Your knee moves freely backwards and forwards; however the thought of it moving from side to side probably makes you cringe. This is because the knee joint has sturdy ligaments either side of it that prevent sideways movement. Of course, we instinctively know that a lot of force would be required to shift it in this direction.
The ligaments on either side of the knee are called the Medial Collateral Ligament (found on the inside the knee). The Lateral Collateral Ligament (found on the outside the knee) and they each work to provide stability and restrict the knee’s movement into a sideways direction.
HOW DOES THIS INJURY OCCUR?
The typical mechanism for this injury is a force that drives the lower leg sideways away from the upper leg. This can occur from an awkward landing from a height, or when twisting with a foot fixed on the ground or from an external force hitting the outside of the knee, such as with a rugby tackle.
WHAT ARE THE SYMPTOMS?
MCL tears have quite a distinctive set of symptoms, with pain and swelling noticed quite specifically to the inside of the knee. The severity of the pain and swelling will be related to the number of ligament fibres damaged. Larger tears will also make the knee feel unstable or loose.
To classify the severity of the injury and help to guide treatment, a grading system is used. With grade 1 indicating that a few ligament fibres have been torn and grade 3 used for a complete tear of the ligament with associated joint laxity. Very severe MCL tears often also involve injury to the medial meniscus and ACL and can require surgical repair. However, most MCL sprains can be managed well with physiotherapy. Grade 1 and 2 MCL sprains take between 2-8 weeks to fully heal and a complete rehabilitation program is strongly recommended to prevent future injury.
HOW CAN PHYSIOTHERAPY HELP?
In the early stages of the injury, treatment is focused on pain and swelling management, while allowing the body to start the healing process through inflammation. This is best managed thought the R.I.C.E. principles (Rest, Ice, Compression and Elevation).
Following any injury, it is natural for muscles to waste a little and the damaged tissues to lose what we call proprioception, the ability to sense their own position in space. This loss of muscle strength and proprioception can contribute to further injury if not restored with a proper rehabilitation program.
Physiotherapy also aims to restore movement to the joint and support the ligament while healing to ensure that it is strong and healthy, and the scar tissue forms in an organized fashion, which makes the new ligament as strong as it can be and protects against future tears.
None of the information in this newsletter is a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.
If you require professional advice or treatment, please see our range of treatment options, or book an appointment online. Physio Direct has many clinics located throughout New Zealand, with no GP referral required to make an appointment.
By now it should come as no surprise that prolonged periods of inactivity are bad for your health. It seems that the science is in, and the bad news is that long periods of sitting or inactivity is a risk factor for many diseases, independent of other factors such as obesity.
What does this mean?
This means that if you are hitting the gym for an hour a day, but are sitting down for long periods during the rest of the day without moving, you may not be avoiding the health risks that come with sitting.
So why is sitting so bad?
There is evidence that shows that when sitting for long periods, our bodies show unhealthy changes in blood pressure and blood sugar levels that over long periods of time can lead to increased risk of diabetes, dementia and obesity. How much sitting is considered too much and how long it takes for these changes to take place is up for debate. What we do know is that regularly breaking up your periods of sitting is a healthy lifestyle choice you can make for yourself in the same way that drinking water, regular cardio exercise and eating vegetables are.
The insidiousness of the issue is that, it’s likely that you are sitting much more than you used to without even realising it. Car commutes to work are getting longer, working days are often spent at a desk and with the rise of online T.V, you might be guilty of three or more hours stuck in one spot catching up with your favourite characters before you know it.
I have an office job, what can I do?
The first step to changing this habit is to start being aware of exactly how long you are sitting for an uninterrupted period of more than 20 minutes. Once you start noticing your daily patterns you can identify moments where changes can be made. We’ve heard of incidental exercise, but we’ll call this ‘incidental standing’. Consider standing on the train instead of sitting or standing when you have a document to read.
Here are a few other tips to get you moving;
Set an alarm to go off every half an hour that reminds you to get up and get a drink. (This might also help to keep you hydrated)
Try out a standing desk.
Stand up to take phone calls or get up to go ask a colleague a question instead of calling them.
Take a walking lunch break.
Speak to your physiotherapist for more ideas tailored to suit your individual lifestyle.
Place a large frying pan or skillet on medium heat with oil, salt and pepper and sauté the onion and garlic until soft. Add cumin, chilli powder and paprika, crushed tomatoes and half a cup of water.
Cover pan and allow the mix to simmer on low heat for 10 minutes. Add more water if required.
Lift lid and carefully crack four eggs into the pan. Cover again and cook for a further 5-6 minutes or until eggs are cooked to your preference.
Add crumbled feta to the dish, remove from heat and garnish with parsley, salt and pepper and olive oil.
Serve immediately with toasted ciabatta bread.
Serves 2.
Optional – add grilled chorizo sausage and a wedge of fresh lemon.
