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ACL injuries

 

We've all come across a friend or famous athlete who has had their season cut short through an ill-timed knee twist and alongside the dreaded "popping" sound. When this happens, it can be daunting.  

Understanding ACL injury and knowing what steps to take to recover will help you get back to the sport you love sooner. As mentioned in our ACL tear article, the ACL is one of the main ligaments controlling the stability of your knee, and injuries to the ACL occur more frequently in sports involving landing and pivoting actions like football, netball, or skiing.   

Diagnosis of ACL Injuries 

 The Lachman Test 

John Lachman (1919-2007) was an orthopaedic surgeon at Temple University in Philadelphia who invented the technique. It's considered the most reliable way to diagnose an ACL injury. It is used by Physios and Surgeons the world over.  

How is the Lachman test performed? 

The Lachman test is performed like this: 

  1. Lie flat on your back. Relaxed, with legs straight. 
  2. Your Physio places your knee in a slightly bent (and sometimes rotated) position. 
  3. One hand is on the back of your lower leg (just under your knee joint), and the other is on the front of your thigh. 
  4. They then pull your shin forwards firmly while stabilising your thigh.

 Why do we do the Lachman test?  

 To measure the endpoint and joint laxity.  

The endpoint is where the end of the joint movement is felt as the shin is pulled forward. If this endpoint feels further away than what's expected, then this may indicate an injured ACL.  

 Joint laxity is the general feel of your joint movement and the sense of how lax (or loose) your ACL feels compared to your other knee.  

 

Grading ACL tears with the Lachman test: 

  • Normal. There's no difference in movement or laxity between your left and right knees. 
  • Mild (grade 1). There's slightly more (about 2-5mm) movement than in your other knee. 
  • Moderate (grade 2). There's moderately more (about 5 to 10 mm) movement than in your other knee. 
  • Severe (grade 3). There's much more (10 to 15 mm) movement than in your other knee. 

 

Because we're all different and have varying baselines of "stiffness", the test should be done on your other leg too. This will give the Physio an accurate idea of what's typical for your joint.  

Anatomy of the L knee showing a ruptured ACL

The Pivot Shift test 

How is the pivot shift test performed? 

 1. Lie flat on your back. Relaxed, with legs straight.  

2. The Physio places one hand on your heel and the other just below the outer side of your knee.  

3. They apply pressure to the outside of your knee while internally rotating your lower leg and bending and straightening your knee. 

 The test is positive if your lower leg sinks backward when the knee is bent at 30-40 degrees. Sometimes a 'clunk' can be heard when this happens. 

 

Treatment options for ACL tears 

 There are two treatment options for an ACL injury: Conservative or surgical management.  

 Your age, previous injury, and fitness and rehab goals should be considered when deciding the best route to follow.  

  

Conservative management 

Conservative or non-surgical management involves a period of Physiotherapy treatment to restore your knee function to pre-injury level.  

 Surgical management 

Having ACL surgery usually requires a minimum of 9 months of rehab tailored towards getting you back into your sport.  This may sound like a long time, but returning to sport too early can have negative implications. Mainly increasing your risk of re-injury.  

 

ACL Surgery  

What surgery is there for ACL tears, and what you can expect? 

 The most common type of ACL surgery is a reconstruction of a new tendon called a graft.  This is typically a minimally invasive procedure done via keyhole surgery using an arthroscope (a small camera through which your surgeon passes tiny surgical instruments).  First, the damaged ACL is removed, and then the graft is attached in its place. There are different types of grafts. They include:   

  • Autografts - Formed from tissues taken from another part of your body (like tendon tissue strands from your hamstring or patella tendon)  
  • Allograft - Formed from tissues taken from another person's body 
  • Synthetic - Formed from an artificial source or donor. 

 Rehab is paramount to your ACL recovery (with or without surgery) . Without rehab, ACL surgery is meaningless. All the top knee surgeons agree.  Your ACL rehab determines the success of your recovery. We recommend an evidence-based programme that's divided into four progressive phases. In our experience, this process takes 9 to 18 months to complete.  

