Ligament Injuries of the Knee
Ligaments are strong bands of tissue that connect bone to bone. Ligament damage is a common injury we see at our clinic, most of these injuries are sports-related. The majority of them are mild to moderate ligament injuries and can be treated without any need for surgery.
Learn more about the knee’s structure and kinetic chain on Dr. Abelson’s blog.
The types of traditional treatments prescribed for ligamentous injuries is dependent upon the degree of injury and the type of activities the patient will be involved in after the injury. Ligamentous injuries are classified into the following major grades:
Grade 1 describes microscopic tears of the ligament.
Grade 2 describes partial tears of the ligament.
Grade 3 describes complete tears or rupture of the ligament.
Grade 1 injuries typically respond well to soft-tissue treatments and rehabilitative therapies. Grade 2 injuries also respond well to soft-tissue treatments, and generally do not require surgical intervention if treated correctly. Grade 3 injuries require surgical intervention to correct the problem. In these cases tendons are taken from other areas of the body and used to replace the ligament.
The four common knee ligament injuries that manual therapy is effective in treating are the:
ACL (Anterior cruciate ligament)
Cruciate means “crossed”, the anterior and posterior ligaments cross each other in the middle of the knee joint. The ACL attaches to the front of your shin bone (anterior intercondylar area of tibia). The ACL restricts anterior motion (prevents anterior displacement) of the tibia (shin bone) on the femur (leg bone).
The ACL, in addition to the muscles on the back of knee, prevents hyperextension of the knee.
PCL (Posterior cruciate ligament)
This ligament attaches to the back of your shin bone (posterior intercondylar area of tibia). The PCL restricts posterior motion (prevents posterior displacement) of the tibia (shin bone) on the femur (leg bone).
An action that would cause increased stress on this ligament would be squatting.
MCL (Medial collateral ligament)
The MCL runs from the inside of the leg bone (femur) to the inside of your shin bone (upper medial shaft of the femur). This ligament stabilizes the inside (medial side) of the knee joint.
LCL (Lateral collateral ligament)
The LCL runs from the outside of the leg bone (femur) to the outside bone just below your knee (head of the fibula). This ligament stabilizes the outside (lateral side) of the knee joint.
Together these ligaments work synergistically to stabilize the knee joints. For example, if your knee is extended, all of these ligaments tighten up. This stabilization effect does not require, and is independent of, muscle action. In comparison when the knee is slightly bent numerous muscles are required for stabilization. There is a fine balance of structural activity when moving from passive ligament stabilization to active muscle control. Restrictions in either ligament motion or muscle contraction can create a weak link in the kinetic chain.
These weak links creates friction syndromes, continued inflammation, development of scar tissue/adhesions and abnormal motion patterns.
The power of manual therapy (Active Release, Graston, Massage therapy) in treating these conditions is two-fold:
Manual therapy can be used to release adhesions in ligaments, muscles and the surrounding soft. This will improve circulatory function, increase blood flow, increase lymphatic flow, and substantially decrease healing time.
In addition, manual therapy can often prevent these conditions from arising in the first place. It does this by improving the quality of all the soft-tissues affecting the knee. By quality I am referring to your muscle’s ability to store and release energy; much like an elastic cord that stretches and releases efficiently until multiple knots are tied into it. Muscles, much like elastic cords, function extremely well until they build up adhesions from repetitive motion, injury or muscle imbalances.
The good news is that when those adhesions are removed, your muscles absorb more shock, you become stronger, and your reaction times improve. Receiving therapy is not just about injury treatment but about preventing injuries, and improving the quality of your experience.
Again as with all injuries any type of treatment must be followed by the right exercises. Without exercise the chance of re-injury will be significant. For more information see our page on “Exercise and Tissue Remodeling”.