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ACL Rehabilitation

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ACL Rehabilitation

ACL injuries are very common.  Most people know at least one other person who has gone through some kind of ACL injury.  But what exactly is the ACL?  Furthermore, what is ACL Rehabilitation?

ACL Rehabilitation is a term used to describe the physiotherapy treatment that takes place after an ACL injury.  It is an important part of the recovery so that individuals can get back to their work and sport

ACL Rehabilitation – What is the relevant Anatomy

The term ACL stands for Anterior Cruciate Ligament.  Ligaments are soft tissues that connect 2 bones together.  Ligaments provide stability to the joint.  The ACL is found in the knee joint.  It is one of the most important ligaments in the knee.

 

ACL Rehabilitation – Where is the ACL located?

The ACL is one of two ligaments found deep inside the knee joint.  The other ligament is called the PCL, or Posterior Cruciate Ligament.  These ligaments cross each other inside the joint, forming an “X”.  Together, they help keep the thigh bone (femur) connected to the shin bone (tibia).  The ACL stops the shin bone from sliding out in front of the thigh bone.  The PCL stops the shin bone from sliding back on the thigh bone.

ACL anatomy

ACL Rehabilitation – What is the function of the ACL?

The ACL is more commonly injured than the PCL.  This is likely because the PCL is wider and stronger than the ACL.  However, the ACL is more important to the overall function of the knee.  Injury to the ACL means that there is too much forward movement of the shin bone.  This has huge impacts on the stability of the knee, especially when doing any weight-bearing activities.

What are some of the signs and symptoms of an ACL injury?

  • A loud ‘pop’ or a ‘popping’ sensation in the knee
  • Severe knee pain and unable to put weight through the knee
  • Immediate swelling of the knee
  • Loss of range of motion
  • A feeling of instability or ‘giving way’ with weight bearing

How does the ACL get injured?

Another important part of ACL Rehabilitation is understanding how the injury happened.  This information helps explain why the injury happened and may help prevent a re-injury.  Specifically, the ACL can be injured in many ways.  Some examples of mechanisms of injury include:

  • Quickly changing direction while running
  • Suddenly slowing down or stopping
  • Incorrectly landing from a jump
  • Twisting the knee with the foot planted on the ground
  • Direct blow to the knee

 

What are some of the risk factors for ACL injury?

For ACL Rehabilitation to be successful, there has to be an understanding of risk factors.

  • Firstly, female gender seems to be a risk factor
    • Women have a higher incidence of ACL injuries according to the research
    • There are a variety of factors, including differences in anatomy, muscle strength and hormones
  • Additionally, certain sports have more risk for ACL injury
    • Sports that involve a lot of sudden direction changes and collisions are more likely to result in ACL injuries
    • Examples include soccer, football, basketball and downhill skiing
  • Lastly, poor strength through the hips and lower legs is an overall risk for ACL injury

ACL injuries – Are they all the same?

ACL injuries can vary from person to person depending on the extent of the injury.  The term for an injury to a ligament is called a sprain.  Sprains are graded based on how severely the ligament is damaged.

ACL Tear

Grade 1 – there is mild damage to the ligament

      • The ligament is slightly stretched
      • The knee joint is still stable
      • There is no requirement for surgery.

Grade 2 – there is a partial tear in the ligament

      • The ligament is stretched to the point where it becomes loose.
      • There is still some stability in the knee joint.
      • There is usually no requirement for surgery

Grade 3 – there is a complete tear or rupture in the ligament

      • The ligament has been split into two pieces
      • The knee joint is unstable
      • Due to the level of damage, there is usually requirement for surgery

Additionally, other structures may be injured at the same time as the ACL.  Specifically, a lot of patients who injure their ACL, also injure their Medial Collateral Ligament (MCL) and/or medial meniscus.  This combination increases the overall severity of the injury.

Unfortunately, ACL injuries can also lead to the early development of osteoarthritis in the knee.  The arthritis can vary in severity depending on the person but can contribute to long term pain for some people.

 

How do we diagnose ACL injuries?

