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Ligament Damage

Ligament damage to the ankle and knee are extremely common among athletes. Ligaments are fibrous tissue that connects bones to other bones to form a joint. A ligament is made up of tough, dense collagenous fibres that possess high tensile strength. This is essential to maintain stability within the joint, preventing dislocation.

The elastic properties within collagen fibres allows the ligaments to stretch to some extent, however ligaments can be plastic and retain their length when stretched over a certain limit for a prolonged period of time. Dislocated joints must therefore receive immediate attention, if the ligament lengthens too much, the joint will weaken and cause future occurrences.

A ligament sprain occurs when the ligaments are over stretched, which can often affect the structure of the ligament, causing tears and joint instability.  Sprains are graded in three categories in terms of their severity:

Grade I - Sprain to the ligament caused by over stretching without tearing or rupturing the ligament meaning that joint stability is maintained.
Grade II - Sprain to the ligament resulting in a small tear, however joint stability is maintained.
Grade III - Sprain to the ligament resulting in full rupture of the ligament which consequently causes severe pain and joint instability.

The main priority with sprains is to reduce swelling and inflammation, control and reduce pain and maintain and increase joint mobility and soon as possible.

It is essential to maintain motion within the joint to prevent immobilization. Having the injury in a cast will limit the range of movement and length of the ligament possibly making the joint stiff, increasing rehabilitation time. The healing process involves scarring of the ligament which as result tightens the ligament increasing stiffness. Mobility exercises can reduce the stiffness and increase rehabilitation time.

Examples of exercises for ankle sprains include rotating the ankle, toe raises, writing numbers while pointing the toe. Keeping the ligaments at the optimum length for movement will increase healing and prevent excessive tightness and stiffness.

Paracetamol and Codeine can be taken to reduce the pain. Also anti-flammatory drugs such as Ibuprofen can be used in the recommended dosage to reduce both the pain and the swelling which helps to ease the healing process.

The most common injury among athletes is to the anterior cruciate ligament (ACL) within the knee. The knee (patellar joint) is stabilized by the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL) and lateral collateral ligament (LCL). Each ligament plays a role in stabilizing and preventing too much movement within the knee; the ACL prevents the tibia from propelling too far forward. 

Tearing or damage to any ligament within the body’s joints will damage the small proprioceptors within the ligament fibres. A greater degree and depth of damage to the ligament will effect proprioception to a greater extent. The small proprioceptor cells within the ligament relay information to the central nervous system about the positioning of the ligament; this information is then forwarded to the brain where it can be processed for an appropriate response to be initiated.

Damage to these cells will therefore cause a proprioception deficit, disrupting the ability of the proprioceptor cells to relay information to the central nervous system and the brain. The consequences of this will result in reduced balance and joint stability.

Physiotherapists along with sport therapists would incorporate balance exercises as part of their clients recovery process to regain proprioception of the ligaments and joint stability. 

The RICE method is the most commonly recommended treatment for ligament injuries:

REST - Take the weight off your joints to help prevent further damage. Rest for 24-48 hours after sustaining the injury and elevate the affected area for 20 minutes every 3-4 hours.
 
ICE - Apply ice to the injury for 20 minutes at 3-4 hour intervals for a period of 48 hours to reduce swelling. Instance ice packs or reusable hot and cold therapies can be used.

COMPRESSION - Use bandages or taping to compress the injury. This helps keep the joint aligned, however be careful not to restrict blood flow.

ELEVATION - The affected joint should be elevated above the heart whilst resting. This reduces swelling and blood pooling in the affected area.