Knee pain

Repetitive stress injuries of the knee and leg are caused when a movement, motion or activity is performed too much. This can include anything from playing soccer, running or simple aging. Acute injuries are caused by large forces that the knee and leg tissues cannot absorb and tolerate.

Incline Health we have a passion for fixing joint and muscle problems. We use evidence-based treatments to reduce knee pain and improve function. Our chiropractors use the latest and highest standards in treatment.

The following is a list of conditions that our chiropractors have put together to educate you about the knee and leg:

  • Medial collateral ligament (MCL) Injury
  • Medial meniscus tear
  • Achilles tendonitis
  • Calf pain
  • Lateral collateral ligament (LCL) injury
  • Anterior cruciate ligament tear
  • Iliotibial band syndrome
  • Jumpers knee
  • Osgood Schlatters disease
  • Patellofemoral pain syndrome
  • Shin splints
  • Calf strain
  • Peroneal tendonitis

Medial collateral ligament (MCL) injury

A sprained medial collateral ligament or MCL injury is a ligament tear inside the knee. This is usually the result of twisting or direct impact.

Causes

An injury to the MCL is the cause of impact to the outside of the knee when the knee is bent. If there is enough force, this will result in the ligament stretching or fibres to tear on the inside of the knee. A twisted knee can also cause a medial ligament sprain.

Symptoms

Depending on the injury, symptoms are classified as grade 1, 2 or 3.

  • Grade 1: Injury in this grade can be mild and tender in the inside of the knee on the ligament. In most cases, there is no inflammation. Test this area with the valgus stress test by bending the knee to 30 degrees and applying force to the outside of the lower leg to stress the medial ligament. You will feel there is no joint laxity, though you will feel pain. A grade one tear compromises less than 10% of the fibres torn.
  • Grade 2: Injury in this grade will be tender in the inside of the knee and some swelling will be experienced along the medial ligament. Test this by using the valgus stress test and there should be mild to moderate laxity in the joint and pain. The knee will not be able completely be able to bend sideways.
  • Grade 3: Injury in this grade will be a complete ligament rupture. Pain in this grade will vary, though grade two is often more painful. The stress test will reveal important joint valgus.

Treatments

Immediate first aid

  • Apply R.I.C.E (rest, ice, compression, elevation)
  • Apply a cold pack for 10 – 15 minutes every hour after initial injury.
  • Wear a knee support or compression bandage to reduce swelling. Wearing a support will be most effective for grade two and three injuries.

Wear a hinged knee brace

A hinged knee, from a knee support, prevents sideways movement of the joint to protect the knee while healing. Knee supports are recommended for grade two and three injuries to restrict movement or bending while the joint is healing.

Electrotherapy

A chiropractor or physiotherapist may use an ultrasound in the early stages to treat by controlling pain and swelling.

Taping

Taping will support and protect the injured area. Taping can be done when the injury occurs or at later stages when returning to physical activity and training.

Taping technique should be considered as certain ways of taping can provide more support than cheaper hinged knee braces. Maintaining and re-applying tape is important when tape effectiveness reduces over time and stretches.

Exercises

In most instances isolated MCL tears will require immediate exercises to take place very soon after the injury for the best results to be achieved long term with rehabilitation. Exercises in the first phase of rehabilitation will be to recovery any lost mobility especially in the extension plane.

Massage

Massage is effective treatment during the rehabilitation program. In the early acute stages, direct massage to the injury tissue should be avoided. When the ligament begins to heal, light cross friction massage may be used.

Meniscus Tear

A medial meniscus tear is a tear to the semicircular cartilage in the knee.

Causes

Twisting the knee is the most common cause of injury to the meniscus. Other causes can be in conjunction with another injury and degeneration, especially in elderly patients.

Both knees have two crescent-shaped cartilage menisci. These cartilage acts as shock absorbers for the knee and when the knee experiences twisting and compression of the cartilage they can tear. Different ways in which the cartilage can tear include bucket handle tears, degenerative, longitudinal and radial tears.

Symptoms

Symptoms include gradual or sudden pain in the inside of the knee when completely bending or squatting down. There may also be swelling, the knee giving way or locking. Tenderness will be experienced along the joint line reducing range of motion.

A chiropractor or physiotherapist will be able to make a specific diagnosis and begin treatment or refer you to the appropriate practitioner.

Treatment

Treatment options include:

  • Applying P.R.I.C.E (protection, rest, ice, compression and elevation)
  • Applying cold pack to reduce swelling and inflammation
  • Resting to allow injured tissue to heal
  • Wearing a knee support or hinged brace.

Once the injury has been diagnosed, your chiropractor or physiotherapist will advise if the injury should be treated conservatively (without surgery) or to operate.

Conservative treatment involves continuing P.R.I.C.E to reduce pain, swelling and inflammation, anti-inflammatory medication, electrotherapy and a joint healing supplement.

Anterior Cruciate Ligament (ACL) tear

Anterior cruciate ligament (ACL) injuries are often the result of contact sport. These injuries are also often the cause of other injuries associated with damage to other structures.

Symptoms

ACL tears are often the cause of a bad twisting with the most common symptom being pain in the knee. Most people explain that they heard a pop or crack at the time of the injury. A feeling of instability in the knee and swelling will usually develop, with the feeling of swelling being caused by the excess of blood in the joint after rupturing the blood vessel.