A doctor or Registered Physiotherapist can assess the knee after the injury.  They may perform some physical tests that may confirm an ACL injury.  However, these tests are not always 100% accurate.  Additionally, with a very acute injury, it is difficult to complete the tests properly due to intense pain and swelling.

As a result, imaging is usually required  to confirm an ACL injury.  Understanding the severity of the injury is important because it will determine if surgery will be required.

Magnetic Resonance Imaging or MRI is the most commonly used imaging test to diagnose an ACL tear.  An MRI uses radio waves and a strong magnetic field to create images of the tissues in the body.  An MRI will be able to show the extent of an ACL injury and any other tissues that may have been damaged.  However, there is usually a lot of swelling soon after the injury happens.  As a result, an MRI is usually not done immediately afterwards.

 

ACL Rehabilitation – What are the treatment options?

 

Physiotherapy

    • For grade 1 or 2 sprains, the treatment is usually conservative.
    • This means that the doctor would refer the patient to physiotherapy to regain range of motion and strength.
    • The physiotherapist will assess the patient and work on restoring their function
    • The physiotherapy treatment may involve:
      • Electrical modalities to reduce inflammation
      • Hands on treatment to release muscle tension, promote circulation and improve flexibility
      • Exercises to help regain range of motion and recover strength and function through the knee
      • The physiotherapist may also recommend a custom knee brace to help protect the knee from instability
      • Education regarding home management and using any necessary gait aids or braces if required
    • The time required for recovery varies from patient to patient, but generally ranges from 8-12 weeks

Surgical repair

    • For sprains that are severe, the family doctor will refer the patient to an orthopedic surgeon.
    • The surgeon will assess the patient and determine if they need surgery for their injury
    • Circumstances where surgery may be recommended include:
      • The patient is an athlete and their sport involves a lot of jumping, cutting or pivoting movements
      • There is injury to more than one structure in the knee
      • The knee buckles regularly with everyday activities

 

 How does surgery affect ACL Rehabilitation?

        • Once the surgery is finished, there will be a recovery process
        • Firstly, to keep the knee from bending, the patient will be placed in a brace
        • Additionally, to be able to move around safely, the patient will be given crutches
        • The surgeon will refer the patient for ACL Rehabilitation
        • The surgery repairs the torn ligament, but the knee will not be able function normally at first
        • Physiotherapy is needed to recover the knee movement, strength and stability.
        • The recovery time after the surgery can range anywhere between 6-9 months. This can be up to 12 months if the patient is returning to high impact sports.
        • For more information about ACL surgeries, please click here.
  • However, there are some patients who can choose not to have the surgery if they can regain function through physiotherapy and if their lifestyle doesn’t place too much stress on the ACL.
  • For example, surgery may not be needed for people who are:
      • Relatively inactive
      • Engage in moderate exercise and/or recreational activities
      • Play sports that put less stress on the knees

 

Whichever treatment pathway the patient requires for their ACL injury, physiotherapists play a huge role in their recovery.  It is important to seek out treatment as soon as possible to prevent chronic problems from developing.  Furthermore, starting your treatment sooner than later, helps you get back to your life.

Call PhysioNow today to book your appointment!

 

 

 

 

Patellofemoral Pain Syndrome
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Patellofemoral pain syndrome

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            Patellofemoral pain syndrome

Patellofemoral Pain Syndrome

Patellofemoral pain syndrome happens when your knee cap does not track properly.  The knee joint consist of two joints.  The tibiofemoral joint which is between the two long bones in your leg and the second one is the patellofemoral joint.  This  is between the femoral condyle (end of thigh bone) and the knee cap. The cartilage on the back of the knee cap glides on the cartilage on the front of the condyles of the femur. The knee cap usually sits in a snug groove at the end of the thigh bone.

Knee movements are controlled by a number of muscles connected to the knee cap. Your  thigh muscle helps to stabilize the knee cap and enables it to move smoothly in the groove.  When this is pulled out of the groove, you can develop Patellofemoral pain syndrome.

