What is a Sprain?

A sprain of the knee occurs when the joint is overstretched or twisted excessively under stress. Sprains affect the ligaments in and around the joint. In the knee, there are four primary ligaments – MCL, LCL, ACL & PCL. The medial (MCL) and lateral (LCL) collateral ligaments keep the knee joint in place from the inside and outside.

The anterior (ACL) & posterior (PCL) cruciate ligaments prevent forwards, backwards and rotational movement of the joint. If these movements are taken beyond their normal range of movement with sufficient force then damage to the associated ligament can occur.

Advised Management

The way to approach treatment of a sprain depends upon the severity. Sprains can be classified into three stages:

• Grade I – mild sprain – this identifies damage to the soft tissue although it is minor. Normal activity can potentially continue during recovery and rehabilitation
• Grade II – partial tear – this represents significant damage to the ligament. There is a risk of further injury and worsening of the condition of the injury site. Further aggravation of the ligament should be avoided until professional opinion and treatment is sought.
• Grade III – complete rupture – if a complete rupture of the ligament is suspected then all activity that places stress on the affected joint must stop immediately. Ligament rupture will manifest itself as severe joint instability. It requires immediate medical attention and may result in surgical repair

What is Tendonitis?

Tendons attach muscles to bones. They are the connective tissue that runs throughout the length of the muscles and, when the muscle fibres diminish, result in a thick ‘rope’ of tissue.

If there is excessive passive tension within the attached muscle or the muscle is contracted frequently over prolonged periods of time then aggravation of the tendon, especially at its bony connection site can occur. this can lead to inflammation, pain and severe loss of function.

Advised Management

Whenever there is an ‘itis’ at the end of a word used to form a diagnosis it identifies the presence of inflammation.

Consequently, a tendonitis can be treated in the same way as general inflammation, although all of the treatment should be directed towards the affected area. Try to maintain normal activity throughout the treatment course to maintain fitness levels and raise the chances of successful rehabilitation into normal function.

What is Osgood-Schlatter’s Disease?

This is a specific condition that primarily affects teenagers and young adults. As previously mentioned, there is a tendon that exits the muscles along the front of the thigh. This tendon the runs across the knee joint and attaches onto the bone underneath the knee.

This section of the shin bone is right at the end of the bone and very close to, if not within the ‘growth plate’ of the knee. During puberty and the well-described ‘growth spurt’ of youth, the bones tend to grow faster than the muscles and this, along with increased activity levels associated with this period of life, increase the tension through the muscles of the thigh. This increased tension is passed onto the attachment site into the bone by the tendon and results in painful aggravation of the muscular attachment site.

Advised Management

Osgood-Schlatter’s disease is an inflammatory condition resulting from aggravation of the tendinous thigh muscle insertion onto the bone below the knee.

This painful condition can lead to the bony attachment being pulled out of shape and leaving a lasting ‘lump’ on the front of the shin bone. The affected site should be treated in the same way as general inflammation. In addition, further aggravation of the inflamed site should be avoided by limiting physical activity intensity to that which is comfortable to avoid bony deformity occurring.

What is Bursitis?

Wherever the ropes of the body (ligaments and tendons) pass close to bony prominences, of which there are many around the knee, they are cushioned by bags of fluid. These bags are called bursae (singular: bursa) and their only job in the body is to prevent aggravation or wear and tear.

Unfortunately these bursae themselves can become aggravated by excessive demands being placed upon them. This may be because of an increase in unaccustomed activity or due to the accumulated passive tension in the associated muscle placing increased pressure or stress upon the bursa resulting in aggravation and inflammation. 

Advised Management

Bursitis signifies an inflammation of one of the many bursae around the knee joint. Because the knee is such a bony joint there are many bursae around it for cushioning against the high forces placed across it.

As is clear from the suffix ‘itis’ on the end of the diagnosis bursitis, this is an inflammatory condition and can be treated in the same way as general inflammation. Where possible without further aggravating the symptoms, normal activity should be continued to aid successful rehabilitation.

What is Osteoarthritis?

Osteoarthritis is a degenerative and incurable joint condition that manifests itself in the knee joint as pain and stiffness accompanied by mild swelling. It is more common in older populations, although it has been recorded in younger individuals. There are many aches and pains associated with the knee joint that are inaccurately attributed to arthritis.

The appearance of osteoarthritic presentation alone on Xray and MRI scans is increasingly accepted as NOT being indicative of painful symptoms. It is very usually possible that conservative interventions such as physiotherapy are highly effective in resolving painful symptoms that used to be attributed to arthritic joint degeneration.

Advised Management

Treatment of osteo-arthritis depends upon the stage of deterioration in the joint and the extent to which the arthritic degeneration is related to the painful symptoms experienced.

Whilst activity may feel counter-intuitive mobility is an incredibly important factor in easing the symptoms of osteo-arthritis. Sufficient pain management should be sought to continue with normal activities of daily living as much as is practicable. Heat therapy and cryotherapy can be very effective in both relieving the general symptoms and management of the aggravation of symptoms following physical activity.