Sports Medicine - Bodybuilding Injuries

Achilles Tendon Rupture | Anterior Cruciate Ligament(ACL) | Back Injury | Concussion | Foot Injuries | Shin Splints | Hamstring | Heatstroke | Knee Injuries | Knee Surgery | Elbow Injury | Groin Injury | Neck Injury | Scaphoid Fracture | Shoulder Injury | Sprained Ankles | Treating Acute Sport Injuries | Acute Mountain Sickness | Muscle Anatomy Charts

Achilles Tendon Rupture

The Achilles tendon is the largest and most exposed tendon in the body. This tendon is a large, strong fibrous cord that connects the muscles in the back of your lower leg to your heel bone. A rupture occurs when the tendon is partially or completely separated. Usually the rupture occurs just above your heel bone, but it can happen anywhere along the tendon. Because a partial rupture can result in little pain, it is often misdiagnosed as a strain, or sprain. A classic sign of an Achilles tendon rupture is a "popping" sound and a sharp pain in the back of the lower leg. A ruptured Achilles tendon usually requires surgery as it will not heal on it's own, it is important to see a physician to confirm the diagnosis.

Anterior Cruciate Ligament(ACL)

An ACL injury typically occurs when the ligament is stretched beyond its limit and tears. Commonly misdiagnosed as sprains or collateral ligament knee strains, ACL injuries are common in sports that require abrupt stops and turns (such as soccer, football and tennis).An ACL tear usually requires surgical repair and extensive rehabilitation, so a visit to a physician is paramount.


A blow to the head can result in a jarring of the brain causing both short-term and long-term consequences, research suggests that concussions are in fact a form of traumatic brain injury. Although this type of injury is getting more attention lately, many athletes still shake it off as not being very serious. If left untreated, a concussion can lead to a slow brain bleed. If the athlete has a history of concussion, the damage can lead to long-term problems with planning abilities, memory and other cognitive abilities. A physician who will perform tests for reflexes, coordination, pupils, and perform a cognitive assessment should always evaluate a head injury.

Foot Injuries

Ligament strains

The many joints which comprise the foot are all bound together by ligaments, or thickened protective parts of the joint coverings. Any of these ligaments may be damaged by abnormal strains. Usually, the strain is the result of a sudden twist. The strain may occur gradually, from repeated over-stretching, if, for instance, you wear unsuitable or unaccustomed shoes. In either case, once a ligament is damaged, it will set up a painful spot which will be aggravated each time you subsequently over-stretch that point, or apply pressure over it. Even a tiny ligament can give severe pain when strained, and the pain can persist for some months.

Treatment may consist of an injection from your doctor; rest; supportive strapping; underfoot supports to prevent stress over the damaged ligament; or electrical and exercise therapy from a physiotherapist. Any painful activities increase the damage and prolong the injury: the more you can rest the foot, the quicker it recovers.

Plantar Fasciitis

The plantar fascia may be strained by a change in shoes. When the fascia is strained, it usually becomes painful where the fascia is attached to the heel bone, and the front of the heel bone feels tender when you press it. The heel hurts on walking and running, and on standing up after you have been sitting down. It also hurts when the sole of your foot is put on the stretch, for instance if you pull your foot and toes backwards towards you with your hands. Specialist treatment may consist of an injection and/or electrotherapy. A soft arch support will take the pressure off the fascia. Painful activities should be avoided. You can resume sport when the tenderness to pressure under the heel has disappeared.


This is a general term to describe pain in the forefoot, between the metatarsal heads. The pain may be associated with, or caused by, structural defects such as an excessively high arch. Treatment aims to correct the defects and improve overall foot function, usually by exercises to improve the balanced working of all the muscles in the food, and by foot supports to improve the mechanical alignment of the joints.


In this condition, technically known as hallux valgus, the big toe is pulled towards the second toe, causing the big toe joint with the first metatarsal to form an angled protrusion on the inner side of the foot. The condition is caused by excessive pull inwards from the tendons acting on the toe. Shoes with pointed toes can contribute to the problem. The deformity may become severe, but it is not necessarily very painful. If it does cause pain, pads are used around the protruding bone, to try to prevent friction from shoes over it. Underfoot support, to try to rebalance the weight-bearing load, may be tried. If the joint becomes very painful, and especially if the second toe is crushed by the sideways drift of the big toe, an operation is needed to remove the protruding part of the bone and straighten the joint.


