Knowledge is power. Having the correct information on your injury and an understanding what is happening can improve your recovery! So firstly, what is a ligament? A ligament is a supportive structure that connects one bone to another. Their main function is used to aid in stability and help joints move with one another
Ligaments are commonly hurt by an overstretching mechanism, combined with extra force that is not usually placed through the joint in this position, common examples are rolling an ankle and shoulder dislocations, however they are also common in the spine!
It is critical to get these injuries assessed as soon as possible for the best chance at recovery. Lack of a rehab program will result in chronic instability and increased likelihood of further injury.
Signs and symptoms of a ligament injury
Grade 1
- Mild injury – some local swelling and tenderness to touch on the ligament site, typically there is no bruising or very minimal.
- Incident wasn’t ‘major’ and typically only one ligament will be involved
- Pain only occurs towards the end range of motion or with excessive force through the joint
- Functional recovery in 7-21 days, structural recovery closer to 6 weeks.
Grade 2
- Bruising is common, this is accompanied by moderate
- swelling
- Generally a more traumatic injury and may involve multiple ligaments, or include muscles and tendon damage as well
- Is a broad spectrum of ligament damage and can be classed as a grade 2 between 11 and 99% of ligament fibers damaged – therefore healing rates wildly differ between people/injuries.
- There is notable instability
- Ankle – obvious limp. Other areas you will try to avoid using subconsciously
- Functional recovery 2-8 weeks, structural recovery 1-3 months.
Grade 3
- Most severe injury of a ligament. Severe swelling and bruising, a fracture should always be ruled out. This is commonly seen in extreme ankle injuries and shoulder dislocations
- Complete tearing of the ligament, structural joint damage is often involved
- Unable to weight bear
- Extreme difficulty or unable to move joint
- Functional recovery 3 months, structural recovery 6-12+ months.
Key principles of ligament healing
Acute Phase
- Very early on in the injury phase.
- Use rest, ice, compression and elevation
- Avoid painful activities and can use pain control
- Get injury assessed and develop a rehabilitation as soon as possible. Ligament injuries can lead to chronic instability.
Post-acute Phase
- With a personalised rehabilitation program we will aim to get pain free range of motion and exercise as quickly as tolerated
- Looking to increase blood flow to the area
- Gentle mobilisations and manipulations to increase joint movement
Remodeling Phase
- The longest healing phase and will involve the bulk of the rehabilitation.
- Slowly increasing tolerance to basic strength, eccentric and concentric exercises before being introduced into return to sport activities.
- Regaining strength and then further improving strength of the ligament, joint and surrounding muscles
- Address factors that may have caused the injury in the first place.
- Failure to improve pain or motion in this phase may require a surgical consult for grade three ligament injuries.
It’s important to consult a health professional through these stages to ensure adequate progress is being made and further chance of re-injury is minimal before progressing
Everyone is different!
No two injuries and recoveries will be exactly the same, and this comes down to a few factors that can either be controlled or uncontrolled some of these include
- Age
- Height
- Economic status
- Access to recovery equipment
- Gender
Things you can change
- Weight (hard to change after injury but can be a factor in injury occurrence)
- Nutrition – adequate hydration and a healthy diet will improve tissue health
- Smoking – Do not smoke
- Alcohol – Will also slow down rate of healing
- Effort – Recovery takes time and can be boring, your level of application will impact the outcome.
Injury and inflammation
- The injury occurs, immediately hematoma formation occurs (clotting and swelling in the tissue) between ruptured areas of collagen and fibroblasts
- Torn tissues and blood cells stimulate the release of inflammatory cells and local hormones to signal the injury has occurred to the body and to begin the healing.
Proliferation and repair
- Macrophages (white blood cells) will clean up the dead tissue from the site of the injury (occurs in the first few days)
- Your body begins to synthesise collagen and proteins to restore the ligament or ‘fill in the gaps’. Creating a new framework for the ligament to build upon and regenerate.
- The hematoma is gradually replaced by the scar tissue that forms across this framework.
- Capillary regrowth – Capillaries are the smallest of our blood vessels and their growth is important in healing, because lack of blood supply means lack of nutrients and a decreased rate of healing. Ligaments have poor blood supply compared to muscles.
Remodeling (THIS WILL TAKE OVER 12 MONTHS)
- Contraction and reorganisation from the scar tissue formed above – this is often when you injure yourself you can feel ‘bumps’ or ‘ropiness’ – ligaments won’t heal perfectly.
- The initial stages of the cell building is purely to ‘fill in the gaps’ left by the tear and does not have much strength or organisation. Through this phase is super important to increase stress and load on the joint to improve this structure and function.
- This is why you can often return to sport and do most things you normally would, however you’ll notice that you subconsciously are not using the joint as normal or it is weaker or unstable – hence why footballers often strap their ankles – the joint is mostly stable, does not hurt, however they don’t have complete trust if they were to take an off balanced step.
- Because this stage takes so long there is a potential for weakness to develop as people stop doing their rehabilitation due to lack of pain or boredom.
- The joint may feel ‘normal’ within a few weeks, but if the remodeling of this scar tissue isn’t continually loaded it will be weaker than the surrounding tissue and have a higher potential for reinjury
Contact the clinic 60211975 or book online to start your rehab today