Causes of Patellofemoral pain syndrome or Anterior knee pain

Patellofemoral pain syndrome, is one of the most  common causes of pain in the knee. Pain is usually felt under the knee cap.  This is where it glides on the femur/thigh bone. If you have patellofemoral pain syndrome, it hurts when you bend and straighten your knee . There are a number of factors which can cause the pain.

Common Causes of Patellofemoral pain syndrome

  • Weakness in the hip and thigh muscles-Weakness in the thigh muscles can cause increased load which may lead to pain. Pain in your knees will further limit the activity of your muscles and over time can cause further weakness. Weakness of the inner thigh muscle  will affect the movement of the knee cap as you do your normal activities. Weakness in your hip muscles also can affect activities like climbing stairs and walking.
  • Excessive loading or rapid increase in the load for muscles around the knee-Depending on your usual activities, your knee will have a level of activity that is tolerated by your joint. Rapid increases in loading of activity may lead to a highly irritable or sensitive joint. This can cause Patellofemoral pain syndrome.
  •  Posture or position of hip, knee and feet-Flat feet or excessive turning in of feet can change movement mechanics further up the leg and cause excessive strain in your knee cap.
  • Tight muscles around the knee-Tightness in the muscles can reduce the movement of your knee and affect  how your joint works . This will lead to excessive loading during activities. The common muscles that become tight are your hamstrings, Quadriceps, Iliotibial band and calf.
  • Previous injury or dislocation of knee cap
  • Desk top work, where a lot of sitting can cause pressure on the kneecap.
  • Irritation of fat pad around the knee
  • Tendinitis of quadriceps tendon
  • Bursitis around the knee
  • Osteoarthritis

When poor biomechanics are repeated with each step of your walking and running it may lead to a highly sensitive joint and Patellofemoral pain syndrome.

Symptoms

  • The onset of  knee cap pain is normally gradual rather than traumatic.
  • Pain at the front, back and sides of the knee with or without swelling.
  •  Bending and straightening of knee can cause pain.
  • Pain after prolonged sitting or when you keep the knee bent for longer periods of time.
  • Clicking or grinding when you bend or straighten your knee.
  • Pain when you go up and down the stairs, up hill /down hill, squatting, running or jumping.
  • Poor knee control or stiffness

Physiotherapy Treatment

Patellofemoral Pain Syndrome treatment

  • Physiotherapy is the most effective treatment for short- and long-term management of Patellofemoral pain syndrome. Your Physiotherapist will fully assess you on your first visit to identify your functional limitation. They will also help to set goals and identify contributing factors for the pain.   They will  provide a customized rehabilitation program.
  • In the initial phase of rehabilitation, treatment is directed towards reducing the pain, swelling and muscle inhibition. To do this PhysioNow will  use electrotherapy modalities, acupuncture, rest, taping, gentle motion or joint mobilization and muscle setting exercises.
  • Once the pain and swelling reduces, treatment is focused towards modifying the  factors that have been identified as a cause for the problem.
  • Rehabilitation typically emphasizes increasing strength and pain free movements.  It also will address postural correction, improving the  stability of the pelvis, balance and functional abilities.
  • Stretching exercises to address the tight muscles and strengthening the weak muscles will improve your load tolerance.
  • Successful rehabilitation requires adherence to your exercise program .
  • You will also need to reduce the aggravating movements and slowly build the endurance and strength for those activities over time.
  • Prior to discharge you will be given a safe progression of exercises and functional activities.
  • For long term management, your foot and knee control will be assessed by your Physiotherapist.
  • As a result, you may require  custom foot orthotics to correct your foot position.
  • This will  help to improve foot and knee control.
  • Others might need a hip stabilization program and your Physiotherapist will be happy to discuss with you the long term rehabilitation plans if this is needed.Custom orthotics for Patellofemoral Pain syndrome

How long it will take to get better?

We expect to see improvements with Physiotherapy over a 3 to 6-month period.   Further improvements continue beyond this period. Adherence to your specific exercise program is important in maintaining the improvement. Most people will get back to their normal function with rehabilitation in the short term. Many patients can continue in their chosen activity during rehabilitation.  Some modification of activity may be all that is needed.

