Knee Pain

ACL Rehabilitation

 

 

 

 

 

 

What is it?      

Recovery after ACL reconstruction requires a thorough rehabilitation programme to ensure both optimal function of the knee and prevention of further injury. The long term goal should be both a return to sport, but also correction of preinjury deficits, potentially making the patient a better athlete than before their ACL injury.

Prehabilitation

There is considerable evidence to demonstrate that rehabilitation before surgery is beneficial to recovery. ACL reconstruction should be performed once the knee has recovered from the acute injury, has a full range of motion, and is pain free in order to optimise the outcome and avoid complications such as knee stiffness

Acute Recovery - Phase 1

Goals of Phase 1
1. Achieve primary wound healing
2. Minimise swelling
3. Restore range of motion
4. Establish muscular control
5. Progress off crutches

Strength and Coordination - Phase 2

Goals of Phase 2
1. Develop good muscle control
2. Recover basic balance & proprioceptive skills.
3. Reduce any recurrent knee swelling.
4. Continue to improve total leg strength.
5. Improve endurance capacity of muscles.

Proprioception and Agility - Phase 3

Goals of Phase 3
1. Resumption of running and jumping skills with good technique
2. Recovery of balance and agility
3. Progression of muscular strength and power
4. Develop confidence
5. Prepare for sports specific skills

Sports Specific Skills - Phase 4

Goals of Phase 4
1. Perfect jumping, landing and change of direction techniques
2. Regain confidence with sports specific drills and skills
3. Prepare for return to a team training environment

Return to Competitive Team Ball Sports - Phase 5

Goals of Phase 5
1. Achieve >90% on Patient Reported Outcome Score (eg IKDC Subjective Score)
2. >90% quads strength & >90% hop symmetry
3. Completed on field sports specific rehabilitation & return to team training
4. Athlete has confidence and is comfortable to return to sports
5. Athlete understands the importance of continued injury prevention program
while active in team ball sports

Patella Tendinopathy

 

 

 

 

 

 

 

What is it?      

Patella tendinopathy is defined as pain and dysfunction in the patella tendon. Clinically, patella tendinopathy presents with localised anterior knee pain and pain with loading tasks such as stairs, jumping, squats, sit to stand, and prolonged sitting. 

What does it feel like?

  • Pain over the inferior pole of the patella.

  • Load-dependent nature.

  • Warm up phenomenon - stiff to warm up but eases with activity. 

  • Increased pain the day after activity.

  • Pain increases as load increases i.e shallow to deep squat, hopping from a greater height, walking down stairs, decline squat.

  • Pain is rarely experienced at a resting state.

  • Patella tendinopathy is rarely associated with global swelling. 

Why does this happen?

This condition is more highly prevalent in athletes that participate in activities demanding energy storage and release from the tendons, with volleyball player being the most effected population. The biggest extrinsic risk factor is thought to be training volume and frequency, and the intrinsic risk factors are thought to include reduced extensibility in the quadricep and hamstring muscles, a more vertical 'stiffer leg' landing pattern, low arch height, reduced ankle dorsiflexion, leg length discrepancy, patella alta and increased waist circumference in men.

Chronic Exertional Compartment Syndrome

 

 

 

 

 

 

What is it?      

Chronic exertional compartment syndrome is an exercise-induced muscle and nerve condition that causes pain, swelling and sometimes disability in the affected muscles of the legs or arms. Anyone can develop the condition, but it's more common in young adult runners and athletes who participate in activities that involve repetitive impact.

Chronic exertional compartment syndrome may respond to nonoperative treatment and activity modification.

What does it feel like?

  • Aching, burning or cramping pain in a specific area (compartment) of the affected limb — usually the lower leg

  • Tightness in the affected limb

  • Numbness or tingling in the affected limb

  • Weakness of the affected limb

  • Foot drop, in severe cases, if legs are affected

  • Often occurs in the same compartment of both legs

  • Occasionally, swelling or bulging as a result of a muscle hernia

  • Pain caused by chronic exertional compartment syndrome typically follows this pattern:

  • Begins consistently after a certain time, distance or intensity of exertion after you start exercising the affected limb

  • Progressively worsens as you exercise

  • Becomes less intense or stops completely within 15 minutes of stopping the activity

  • Over time, recovery time after exercise may increase

Why does this happen?

  • The cause of chronic exertional compartment syndrome isn't completely understood.

  • When you exercise, your muscles expand in volume.

  • If you have chronic exertional compartment syndrome, the tissue that encases the affected muscle (fascia) doesn't expand with the muscle, causing pressure and pain in a specific area (compartment) of the affected limb.

  • Some experts suggest that how you move while exercising (your gait) might have a role in causing chronic exertional compartment syndrome. Other causes might include having muscles that enlarge excessively during exercise, having an especially inflexible fascia surrounding the affected muscle compartment, or having high pressure within your veins.

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