A common injury of the knee is a tearing of the ACL (Anterior Cruciate Ligament). This ligament is very important for stability of the knee and often needs to be repaired surgically. The primary function of the ACL is to keep the bottom surface of the knee joint from sliding forwards during movement. An unrepaired knee may feel unstable or give way suddenly.

Not all ACL injuries require surgery and some may heal well with proper rehabilitation, however for those who do need surgery, there is a significant rehabilitation period afterwards.

What does the surgery consist of?

Every surgeon will have a slightly different technique for surgery. The most common approach is the arthroscopic approach, which uses a small camera and allows the surgeon to make only small incisions into the knee. They will then replace the torn ligament with either a graft from a tendon or ligament at another part of the body or using a synthetic graft.

How long does rehabilitation take?

Full rehabilitation following surgery can take up to nine months and rehabilitation is divided into different stages. As all surgeons will have different protocols for their approaches to surgery, time frames will vary for everyone.

Initially after surgery, the graft will be quite weak while a new blood supply is being established. It can take up to 12 weeks before the graft is at its strongest point and evidence shows that it may never have the strength of the original ligament.

In the early stages, rehabilitation will be focused on restoring movement to the joint and strengthening the muscles around the knee without putting any undue stress on the graft.

As the graft begins to heal and strengthen, rehabilitation can progress to include stability and control exercises and gradually build up to a complex program that prepares the knee for a full return to sport.

The path to full rehabilitation from a knee reconstruction can be a long and bumpy one, however there are high success rates with this surgery, particularly when followed up with full physiotherapy rehabilitation.

The information in this newsletter is not a replacement for proper medical advice. Always see a medical professional for assessment of your individual condition.

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Golfer’s elbow is defined as chronic degeneration of the tendon on the inside of the elbow, usually due to overuse. As its name implies, it is a condition common in golfers. However, as with all sporting injuries, this condition can affect anyone. Golfer’s elbow is similar to Tennis elbow, occurring on the inside of the elbow rather than the outside.

What are the symptoms?

Typically, someone suffering from this condition will experience pain on the inside of the elbow, forearm and possibly extending down to the hand. The pain will be worst with activities that require gripping of the hand and movements of the wrist. Less common is the experience of pins and needles in the hand.

How does it happen?

The exact cause of this condition is unknown, however it is generally thought to occur when the forces transmitted through the tendon become too great. This can be due to increased demands on the tendon or reduced quality of the tendon tissues.

As the tendon is attached to muscles that bend the wrist and provide grip strength, activities such as golf, rock climbing or manual work that involve gripping objects can easily create forces that damage the tendon.

Conversely, factors such as poor blood supply or simply the normal processes of aging can reduce the quality of the tendon. If the tissue is not functioning well, then even simple but repetitive movements in an office job can cause Golfer’s elbow.

There are a few other known contributing factors for Golfer’s elbow, such as poor posture, neck dysfunction, a recent change in activity and a history of trauma, such as a fall onto an outstretched hand.

What is the treatment?

Golfer’s elbow usually develops slowly, and healing can be a long process. The first step to effective treatment is accurate diagnosis, as many other conditions have similar symptoms and need to be excluded first by a medical professional.

Once a diagnosis of golfer’s elbow has been confirmed, treatment is aimed at allowing tissues to heal and regenerate. This will require a certain level of rest, and changes to the forces affecting the tissues, sometimes through bracing or taping.

Specific exercises have been shown to assist tissues in coping with and responding to load; these are called “eccentric” exercises. Other treatments include increasing blood flow to the area to promote healing. In chronic and severe cases, injections of corticosteroids are used, and in severe cases surgery may be undertaken.

The information in this newsletter is not a replacement for proper medical advice. Always see a medical professional for assessment of your individual condition.

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Ankle sprains are extremely common, however, this doesn’t make them easy to cope with when they happen to you. If you’ve ever spent two weeks hobbling around on crutches after an unfortunate twist, you’ll understand just how painful and difficult they can be.

What are they?

Ankle sprains refer to a tear to the ligament fibres of the ankle. Commonly, a person will roll their ankle inwards and tear the ligament on the outside. Occasionally, the ankle will twist outwards and the ligaments on the inside of the ankle are torn and even less commonly, the fibres of the ligament that hold the two bones of the lower leg together tear (high ankle sprain). A sprained ankle will usually be painful, swollen, bruised, difficult to walk on and in some cases unstable.

How does it happen?

Ankle sprains can occur from something as simple as putting weight onto your leg when you think your foot is flat even though it’s not. The most typical pattern is of a person jumping and landing on the outside of their foot or simply slipping and twisting their ankle. A sprained or twisted ankle is one of the most common injuries presented to emergency departments around the world. This is important as a severely sprained ankle can actually have very similar symptoms to a broken ankle and will need an X-ray.
A medical professional should assess any severe sprain. However, there are some guidelines to help decide if a sprained ankle needs X-ray.