The AC (Acromio-clavicular) joint is a thick fibrous joint that connects the top of the shoulder blade to the outer end of the collarbone. The joint is required to be strong and supportive and is the primary way in which weight bearing forces are transferred from the upper limb to the rest of the skeleton. The joint is connected by three strong ligaments, the Acromioclavicular, Corococlavicular and Corocoacromial ligaments.
HOW DOES THIS INJURY OCCUR?
The primary mechanism that will cause this joint and it’s ligaments to be injured is a force that separates the shoulder away from the collarbone, usually in a downwards direction. This can occur from a fall into the ground where the top of the shoulder hits the ground first, a rugby tackle or a fall onto an outstretched hand. As with all injuries, there are many variations in severity. A grading system has been developed to classify AC joint injuries.
WHAT ARE THE SYMPTOMS?
After an AC joint injury there is usually immediate pain on the top of the shoulder, swelling and bruising. There is often loss of movement of the shoulder, and pain from putting weight through the arm or carrying heavy objects. In severe cases there is a visible lump on top of the shoulder, known as a ‘step deformity’. This is an obvious difference in height between the top of the shoulder and the collar bone. There is frequently pain felt when reaching across the body, as when putting on a seatbelt.
To confirm the diagnosis, your physiotherapist can perform some clinical tests and an X-ray can help to grade the severity of the injury. The classification that would be given to you by your physiotherapist or doctor help to determine the optimal course of action for each injury based in current research and available techniques.
There are different classification systems, some use four grades and other six. Injuries with a smaller number of ligament fibres being torn are given a lower grade classification, going upwards as further damage is incurred. Injuries classified as higher grades will require surgical repair.
HOW CAN PHYSIOTHERAPY HELP?
The role of physiotherapy in this case is to ensure the joint is supported and given a chance to heal naturally, while maintaining the strength and normal movement of the shoulder girdle. This is done initially by providing support to the joint. You may need to have your arm supported in a sling or brace for some of this time. Your physiotherapist can show you some taping techniques to add support.
Most AC joint sprains take six weeks to fully heal, although many patients report shoulder problems in future years. For this reason a comprehensive rehabilitation program is very important. More severe sprains are often treated with surgery to stabilise the joint and treat any possible fractures. Surgical repair will also require a proper rehabilitation program.
None of the information in this newsletter is a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.
If you require professional advice or treatment, please see our range of treatment options, or book an appointment online. Physio Direct has many clinics located throughout New Zealand, with no GP referral required to make an appointment.
While pain and stiffness often go together, joint stiffness can occur on it’s own. Joint stiffness can limit your ability to perform usual tasks. For example, turning your neck to check behind you while driving. Stiffness can also be a warning sign that part of the body is vulnerable to future injury. There are actually many different causes of stiffness. We will explore a few of the reasons why you might not be feeling as flexible as normal.
Disuse and lack of movement
Our bodies are made to move. When we are not regularly moving them through their full range, they can begin to feel ‘tight’. This can be caused by a combination of the capsule that surrounds the joint tightening up and the muscles that surround the joint shortening and losing flexibility. Stiff and tight muscles can cause you to feel as though your joints are stiff, even if it is only the muscle length that is restricting the movement. Joint mobilizations, manipulation and muscle stretches/massage can have a significant effect in improving the symptoms.
The most important way to maintain full movement is to regularly move joints through their full range, which also helps to keep muscles and joints healthy. Your physiotherapist can advise you on how o best approach this with a targeted set of exercises.
Osteoarthritis (OA)
OA is a degenerative disease, characterized A person with OA will usually feel stiff for around 15-20 minutes after being still. Physiotherapy programs to strengthen the muscles surrounding the joints, so as to help absorb weight-bearing forces, has been shown to have positive results on OA symptoms.
Inflammatory Related Stiffness
The inflammatory process is characterized by swelling and pain around a specific area. Usually this is a response to damage by the body. As an area swells, this will allow less space for movement and a sensation of stiffness, as anyone who has had sprained an ankle can attest to. Acute inflammation will cause swelling that increases over 24-48 hours and subsides gradually. Autoimmune disorders can cause the body to mistakenly have an inflammatory reaction where there has been no injury, with resulting pain and stiffness. Rheumatoid arthritis and ankylosing spondylitis are two examples of such disorders.
Stiffness caused by inflammatory disorders is characterized by feeling of stiffness after rest, particularly in the morning that can take longer than 30 minutes to subside. Inflammatory disorders unrelated to injuries are complex in cause and require collaboration with medical teams for best treatment outcomes. Acute injuries are best managed by following RICE protocols (Rest, Ice, Compression, Elevation). Speak to your physiotherapist for more information regarding a specific condition.
a breakdown of joint surface cartilage and the growth of bony osteophytes around areas of stress. While OA is increasingly common as we age, it is thought that the primary cause is abnormal load and stress to joint surfaces and not simply aging itself. As the joint space between two joint surfaces become uneven, joints affected by OA can feel stiff or even ‘blocked’.
