Josephine Lawson Physiotherapy Clinic - Summer 2009 Newsletter - Issue No. 24

Knee Injuries

The most common injuries occurring to cricketers knees are either to the ligaments or to the cartilage.

Ligaments

These are short bands of tissue that connect bones in and around joints and prevent excessive movement at the joint.

There are 4 major ligaments in the knee
• Medial collateral ligament
• Lateral collateral ligament
These are either side of the knee.
• Anterior Cruciate ligament(ACL)
• Posterior Cruciate Ligament (PCL)

Injury;
Injury to the ligaments occur more often to bowlers as result of a twist or turn often on a fixed foot, such as catching the stud in the turf, sliding or landing awkwardly.
The injury can either be a strain, or in extreme, cases a tear.

Strain;
A minor strain will heal in a couple of weeks.
A major strain can take a few months to heal.
In both cases treatment as early as possible is recommended with Rest, Ice and Elevation, being the first things to do.
Followed by physiotherapy, which will include stretching and strengthening exercises.

Tear;
This does not necessarily need surgery, it depends on the extent of the tear which will need to be ascertained by a scan.

Cartilage
There are two cartilages in the knee.
These are crescent shaped pieces of gristle that lie on the articulating surface of the tibia (shin bone). They form the shock absorbers of the knee.
They do not have a blood supply so if they are torn they do not repair themselves.

Causes of injury;
Twisting strain, as in moving forward with the foot fixed if the foot has got caught in a rut or during a fall.
General wear and tear, as with excessive compression and force through the knee as in bowling.

Ankle & Foot

Leg symptoms arising from the back

Pain can be felt anywhere down the leg as a result of a nerve from the back, being pinched.
The sciatic nerve, the most common nerve to be affected, passes from the lumbar (lowest vertebrae in the back), spine, through the buttock and on down the back of the leg to the heel and into the foot.
Pinching can occur as a result either, of the disc bulging and pressing onto the nerve, or, a muscle spasm in the back or hip due to a strain, from making an awkward move. The nerve becomes compressed resulting in pain, not necessarily in the back or buttock, but further down the leg, such as in the heel, which is why this cause is often missed and the heel or leg pain is then treated locally (that is at the sight of the pain) without there being any improvement.
Typically nerve pain is more of a burning and aching type of pain and can be present at rest and more often, at night.

Treatment to the back and buttock, with stretching, mobilisation, manipulation and massage, usually relieves the symptoms.

Achilles Injuries

The Achilles tendon is the large tendon at the back of the ankle. It attaches the calf muscle (gastrocnemius and soleus muscles) to the heel bone (calcaneus) and provides the power in the phase of the gait cycle (walking and running).

Achilles tendonitis is often now being referred to as Achilles tendinopathy. This is because it is no longer thought to be an inflammatory condition.
It can be either acute, meaning occurring over a period of a few days, or chronic which occurs over a longer period of time. The condition can be ei- ther at the attachment point to the heel or in the mid-portion of the tendon (typically around 6cm above the heel). Healing is often slow, due to its poor blood supply.


Symptoms of Achilles Tendinopathy

•Acute tendinosis:

Gradual onset of pain over a period of days
Pain at the onset of exercise which fades as the exercise progresses.
Pain eases with rest.
Tenderness on palpation.
Chronic Achilles tendinopathy may follow on from acute tendinosis if it goes untreated or is not allowed sufficient rest.

•Chronic tendinopathy:

Gradual onset of pain over a period of weeks, or even months.
Pain with all exercise, which is constant throughout.
Pain in the tendon when walking especially up hill or up stairs.
Pain and stiffness in the Achilles tendon especially in the morning or after rest.
There may be nodules or lumps in the Achilles tendon, particularly 2-4cm above the heel.
Tenderness on palpation.
Swelling or thickening over the Achilles tendon.
There may be redness over the skin.

Causes of Achilles Tendinopathy

• Increase in activity (either distance, speed or hills).
• Less recovery time between activities.
• Change of footwear or training surface.
• Weak calf muscles.
• Decreased range of motion at the ankle joint, usually caused by tight calf muscles.
• Running up hills - the Achilles tendon has to stretch more than normal on every stride. This is fine for a while but will mean the tendon will fatigue sooner than normal.
• Overpronation or feet which roll in when running can place an increased strain on the Achilles tendon.
• Wearing high heels constantly shortens the tendon and calf muscles. When exercising in flat running shoes, the tendon is stretched beyond its normal range which places an 'abnormal' strain on the tendon.

What can you do?

Rest and apply cold therapy.
Wear a heel pad to raise the heel and take some of the strain off the Achilles tendon. This should only be a temporary measure while the Achilles ten- don is healing.
See a sports injury professional who can advise on treatment and rehabilitation.

What can we do?

If the Achilles tendinosis is acutely injured there may be inflammation present and therefore the use of anti-inflammatories may be appropriate. Tak- ing fish oil tablets and drinking green tea are also good ways of reducing inflammation.
Identify predisposing factors such as biomechanical abnormalities, inappropriate training methods or strength deficits.
Prescribe a rehabilitation programme to appropriately load the tendon.
Apply manual therapy such as sports massage, mobilization of the tendon or taping techniques.
Use ultrasound treatment

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