1. You are unable to put weight on the ankle immediately after the injury.
2. You are unable to take more than 4 steps immediately after the injury.
3. Pain on the bony edges of the outer foot and ankle.

How long do sprains take to heal?

Depending on the severity of the tear, from one to six weeks. Your physiotherapist is able to help with recovery and ensure nothing slows down the healing. Following any injury of the body, joints may remain a little stiff and lose strength and control. Even though the injured tissues have healed, the ankle doesn’t move quite the way it used to. This means that your risk of twisting it again is higher than before the injury.

How can physiotherapy help?

Correct rehabilitation can help to prevent recurring injuries. As well as providing support to the unstable ankle, your physiotherapist will help you to strengthen any weak muscles and restore balance and control through exercise. They are also able to correct any abnormal movement of the joint following swelling.

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Orthopaedic surgery is any surgery performed primarily on the musculoskeletal system of the body. Common orthopaedic surgeries you may have heard of are joint replacements and reconstructions.

Physiotherapists have a large role to play in the recovery of these kinds of surgeries especially in the more extensive operations, such as a total hip or knee replacement.

It is not unusual to wake up in the hospital a few hours post-op knee replacement, hip replacement or shoulder reconstruction to your hospital-based physio asking you to get out of bed for the first time. This may seem daunting and entirely too early, however there is very well researched evidence for why getting out of bed early is so important: your speedy return to normal health and wellbeing!

Hospital-based physiotherapy typically includes re-learning how to walk and making initial improvements on your range of movement and function of the affected joint. The physio will also help you maintain healthy respiratory function by checking your lungs regularly. Drugs administered during surgery change your breathing pattern, which can lead to complications in the days after surgery.

Following your in-patient stay, it is highly likely your surgeon will request for you to continue with outpatient physiotherapy either in an outpatient hospital-based setting or in a private-practice setting.

With your outpatient physio, your recovery will be measured and monitored, goals will be discussed and set, and you will be given an exercise program created to achieve those goals.

Physiotherapists use a variety of treatment methods to assist a post-operative orthopaedic surgery patients achieve their goals. These include soft tissue work, stretching, hydrotherapy, manual therapy and gym-based exercise.

Recovery from orthopaedic surgery can take up to 12-to-18 months to occur. During this time, it is not unusual to experience bouts of pain and swelling; however these episodes should reduce the further into rehabilitation you progress.

Many post-operative orthopaedic surgery patients can expect to return to a normal life following a period of rehabilitation guided by a physiotherapist. This includes return to some sport and regular exercise!

Note: Please seek professional advice prior to beginning a post-operative exercise program.

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Recognising and Managing Ankle Fractures

Ankle fractures are surprisingly common injuries, both in athletes and the general population. Being able to quickly identify the signs and symptoms of a fracture is extremely important in ensuring quick and effective medical management.

Ankle fractures come in different shapes and forms. For example, a netballer with shin splints may experience a stress fracture, while a soccer player colliding with another player may experience a large break of the bone at the base of the ankle. In either case, bony tissue has been disrupted and must be treated accordingly.

Knowing the signs and symptoms of fracture

Understandably, swelling and bruising will occur when a bony injury to the ankle takes place. Inability to bear weight on the affected leg, along with extreme pain when the affected area is touched are also very common signs of fracture. However, as an ankle sprain will often present with these same symptoms, it can be easy to misdiagnose an ankle fracture as a severe sprain.

Luckily, there are some established rules to follow if you a suspect an ankle fracture. If one or more of the following signs are present, along with a history of trauma, it is recommended that you seek medical advice as soon as possible.

1) Inability to fully bear weight on the affected limb for 4 or more steps.
2) Tenderness to touch along the inner and outer bony aspects at the base of the ankle.
3) Pain to touch at the outer part of the foot.

Following diagnosis of a fracture, the doctor may decide to use a plaster (cast) to protect the bones while they heal. Severe fractures will need to be surgically stabilized. After surgery or time in a cast, ankles can be surprisingly weak and stiff due to disuse, leaving them vulnerable to becoming reinjured.

After removal of a cast, wearing a fabric brace is usually recommended for a few weeks. The brace provides an element of stability while the joint is regaining strength and balance. During this time, it is important to start strengthening and mobilizing the ankle. A physiotherapist can develop a rehabilitation program that involves a gradual return to normal daily activities and eventually sport.

This rehab program will allow your bones to continue healing while adjusting to the increasing stresses being placed on them. You may begin rehab in a non-weight-bearing setting such as the pool, and progress to increased weight-bearing activities such as cycling. Eventually you will be able to start a weight-bearing program on the grass or even on a hard surface to assist with your return to sport.

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