.

Elevation – Prop your leg up so that your ankle is elevated above the level of your heart. This will help to minimise the swelling.

From there, physiotherapy treatment will start with gentle movement, strengthening and balance exercises. Once the ligaments have healed sufficiently more vigorous exercises, such as agility and sport specific training. Your physiotherapist may recommend using an ankle brace when returning to sport, either initially or for ongoing use. This will depend on the individual and the nature of the injury.

ANATOMY AND MECHANISM

The anterior cruciate ligament (ACL) of the knee attaches to the back of the femur (thigh bone) and front of the tibia (shin bone) and is one of the main stabilisers of the knee. It prevents excessive movement of the tibia forward in relation to the femur, and also provides some rotational stability.

It is commonly injured in sports such as netball and rugby, when stopping suddenly. For example being tackled in rugby, when the lower leg is suddenly immobilised and the knee hyper-extends.

The ACL may be strained (only some of the fibers torn) or ruptured (all of the fibers torn).

SIGNS AND SYMPTOMS

• Pain
• Instability (feeling that the knee may “give way”)
• Immediate severe swelling
• Audible “pop” sound at time of injury (with a ruptured ACL)
• Difficulty walking
• Limited range of movement

TREATMENT

Immediate treatment, and within the first 3 days, consists of the RICE principles:

Rest – rest the knee, avoid too much walking and refrain from playing sport.

Ice  – Every 2 hours apply ice, this will help with the pain and swelling.

If using an ice pack (or frozen peas), leave it on for 10-20 minutes, using a tea towel or similar between the pack and skin to prevent ice burn.

If using an ice cube, “massage” your knee with the ice, gently rubbing it over the skin. Keep the ice cube moving to prevent ice burn and do this for no longer than 5 minutes.

Compression – Use Tubigrip if you have some on the knee to apply some compression, this will help to alleviate the swelling.

Elevation – Prop your leg up so that your knee is elevated above the level of your heart. This will help to minimise the swelling.

If the ACL is strained treatment will likely be conservative (non-surgical). If the ACL is ruptured treatment may include surgical repair of the ligament or conservative treatment.

Surgery is often recommended to athletes who intend to continue competing in demanding sport. This involves a reconstruction of the ligament rather than a repair, where a graft is taken from a hamstrings tendon or the patellar tendon and replaces the ruptured tendon. This is done arthroscopically (key-hole surgery).

Following surgery it will be at least 6-9 months before you can return to sport and you will require physiotherapy rehabilitation. This will initially include exercises to return the joint’s normal range of motion, followed by a strengthening programme which is gradually progressed to introduce more stressful/demanding activities and, finally, a functional programme aimed at sport-specific activities to aim for returning to playing sport.

If you do not have surgery, physiotherapy rehabilitation will still be important. This will consist of exercises to retain the joint’s range of motion, reduce swelling and increase strength of the muscles around the knee in order to increase stability. You may still be able to play some sport, but this will need to be discussed with your physiotherapist and/or specialist.