Causes

Twisting and contact sports are the most common cause of an ACL tear. This kind of injury results in other associated injuries to other structures of the knee joint, which will also need to be diagnosed and treated.

Treatment

If you have torn your ACL, or think you have, we recommend you contact your practitioner to receive a diagnosis and the appropriate treatment as soon as possible.

Immediate treatment options include applying P.R.I.C.E (protection, rest, ice, compression and elevation) for the first 72 hours or until you see a practitioner and seek advice.

Once the injury has been diagnosed, your practitioner will advise if the injury should be treated conservatively (without surgery) or to operate. Each case is different and the decision to operate will be based on the age, occupation, lifestyle and instability of the knee of the person. A surgeon will be able to advice of the type of surgery that will be most effective. If surgery is recommended, the operation will be performed as soon as possible or in the coming days or week from when the injury occurred and pre-injury exercises will be recommended.

If surgery is not recommended, your practitioner will provide you with mobility and strengthening exercises you can do to heal the injury to your knee.

Lateral Collateral Ligament (LCL) Sprain

A lateral ligament sprain is an injury to the outside of the knee that occurs because of a tear to the ligament.

Causes

The major cause of a LCL sprain is a direct force/blow to the inside of the knee. This force to the inside of the knee causes the lateral collateral ligament of the knee to tear (sprain).

Symptoms

Depending on the injury, symptoms can vary from being mild to more serious, with a complete rupture of the ligament.

  • Grade 1: Symptoms in this grade include tenderness over the ligament on the outside of the knee. In most cases, there is little or no swelling. Pain is felt, though no joint laxity when the knee is bent to 30 degrees and force is applied to the inside of the knee.
  • Grade 2: Injury in this grade will be tender on the outside of the knee over the lateral ligament. This grade will experience some swelling over the ligament, pain and some laxity in the joint.
  • Grade 3: Injury in this grade will be a complete tear of the ligament. Pain in this grade can be experienced less than pain in grade two. Stressing the knee will reveal significant joint laxity.

Treatments

Immediate first aid

  • Apply R.I.C.E (rest, ice, compression, elevation)
  • Apply a cold pack for 10 – 15 minutes every hour after initial injury.
  • Wear a knee support or compression bandage to reduce swelling. Wearing a support will be most effective for grade two and three injuries.

Wear a hinged knee brace

A hinged knee, from a knee support, prevents sideways movement of the joint to protect the knee while healing. Knee supports are recommended for grade two and three injuries to restrict movement or bending while the joint is healing.

Electrotherapy

A chiropractor may use an ultrasound in the early stages to treat by controlling pain and swelling.

Taping

Taping will support and protect the injured area. Taping can be done when the injury occurs or at later stages when returning to physical activity and training.

Taping technique should be considered as certain ways of taping can provide more support than cheaper hinged knee braces. Maintaining and re-applying tape is important when tape effectiveness reduces over time and stretches.

Exercises

In most instances isolated LCL tears will require immediate exercises to take place very soon after the injury for the best results to be achieved long term with rehabilitation. Exercises in the first phase of rehabilitation will be to recovery any lost mobility especially in the extension plane.

Massage

Massage is effective treatment during the rehabilitation program. In the early acute stages, direct massage to the injury tissue should be avoided. When the ligament begins to heal, light cross friction massage may be used.

Calf pain

Calf pain is an extremely common presentation to one of our chiropractors cases of calf pain can be treated with simple treatments and give lasting results.

Common causes

The soleus muscles and the gastrocnemius together make up the calf muscles. Calf strains are tears that occur in these areas. There are different types of calf strains, including:

  • Calf muscle contusion: Occurring at the back of the lower leg from a direct blow that causes the bone to bleed and be in pain and swell. Treatment includes ice, rest, stretching, strengthening exercises.
  • Cramp in the calf muscle: This is a painful sudden, involuntary contraction. This kind of cramp can be experienced at the end of a long and hard exercise session. Causes of the cramp are suspected to be low salt and carbohydrate levels and dehydration.
  • DOMS (delayed onset muscle soreness): DOMS is muscle soreness that occurs in the hours after exercise. Time is the most effective form of treatment.

If you have an existing injury elsewhere, this pain can move itself into the back of the lower leg, which can be mistaken as a calf injury. Calf pain can be referred from the lower back through pressure on the sciatic nerve. Swelling at the back of the knee or a Bakers cyst can also refer pain into the calf.

Less common causes

Less common causes include:

  • Posterior deep compartment syndrome: This is where the muscles become too large for the sheath surrounding it. A direct blow can cause this, making the muscle bleed, or it can occur gradually. Pain during exercise will be experienced, causing the person to stop their session.
  • Stress fracture of the fibula: This is a hairline crack in the bone caused by overuse or repetitive stress. This fracture is less common that a stress fracture. Pain on the fibula bone deep in the calf muscles is the most common symptom.
  • Stress fracture of the tibula: This is a hairline fracture in the weight bearing tibula bone. This fracture is caused by overuse. Shin pain is likely to be experienced in the lower third of the inside of the shin and in the calf.
  • Varicose veins can also be the cause of calf pain.

If you have an existing injury elsewhere, this pain can move itself into the back of the lower leg, which can be mistaken as a calf injury. Calf pain can be referred from the lower back through pressure on the sciatic nerve. Swelling at the back of the knee or a Bakers cyst can also refer pain into the calf.

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