Ligament Sprains Conditions
Ligaments are made of collagen fibres organised into a thick band of rope-like tissue connecting one bone to another and therefore important for stabilising joints. Ligament injuries (sprains) are classified into grades according to severity but they can be painful at any grade, especially when the injury first occurs. The three grades are defined as follows:
Grade 1 : the ligaments are stretched, not torn and will usually take 2-3 days to heal
Grade 2 : a moderate sprain with partial tears to ligament fibres, the ligament is partly intact and can take 2-6 weeks to heal
Grade 3 : the ligament is completely torn and can take 6 weeks to heal and in some cases may require surgery
What is a wrist sprain?
Wrist sprain, whether minor or major, describes an injury to the soft tissues of the wrist including muscles, joint capsule, ligaments and tendons. The term is not specific to a particular soft tissue in the wrist or indicative of how badly the wrist has been injured but distinguishes the injury from a bone fracture.
Following a short period of rest, many wrist sprains will heal reasonably quickly and without any lasting side effects, but in a small percentage of people these injuries cause significant pain and dysfunction because important structural ligaments have been damaged. Damage to the ligaments that stabilise the wrist joint by holding the ten bones of the wrist together, can result in ongoing weakness and pain.
Wrist sprains happen when the wrist is forced too far in one direction and tissues are stretched or torn. A common cause is a fall onto an outstretched hand, especially from a height or at speed. Young people’s bones are very strong, so they can fall quite heavily, not breaking a bone but instead sprain their wrist. The same fall in an older person might result in a fractured wrist.
Soft tissue injuries are very common in ball sports or from falling off a bike but may also happen when the wrist or hand is over-twisted as occurs when using a drill or racquet that forces the forearm into excessive rotation. The force and direction of the injury will affect which soft tissues in the wrist are damaged and the severity of the trauma.
Another cause of soft tissue injury is called attrition where a ligament is gradually worn down until it breaks as a result of repeated strain through it over many years.
How do I know if I have a wrist sprain?
Immediately after the injury the wrist will be painful and swollen and movement, lifting and leaning on it will usually be difficult. While X-rays confirm that no bones have been fractured, the wrist sprain may still be serious.
Over time you may notice pain when lifting or pushing through your palm, or you might not be able to complete all your usual activities without pain. If after a week your wrist feels better but not 100%, seeking a diagnosis from your physio is recommended as it is a lot easier to treat the problem in the early stages compared to six weeks (or even months) later.
How can physio help my wrist sprain?
It’s important to pay attention if your wrist sprain doesn’t go away completely after a few days because it could be a more serious soft tissue injury requiring specific treatment. It is therefore recommended you have your wrist injury properly assessed by your physiotherapist.
Your physio will diagnose your injury and determine which tissues appear to be injured and the severity of the injury. Initial treatment of sprains involves rest, often by placing the wrist in a splint or brace or by taping it.
Your physio may perform soft tissue treatments on the surrounding muscles and tendons in combination with heat or dry needling. Exercises are essential to regain movement, strength and stability in your wrist.
What is skier’s thumb?
This injury occurs to an important stabilising ligament (the ulnar collateral ligament) at the knuckle joint of the thumb. This ligament gives strength and stability to the thumb when pinching or gripping.
Skier’s thumb is usually caused by an injury when the thumb is pulled or pushed away from the hand, often during ball sports, falling over with a ski pole in your hand while skiing, or a forceful tackle when playing footy. It can also be caused by repetitive low-level strain and twisting over many years.
The extent of the injury varies from a mild tear (grade 1 injury) to a complete tear (grade 3 injury), and can be to the ligament only or pull a tiny bit of bone off as it tears.
How do I know if I have a skier’s thumb injury?
When this ligament is injured there will be pain and swelling at the joint where the thumb joins the hand. The condition is usually quite painful when gripping or pinching with the affected thumb and the thumb will usually be swollen and sore to the touch around the inside of the joint (felt in the webbed area between thumb and index finger). A stretch to the area if the thumb is caught on clothing for example, can cause pain and weakness. An X-ray is indicated to determine whether the injury has chipped off a bone fragment.
How can physio help my skier’s thumb?
A partial tear of the ulnar collateral ligament needs to be supported to heal. Your physio will usually need to fit you with a splint to prevent further injury and limit pain while allowing gentle function during activities of daily living. Once the ligament has healed splinting will be required less frequently and strengthening exercises will be introduced. Protective taping, splinting or a special sports guard may be required for some time depending on the severity of the injury and if the aim is to return to sport.
What are knee ligament injuries?
The knee joint has four main ligaments, two of which are located inside the knee joint - the anterior cruciate ligament (ACL) and the posterior cruciate ligaments (PCL). The other two ligaments are outside the joint - the medial collateral (MCL) and the lateral collateral (LCL) ligaments.
The most common and serious knee ligament injuries include those to the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL). Australia has the highest incidence in the world of ACL injuries, thought to be due to our climate along with the sports we play and the types of grass surfaces played on. PCL injuries are less common.
An ACL injury usually occurs during cutting or twisting movements, sudden stopping or incorrect landing from a jump (all called non-contact ACL injuries). These movements are common in sports such as netball, football, basketball, soccer and gymnastics. Less frequently, the ACL can be injured during a tackle or collision with another player (known as a contact ACL injury), or an awkward fall while skiing. ACL injuries usually happen when the athlete’s foot is in contact with the ground and their knee is suddenly forced backwards, or when the knee is slightly bent and collapses inwards. Young females and people with a family history of ACL injuries are statistically at higher risk of ACL injury.
MCL damage tends to occur when the lower leg (tibia) is stretched outwards, causing the knee ligaments on the inner aspect of the knee to tear. MCL injuries commonly occur during an awkward landing, a tackle or fall over another player, while skiing or when a foot or ski gets caught, causing the knee to collapse inwards.
PCL injuries tend to be associated with cartilage tears and are less common than either ACL or MCL. PCL injuries commonly occur during a fall onto a very bent knee or via the knee hyperextending as a player lands on the front of the knee in such a way that the shin is forced backwards relative to the thigh bone.
How do I know if I have a knee ligament injury?
Your symptoms will depend on which ligament was injured and the severity of the injury. Complete ACL injuries are usually accompanied by a pop or a crack and significant pain at the time of injury, an inability to continue with activity and a “wobbly” knee when walking. However, some people’s pain settles within a few minutes and they can stand, walk and even run, sometimes returning to the field without pain or instability, but when they try to change direction, their knee may give way.
If you have injured your ACL you will have a swollen knee within a few hours of the injury, accompanied by pain at the back and outside of the knee which feels restricted when fully bending and straightening.
If you have injured your MCL you will have tenderness on the inner aspect of the knee, with slight swelling and restriction of movement which will vary in intensity according to the severity of the injury. A complete ligament rupture can be accompanied by a noise at the time of injury, and a “wobbly” feeling when walking.
If it’s your PCL that has been injured your knee will be less swollen (unless other structures have also been injured) but pain will be more widespread and worse at the back of the knee and calf.
How can physio help my knee ligament injury?
Your physiotherapist will examine your knee to determine which ligament or combination of ligaments have been injured and assess the severity of the injury. They will refer you for imaging if necessary. Your physiotherapy management program will include:
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