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Ligament pain

Definition of a ligament sprain

 

A ligament connects a bone to a bone. It provides stability at a joint by holding the bones of the joint together. Ligaments are composed of collagen fibres packed tightly together although some elastin fibres are present. Fibroblasts create the fibrin threads of collagen. These collagen fibres provide ligaments a strong tensile force, such as to withstand pulling forces.

 

Ligament sprains can occur in any sport, for example ankle sprains can arise during the game due to the many manoeuvres involved such as pivoting, twisting, turning, alongside jumping and landing on the playing surface. These manoeuvres can place your ankle in a vulnerable position by means of rolling over and by sustaining a potential sprained ankle of variable degrees of severity from a slightly pulled ligament to a complete ruptured ligament.

 

The severity of a ligament sprain must be assessed carefully with respect to appropriate decisions about their management throughout the rehabilitation process (1,2,3). Severity of injury is generally described using three grades of severity e.g. laxity and instability see Figure 1 (4,5).

 

  • Grade 1 (mild sprain) ligament fibres are stretched leading to partial micro tears, symptoms include minor haemorrhage, tenderness, swelling, the knee should have a certain end point with no increased laxity. 

 

  • Grade 2 (moderate sprain) is more significant but less than complete rupture (ligament fibres are partially torn) symptoms include moderate haemorrhage, tenderness, swelling, the knee is likely to have some laxity resulting in some loss of function with increased anterior translation e.g. the knee joint may feel unstable or give out during activity. 

 

  • Grade 3 is a complete rupture (ligament fibres are completely torn) symptoms include swelling tenderness with significant laxity and no end feel, the knee joint function is comprised and unstable as the ligament cannot control range of movements (4,6,7,8).

 

For example, an anterior cruciate ligament (ACL) injury is commonly referred to as a sprain. A sprain follows when the threads of fibres of the ligament are torn or stretched and often occurs in the middle of the ligament following a valgus/external rotation trauma with a slightly bent knee (1,2,4,9,10).

 

Avulsion fracture i.e. Segond fracture may typically occur when the ACL soft tissue structures are torn away from the leg bone with a piece of bone (11).

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To rehabilitate a ligament sprain the treatment must be a systematic controlled gradual process where the therapist sets achievable goals for the patient which allows a safe and effective healing process.

         His knowledge of anatomy was incredible. ...The pain I experienced disappeared almost instantly after I left the treatment room and has been a lot better since... Thanks Nick!

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References

  1. Beynnon B, Johnson R, Abate J, Fleming B, Nichols C (2005) Treatment of anterior cruciate ligament injuries, Part I.

  2. Trees A, Howe T, Dixon J, White L (2005) Exercise for treating isolated anterior cruciate ligament injuries in adults (review).

  3. Cascio B, Culp L, Cosgarea A (2004) Return to play after anterior cruciate ligament reconstruction.

  4. Shelbourne KD, Klootwyk TE, Carr DR, (2003). Low-velocity knee dislocation associated with sports injury.

  5. LaPrade RF, Scott Resig S, WentorfF,Lewis JL (1999). The Effects of Grade III Posterolateral Knee Complex Injuries on Anterior Cruciate Ligament Graft Force. A Biomechanical Analysis. 1999 27: 469

  6. Brukner P, Khan K, (2001; 2006). Clinical Sports Medicine, (2nd & 3rd ed.).

  7. Peterson L, Renstrom P (2001). Sports injuries: their prevention and treatment. .

  8. Robb G, Reid D, Arroll B, Jackson R, Goodyear-Smith F, (2007).

  9. Grinsven S, Cingel CJM and Loon CJM (2009). Evidence-based rehabilitation following anterior cruciate ligament reconstruction.

  10. Koga H, Muneta T, Yagishita K, Ju Y, Sekiya I, (2012). Surgical management of grade 3 medial knee injuries combined with cruciate ligament injuries.

  11. Dai B, Butler RJ, Garrett WE, Queen RM, (2012). Anterior Cruciate Ligament Reconstruction in Adolescent Patients Limb Asymmetry and Functional Knee Bracing. Am J Sports Med 2012 40: 2756 originally published online October 3, 2012.

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