If you play sports, you will need to do sports specific exercises to ensure a safe return to sports. It is good to wear proper supporting footwear to help keep your feet in a good position.  This will  improve alignment of your knees.

How to book an appointment with a Physiotherapist at PhysioNow?

We have four Physiotherapy clinics of which three are located in Mississauga and one is in Etobicoke. You can call 289-724-0448 to book into any of these clinics  for an appointment with a Physiotherapist.

Most of the time we can arrange your initial visit on the same day in a location which is nearest to you. Your initial appointment will be a one to one 40-60 minute session with a Physiotherapist which includes treatment as well on the first day.

Your follow up appointments  will typically take  40 minutes.  Normally, we would recommend 2 to 3 sessions per  week depending on the factors identified on initial assessment, treatment plan and your goals.  If you have limited funding available, we will be happy to work with you to develop a home exercise program.

Please call today to get started on your treatment for Patellofemoral Pain Syndrome at PhysioNow!

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Heat therapy

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Heat and Cold therapy

How it works

When we apply Heat therapy, it improves circulation and blood flow to  that area due to increased temperature. Heat therapy can relax and soothe muscles and heal damaged tissue.

Heat therapy

Types

  • Dry Heat therapy includes sources like heating pads, dry heating packs, and even saunas. This heat is easy to apply.
  • Moist Heat therapy includes sources like steamed towels, moist heating packs, Theratherm heating pads that take moisture from the air, or hot baths. Moist heat may be slightly more effective as well as require less application time for the same results.

Contraindications

  • diabetes
  • dermatitis
  • vascular diseases
  • deep vein thrombosis
  • multiple sclerosis (MS)

 Heat is useful for relieving:

  • osteoarthritis
  • strains and sprains
  • tendonitis, or chronic irritation and stiffness in the tendons
  • warming up stiff muscles or tissue before activity
  • relieving pain or spasms relating to neck or back injury, including the lower back

Cold therapy

How it works

Cold therapy is also known as cryotherapy. It works by Louis- hunting reaction theory. When we apply Ice to an injured site, it reduces the blood flow by vasoconstriction. After some time, it causes vasodilatation and increases the blood flow to the area. This process goes on continuously. This reduces inflammation and swelling that causes pain, especially around a joint or a tendon. It can temporarily reduce nerve activity, which can also relieve pain.

Types of Cold Therapy

There are a number of different ways to apply cold therapy to an affected area. Treatment options include:

  • ice packs or frozen gel packs
  • coolant sprays
  • ice massage
  • ice baths

Cold treatment can help in cases of:

  • osteoarthritis
  • a recent injury
  • gout
  • strains
  • tendinitis, or irritation in the tendons following activity

Contraindications

  • people with sensory disorders
  • uncontrolled diabetes
  • You should not use cold therapy on stiff muscles or joints.
  • Cold therapy should not be used if you have poor circulation.

Here’s a general guide that helps you to decide which to use heat or ice : https://www.healthline.com/health/chronic-pain/treating-pain-with-heat-and-cold#cold-therapy

In General,  use ice for the first few days after an injury.  Beyond that, heat usually does the trick.  There is some evidence that suggests that using ice beyond the first few days can actually slow down injury healing.  It pushes away the healing agents that help you to get better.

If you have been injured and need advice or treatment, please call PhysioNow today.  We are always happy to help!

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Baker’s Cyst

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Baker's cyst

A Baker’s Cyst, also known as a popliteal cyst, is a fluid-filled swelling that causes a lump at the back of the knee. This leads to tightness and restricted movement. The Baker’s Cyst can be painful when you bend or straighten your knee.

? Causes of a Baker’s Cyst

Synovial fluid is a clear liquid that normally circulates through the spaces in your knee joint. Sometimes the knee produces too much of this fluid. The increasing pressure forces the fluid to the back of the knee via a one-way valve. This creates a bulge. This  swelling of the knee causes a Baker’s Cyst to form.