The tendons over the top of the foot are vulnerable to this condition. A direct blow, friction from tight shoelaces, or overuse strain, can cause irritation between these tendons and their covering sheaths. Over-stretching the tendons, by extending the ankle and pointing your foot down, is painful. If you touch the tendons and move your foot, you will feel a slight 'grating' sensation. Specialist treatment may include an injection, or various forms of physiotherapy treatment. You should check your shoes for tightness over the mid-foot, hard lacing eyelets, or roughness on the shoe tongues. If necessary, you should place a padding along the whole tongue. Painful activities and over- stretching should be avoided until the pain and grating have subsided.

Black toenails

These occur because of a direct blow to the nail, or through friction from tight shoes, or from disruption of the nail, for instance if an inner seam in a shoe catches on the toe and lifts the nail away during movement. The blackness is blood and bruising under the toenail. If the nail is painful, with a feeling of excessive pressure, you can ease it by boring through the nail with a sterilized needle, to release some of the blood. If the nail is persistently painful, you should ask your doctor either to treat it, or to refer you to a chiropodist or podiatrist (foot specialist). You should take care to trim all your toenails evenly, straight across the top of the toes, to avoid the further problem of ingrown toenails.

Stress Fractures

Runners push off from their toes, putting great stress on the metatarsal heads. The 1st metatarsal is usually immune to fracture because it is much thicker and stronger than the others. The 5th metatarsal is relatively immune because the major force of "toeing off" comes from the first 2. The 2nd, 3rd and 4th metatarsals are usually susceptible because of their thin diaphyses.

Symptoms, Signs and Diagnosis
Patients usually present with forefoot pain, often during a long or intense workout, which disappears within seconds of stopping exercise. On successive exercising, the pain returns earlier than previously, ultimately becoming so severe that it may prohibit exercise and persist even with the patient lying in bed. Palpating the swollen area causes pain at the facture site. An x-ray usually is not sensitive enough to diagnose the fracture until a callus forms 2 to 3 wk after the injury.

Treatment includes stopping all sports that require running. Healing usually takes 3 to 12 wk (it may take longer in elderly and in debilitated patients). Women with recurrent stress fractures and oligomenorrhea or amenorrhea may need to be treated with calcium, estrogen and progesterone.

Scaphoid Fracture

This common wrist injury often occurs from a fall on an outstretched arm. The scaphoid is a small bone entirely within the wrist joint and about the size of a peanut shell. This bone sits below the thumb and has a unique blood supply that can be easily disrupted by a fracture. Because the symptoms of a scaphoid fracture are similar to a sprain, it is often overlooked by an athlete and may be misdiagnosed by a physician. There is often only a little swelling and the amount of pain may vary. Usually, the swelling will go away in a few days. Unlike the fractures of the forearm, hand, and finger bones, fractures of the scaphoid almost never show any obvious deformity of the wrist making it common for the diagnosis to be delayed for weeks or months. Diagnosis by a physician and treatment is essential for proper healing.

Shin Splints

Anterolateral Shin Splits

The anterior compartment muscles (tibialis anterior, extensor hallucis longus and extensor digitorum longus) hold the forefoot up during foot descent and contract eccentrically immediately after the heel strikes the ground. They are opposed by the much larger gastronomies and soleus muscles, which pull the forefoot down. The tremendous force of eccentric contractions can damage the anterior compartment muscles
Symptoms and Signs
Pain occurs in the anterior compartment muscles, at first only immediately after the heel strikes the ground during running. If running is continued, the pain will occur throughout each step, eventually being felt constantly. By the time advice is sought, there is usually severe point tenderness over the anterior compartment muscles.
Treatment includes stopping running, trying an alternate exercise, stretching the calf muscles, and doing exercises to strengthen the anterior compartment muscles after they start to heal.

Posteromedial Shin Splints

The main function of the posteromedial compartment muscles is to supinate the foot and raise and avert the heel just before "toeing off". Increased traction on the muscles is caused by excessive pronation and by running on banked tracks or crowned roads (exacerbated by wearing shoes that do not effectively restrict pronation). Excessive pronation causes the arch to drop lower than normal, increasing the force necessary to lift the arch during supination.
Symptoms, Signs and Diagnosis
Pain usually starts in the postremedial compartment muscles; 2 to 20 cm above the medial malleolus. It becomes more severe when the athlete rises up on his toes or averts the foot. If he continues running, the pain then moves forward to involve the medial aspect of the tibia, and can then move up the medial side of the tibia, to reach within 5 to 10 cm of the knee.
Pain location and severity depend on injury progression. First, there is a tendonitis of the muscles of the deep posterior compartment. If the athlete continues to run, the pain may progress into the muscle bodies themselves; then traction on the tibialis posterior tendon can lift the muscle from its bony origin, causing subperiosteal hemorrhage and periostitis. With continued traction, part of the tibia can be torn away.
Treatment is to stop running, until it causes no pain, choose an alternate exercise, wear shoes with rigid heel counters and special arch supports to limit pronation, avoid future running on banked tracks and crowned roads, and strengthen the injured posteromedial muscles.