Phase 1: Restore knee extension and reduce swelling  

Immediately after sustaining your injury or after your surgery, the muscles around your knee may feel weak, and your joint may be swollen and painful. In addition, you may not be able to completely straighten your knee.  During this stage of your recovery, the aim is to reduce swelling and pain and get your knee completely straight again. This phase typically takes 2-3 weeks.  

  

Phase 2: Strength & Neuromuscular control  

 After you've passed the criteria to move onto phase 2, the fun stuff begins!  You'll introduce a new set of exercises, including squats, lunges, leg presses, and more. These will continue throughout your rehab programme, becoming more complex as you advance through the various stages. 

  

Phase 3: Plyometrics 

After passing all the phase 2 criteria, you can ramp up the fun a little more and start introducing hopping, jumping, landing, and running movements.  These sport-specific functional activities need to be retrained for your to safely return to your sport.  

  

Phase 4: Return to Sport  

Until this moment you have been working towards Phase 1-3.  Before you get back to your sport, you and your Physiotherapist should discuss how and plan how you will do it.  

  

General guidelines for ACL rehab 

  • Follow each phase-specific exercise and test and only move on to the next phase once you have mastered the current one. 
  • You need to achieve your rehab goals in the correct order to ensure you fully recover. 
  • If you stop or skip steps in your rehab, you can worsen your current injury or increase your chances of re-injury when you eventually return to your sport.   

 

Conclusion 

Now that you know how to get a diagnosis, choose the proper treatment, and understand the rehab process better, you can move on from your ACL injury in the right direction. Yes, the rehabilitation process is long and requires dedication and patience. But, with the right team supporting you, your progress can be smoother, and it can be a whole lot more fun! 

 

Our highly experienced and knowledgeable Physiotherapists can get you where you want to be. So, call us now and put your ACL recovery planning in our hands! 

Knee Pain

 

Knee pain is common. For some, the simple activities of daily living such as walking or climbing stairs can become cumbersome when your knee hurts. For others a niggle in the knee can deteriorate and adversely affect sporting performance. There are many causes of knee pain, so it is important for you to know what is causing the pain. There are however some common themes that occur with most types of knee pain.

Why does my knee hurt?

The knee is comprised of many structures including ligaments (connects bones together) tendons (attach muscles to bone) and cartilage (the connective tissue between bones). Most injuries in this area are caused by multiple problems over a long period of time- this could include muscular weakness, overuse, direct trauma or even lifestyle factors.  

Most patients say that when their knee hurts, they tend to want to do less activity as more activity requires bearing extra load through the knees.  Otherwise simple activities such as climbing the stairs or even going on a run can feel scary.  Often, it leads to us searching for answers by having x-rays or scans.  Sometimes a scan can look really scary, and sometimes we are told that we have “bone rubbing on bone” or our cartilage has “completely gone”. This can increase fear and further reduce activity and weight bearing through the knee. 

However, just like we all get wrinkles or grey hair, age related chages to our knees are inevitable. Researchers now believe that inactivity is a major contributor to age-related diseases and disabilities, and that regular exercise can reduce or reverse those risks.

What should I do if I have knee pain?  

Most knee pain can be treated through a graded rehab programme. Typically, this consists of a combination of strength training, education and a good understanding of how to implement your programme.  It is important to have a supervised programme so that you know exactly where to start and know exactly how you are going to progress over the course of the rehab programme.  

When we strengthen the muscle around our knees we increase our knee’s ability to withstand the load that we tend to put on them on a daily basis.

FUN FACT:  Forces transmitted across the knee joint during normal walking range between 2 and 3 times body weight!

This makes them much less likely to experience pain in the future. Over recent times we have seen a huge body of evidence to suggest that an 8-12 week exercise programme can significantly reduce knee pain and symptom progression.  

What Should I Do Now?  

  • Seek out advice from a healthcare professional who understands knee pain and is up to date with the current research.
  • As mentioned before, scans are not always needed, and scans often do not correlate with the pain you are experiencing. 
  • Begin strength training with the supervision of a healthcare professional.  
  • Other factors to consider are sleep, diet and body weight- all of which can contribute to pain and pain sensitivity.  