The most common causes of a Baker’s Cyst are:

  • damage to the knee’s cartilage (meniscus)
  • arthritis of the knee
  • rheumatoid arthritis
  • other knee conditions that cause joint inflammation

? Symptoms of a Baker’s Cyst

Some patients may have no pain and may not even notice the cyst is there. However, the signs and symptoms of a Baker’s cyst can include:

  • Swelling or lump behind the knee (the main sign) – this is more evident when standing and comparing one knee to the other. It may feel like a water-filled balloon.
  • Knee pain.
  • Calf pain.
  • Accumulation of fluid around the knee.
  • The knee joint may click or buckle.
  • The knee joint may lock.

    • ? Diagnosis of a Baker’s Cyst

    • Your doctor will examine your knee and feel the swelling. If the cyst is small, they may compare the affected knee to the healthy one and check your range of motion.
    • Your doctor may recommend non-invasive imaging tests if the cyst rapidly increases in size or causes severe pain or fever. These tests include an MRI or ultrasound. An MRI will enable your doctor to see the cyst clearly and to determine if you have any damage to the cartilage.
    • These tests will determine if some other form of growth, such as a tumor, is causing the swelling.
    • Although the cyst won’t show up on an X-ray, your doctor may use one to check for other problems, such as inflammation or arthritis.

    Web MD has additional info on this condition.

    ? Treatment

    A Baker’s Cyst doesn’t need treatment. It will go away on its own. However, if the swelling becomes large and causes severe pain, your doctor may recommend one of the following treatments.

    • Fluid draining

      Your doctor will insert a needle into the knee joint and may use an ultrasound to help guide the needle to the correct place. They’ll then draw the fluid from the joint.

    • Medication

      Your doctor may recommend a corticosteroid medication, such as cortisone. Your doctor will inject this drug into the joint, and the medication will flow back into the cyst. Though it may help relieve the pain, it doesn’t always prevent a Baker’s Cyst from recurring.

    • Physiotherapy

      Regular, gentle exercises may help increase your range of motion and strengthen the muscles around your knee.

    If you think you or someone you know may have a Baker’s Cyst, please call PhysioNow today!  We would be happy to help! We have highly trained Registered Physiotherapists ready to see you Now!

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Knee Arthroscopy

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Knee Arthroscopy

knee arthroscopy

Custom Knee Bracing


Knee arthroscopy done by orthopedic surgeons “clean up” or repair the cartilage or meniscus in the knee. Typically, knee meniscus injuries will happen one of two times. A large bucket handle tear is one that creates a three cornered flap. This is much like if you catch the sleeve of your coat on a nail. This flap can be stable or unstable. After the initial swelling and pain heals, a stable flap rests in place and does not interfere with your daily activities and use of your knee. An unstable tear will flip up much like the handle of a bucket. If this is occurs, often your knee will lock and you will have very limited movement in your knee. The second type of meniscal damage is wear and tear, or degeneration. This will consist of tiny tears, called microtears, which create a fraying of the cartilage.
All of the different types of meniscal damage can be treated by knee arthroscopy surgery. There are two small incisions used for this surgery. In one, the surgeon will place a scope, or a small camera. The other incision is used for a tool which will trim or shave the meniscus depending on the damage that has occurred. This procedure is typically a day surgery and you should be able to walk immediately after it is over. Some people prefer to use crutches or a cane, but if all heals well, you should be able to stop using these after a day or two.
Regardless of the injury, researchers are now suggesting that a course of physiotherapy focusing on strengthening and balance, or proprioception, is critical before knee arthroscopy surgery. Studies are indicating such a physiotherapy treatment program can reduce pain and increase function to the same degree as surgery in most cases. This can in some cases eliminate the need for surgery altogether. It also can eliminate the risk of infection and reduce the chances of future osteoarthritis.
Lastly, sometimes, custom knee bracing can be effective to offload the side of the knee that has a meniscus injury.
If you have knee pain, see a physiotherapist today. They can help!
knee arthroscopy

knee arthroscopy