Sports & Knee Injuries Part Three – Football

Football is one of the most physical sports, and therefore one of the most dangerous.  Running backs and wide receivers are running routes at full speed – these routes in general aren’t straight lines or gradual turns; these are hard cutting right or left turns.  These turns are extremely hard on the knee as they are twisting the body at such high speeds.

Think about these high-speed movements, even before adding the possibility of a defensive player tackling them.

In football, there are a few possible knee injuries that one may endure over the course of their playing career:

  • ACL sprain
  • PCL sprain
  • MCL sprain
  • Meniscal tear
  • Patellar dislocation

An ACL sprain is a stretch or tear of the anterior cruciate ligament.  More serious sprains involve complete tears of one or more of the knee ligaments. Changing direction rapidly or stopping abruptly while running can cause the twisting motion that tears the ACL.  This is why it is so easily sprained or strained during football.

If you sprain your knee, at the time of injury you may hear sounds like :

  • Popping
  • Snapping

Following the popping or snapping sound, the athlete will almost instantly notice:

  • Pain coming from within the knee,
    • Especially with movement
  • Inability to weight bear on that leg,
  • Swelling
  • Fluid behind the kneecap
  • Instability in the knee, or looseness

MCL sprains and other MCL injuries occur when a sudden force or twisting motion is applied to the outside of the knee forcing the knee inward, most often when the foot is planted on the ground. The MCL extends from the end of the thigh bone to the top of the shin bone on the inside of the knee. Although common in sports, most MCL injuries respond well to non-surgical treatments. MCL sprains involve:

  • Stretching of the ligament
  • partially tearing or,
  • rupturing the ligament

 

This can happen when a football player receives a low tackle that targets the knee when the foot is firmly planted, when an athlete hurdles a defensive tackle to only land awkwardly, or when a quarterback has his offensive lineman fall back onto his leg as the quarterback looks down field for a receiver.

Symptoms depend on the severity of the injury and are classified according to the extent of the injury.  MCL injuries are classified as grade 1, grade 2 or grade 3.

  • Pain on the inside of the knee
  • Tenderness to touch
  • Swelling
  • Stiffness
  • Internal bleeding (grade 2)
  • Somewhat unstable joint (grade 2)
  • Unstable joint (grade 3)
  • Unable to put weight on the leg (grade 3)

For treatment of these types of injuries an individual can look to:

When it comes to prevention of such injuries, we must first realize that athletes take risks when they play sports, and knee ligament injuries are among those risks. Some MCL injuries are not avoidable, but you can reduce your risk for an injury by:

  • Avoid sudden increases in
    • Frequency
    • Duration, or
    • Intensity of exercise
  • Wear athletic shoes that provide strong lateral support

PCL tears are not as common as other knee ligament injuries. In fact, they are often subtle and more difficult to evaluate than other ligament injuries in the knee. The posterior cruciate ligament is located in the back of the knee. It is one of several ligaments that connect the femur to the tibia. The posterior cruciate ligament keeps the tibia from moving backwards too far. An injury to the posterior cruciate ligament requires a powerful force.

 

Often, when a PCL injury occurs, it is accompanied by other injuries in the knee.  These could be other ligament, cartilage, or bone injuries.  Injured ligaments are considered “sprains” and are graded on a severity scale:

Grade 1 Sprains:
The ligament is mildly damaged in a Grade 1 Sprain. It has been slightly stretched, but is still able to help keep the knee joint stable.

Grade 2 Sprains:
A Grade 2 Sprain stretches the ligament to the point where it becomes loose. This is often referred to as a partial tear of the ligament.

Grade 3 Sprains:
This type of sprain is most commonly referred to as a complete tear of the ligament. The ligament has been split into two pieces, and the knee joint is unstable.

 

Posterior cruciate ligament tears tend to be partial tears with the potential to heal on their own.  People who have injured just their posterior cruciate ligaments are usually able to return to sports without knee stability problems. An injury to the posterior cruciate ligament can happen many ways.  It typically requires a powerful force:

  • A direct blow to the front of the knee
  • fall onto a bent knee in football
  • Pulling or stretching the ligament (such as in a twisting or hyperextension injury)
  • Simple misstep

The typical symptoms of a posterior cruciate ligament injury are:

  • Pain with swelling that occurs steadily and quickly after the injury
  • Swelling that makes the knee stiff and may cause a limp
  • Difficulty walking
  • Knee instability

Meniscal tears occur mostly as a result of trauma. The meniscus is vulnerable to injuries in which there is:

  • Compression
  • Twisting across the knee

 Meniscus tears are most common in:

  • Contact sports (i.e., football)
  • Skiing & snowboarding
  • Volleyball

 

Like other knee injuries, it is not uncommon for one or more of the ligaments in the knee to be injured in addition to the injured meniscus.  Some symptoms that may be experienced by the injured athlete include:

  • Swelling
  • Pain in the knee
  • Popping sensation at the time of injury
  • Difficulty during flexion and extension
  • Knee locking

 

After sustaining injury, the athlete has a few options to maintain the state of the knee and to reduce chance of further injuring:

  • Rest the knee
  • Avoid weight bearing
  • Cold therapy
    • Reduce pain and swelling
  • Compression
    • Reduce swelling

 

If the pain and swelling has not subsided after 2-3 days, repair of the meniscus may be necessary. The decision to repair is based on many factors, including the location of the tear and age of the patient. At this time a physician, and most likely a specialist, is needed to help the injured athlete decide the best course of action to resolve the situation. Unfortunately studies have shown that individuals who tear their meniscus are at a higher risk of developing osteoarthritis of the knee later in life.

Patellar (kneecap) dislocations often occur in younger athletes, however even elite athletes can endure this injury. Generally, the dislocations occur with the patella moving laterally rather than medially, however both are possible.

Dislocation is accompanied by:

  • Intense pain
  • Swelling

 

Unlike quite a few knee injuries, this is an injury where the athlete is physically able to see the dislocation of the patella. Often for the patella to get back into place, the extension of the leg will naturally pull it back.  Patellar dislocations can occur either in contact or non-contact situations. An athlete can dislocate his/her patella when the foot is planted and a rapid change of direction or twisting occurs. Direct blows to a knee can cause dislocations as well. The force of these is obviously much greater and usually causes more severe damage especially to restraining ligaments.

 

Symptoms include the following:

  • Rapid, acute swelling
  • Extreme pain initially until relocation occurs.
  • Continued pain along medial ligaments.
  • Discoloration medially at site of ligament injury.
  • Sense of instability and apprehension that problem will recur.

 

In the rehabilitation process, athletes may have to wear a brace with a buttress that holds the patella in its proper place (Bledsoe 20.50 Knee Brace).  Depending on the patella’s tendency to move, the buttress will stop it from moving laterally or medially.  It addition to this, it may also be noticed that the VMO (vastus medialis oblique) is weak or has atrophied.  This is one of the quadriceps muscles, which is located above the knee cap on the medial side. The KneeHab is a popular product that offers TENS and NMES programs to help the muscle’s hypertrophy and reduce pain.

 

If you have sustained a knee injury while playing football, or if you want to better protect your knee from injury, then please contact the Arthritis & Injury Care Centre.  We offer a variety of products and services such as knee braces and cold therapy to help prevent injuries and get you back into the game.


Author:

Brandon Downing
Orthopedic Bracing Specialist

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