 Here are some great simple knee exercises to try at home:

 

Long Covid: Breathing pattern disorder

 

Without it, life cannot be sustained, it is as simple as that. Breathe in, breathe out, our simple but most important automatic reflex-controlled function. Most of the time, our brain and reflexes do all the work for us. Have you ever observed a sleeping baby, breathing gently as their chest rises and falls, effortless and without any conscious process involved?

When the demand arises, we can consciously decrease or increase our rate of breathing. Do you remember the days of “hide and seek” when the suspicious seeker was dangerously so close you’d dare not breathe, or the exhilaration associated with the rapid preparatory breathes I take before that first jump off the highboard at the local swimming pool?

What is a normal breathing pattern?

  • Gentle breathing through the nose
  • Breathing in for 1-1.5 sec
  • Breathing out for 1.5-2 sec
  • Pause between in and out breath
  • Take 10-14 breaths per minute in adults
  • Breathe about 500ml of air per breath
  • Breathing is quiet

 

The normal breath cycle

Sometimes it goes wrong and our breathing becomes dysfunctional. What is dysfunctional breathing (DB)?

This can occur with heavy exercise, strong smells, cold weather, stress or other triggers. People would breathe rapidly through the mouth, breathe using the upper chest. The accessory neck muscles work hard and you will effectively hyperventilate.

The primary symptom is often breathlessness but is usually clarified as a feeling or need for more air or “air hunger”. Additionally, DB may cause non-respiratory symptoms such as dizziness and palpitations. It has been identified across all ages. In the United Kingdom, its prevalence is approximately 9.5% among adults.

What happens when we breathe?

We breathe in air containing a mixture of oxygen (O2) and carbon dioxide (CO2) and other gases. Our bodies process and use some of the inhaled oxygen to make energy, and creates carbon dioxide as a result. When you breathe out the air contains less oxygen and more carbon dioxide. However, carbon dioxide is not just a waste product of our body’s processes, it also has a vital role in regulating the pH of the blood. During stressful situations, a higher level of CO2 in your blood, helps your body to produce adrenaline which will help you flee from danger.

How does hyperventilation affect our bodies?

Some of the most common symptoms of hyperventilation

When we hyperventiltate, and there is less CO2 and more O2 in the blood, this causes respiratory alkalosis, or decreased acidity of the blood. This causes our blood vessels to constrict and causes reduced blood supply to the brain, among other things. This causes a feeling of light-headedness and pins and needles in the fingers, muscle cramps and exhaustion.

When overbreathing becomes regular and more permanent, the brain recognizes this lower level of carbon dioxide and accepts it as being normal. Consequently, the body is constantly on alert. This cycle of hyperventilation causes a self-perpetuating cycle, that fuels back into the system making you feel more anxious, more breathless and more hungry for air.

We also alter our posture significantly when we over breathe, adopting hunched-up shoulders as a result of rapid breathing. This causes us to use our neck accessory muscles to help draw air into our lungs. Prolonged and ongoing use of these neck muscles can cause an aching neck and stiff shoulders. Typically we can overuse sternocleidomastoid and scalene muscles which are at the front of our necks to do so. Check out this helpful video to hear more about breathing pattern disorder.

Our Waterloo location has reopened!

The wait is over and the clinic has now been completely refurbished.

Come and visit us at Roupell Street from Monday the 24th of February and enjoy our new comfortable setting.

Picture by Tom Reading – Creative Commons Attribution 2.0 Generic (CC BY 2.0)

Our Waterloo location has re-opened!

The wait is over and the clinic has now been completely refurbished.

Come and visit us at Roupell Street from Monday the 24th of February and enjoy our new comfortable setting.

Picture by Tom Reading – Creative Commons Attribution 2.0 Generic (CC BY 2.0)

 

Temporary London location while we are refurbishing!

We are pleased to announce that the Clinic will be undergoing large scale renovations this Summer. We expect works to be completed by November 2019. In the meantime, we will be treating all our patients a mere stone’s throw away, still in Southwark.

We will be running our clinic at:
Conrad O’Hagan Fitness Studio
38 Copperfield St, London SE1 0EA

You can still book online as usual here:
https://www.vitality-physio.co.uk/book-an-appointment-online/

Should you have any questions or concerns, please email us on info@vitality-physio.co.uk or call us on 020 7193 9928.