Acute injury

An acute hamstring injury can happen in a variety of different ways, with the one common factor that there is a sudden pain in the muscles, which is directly related to a particular movement or incident.

The hamstring muscles or their tendons may tear as a result of an over-stretch injury, for instance if you have to sprint suddenly when you are cold, or when your muscles are tightened because of a previous strain, or fatigue from training hard the previous day. Over-stretching may happen if your foot slips forward when your leg is straight in front of you, for instance as you land during hurdling. A direct blow to the hamstrings while they are contracting can tear the muscles. You may be hit by a hockey ball or a squash racket while you are running fast. Inefficient muscle function can also contribute to sudden tears in the hamstrings.

What you feel is a sudden pain in the hamstrings, which may be no more than a twinge, up to a searing pain. You may see bruising, immediately, or some time after the injury has happened, and the bruising, with perhaps swelling, will tend to track downwards towards the knee. If there is a severe tear, you may see a knot of tissue forming a bump on the thigh, especially if you work the hamstrings by trying to bend your knee. After the initial pain, the torn part feels sore to touch, and gives pain in the same area whenever you contract the hamstrings, either by extending your hip or bending your knee; and when you stretch the muscles, by keeping your leg straight and bending forwards at the hips.

A severe tear, involving a lot of muscle tissue, may need to be stitched together again by a specialist surgeon. However, if the tear is more minor, your doctor may decide that you need no more than a conventional rehabilitation program, which you must follow completely.

A gradual pain in the hamstrings, directly related to a particular movement or activity, is usually termed a hamstring 'pull' or 'strain'. This injury happens for similar reasons to the acute tear. The muscles are tight, fatigued, or weakened, and are then strained by overwork. Over training, especially if this involves repetitive movements, is a common cause of hamstring overuse strains.

By definition, the overuse strain starts with only a very slight pain, which gradually gets worse, as you continue with the activity which caused the problem. Occasionally, the pain is only evident when you work the hamstrings against resistance in their least efficient range, lying on your stomach with your knee held bent to a right angle, and extending your leg backwards at the hip.

The problem with overuse injuries to the hamstring is that they tend to recur. Even if they do not develop to the stage of an acute tear, they limit your ability to run, sprint, hop, and stretch your leg out. Specialist treatment may include injections, and various forms of physiotherapy. But the most important factor in recovery is regaining full flexibility in the muscles, and efficient function. If you try to resume your sport before you have completed the whole recovery process, you are making a recurrence of the problems inevitable.

A mild hamstring injury may recover within ten days to two weeks, but a more severe problem can last for over three months. If your hamstring injury does not improve, despite careful rehabilitation, it may be that there is an underlying problem. Hamstring pain and spasm can be caused by a stress fracture in the thighbone.


Exposure to high ambient temperature may lead either to excessive fluid loss and dehypovolemic shock (heat exhaustion) or to failure of heat mechanisms and dangerous hyper pyrexia (heatstroke)

Common sense is the best preventive; strenuous exertion in a very hot environment and insulating clothing should be avoided, and an adequate fluid intake is important.

Heatstroke (Sunstroke)

An abrupt onset is sometimes preceded by prodromal headache, vertigo, and fatigue. Sweating is usually but not always decreased, and the skin is hot, flushed, and usually dry. The pulse rate increases rapidly and may reach 160; respirations usually increase, but the blood pressure is seldom affected. Disorientation may briefly precede unconsciousness or convulsions. The temperature climbs rapidly to 41C and the patient feels as if burning up. Circulatory collapse may precede death; after hours of extreme hyperpyrexia, survivors are likely to have permanent brain damage.

Old age, debility, or alcoholism worsens the prognosis.

Heroic treatment measures must be instituted immediately. If distant from a hospital, the patient should be wrapped in wet bedding or clothing, immersed in a lake or stream. The temperature should be taken every 10 minutes and not allowed to fall below 38C to avoid converting hyperpyrexia to hypothermia.

The patient should be taken to hospital as soon as possible after the emergency methods have been instituted for further management.

Bed rest is desirable for a few days after severe heatstroke, and temperature liability may be expected for weeks.

Heat Exhaustion

Because of excessive fluid loss, this disorder gives adequate warning by increasing fatigue, weakness, anxiety, and drenching sweats, leading to circulatory collapse with slow thready pulse; low or imperceptible BP; cold, pale, clammy skin; and disorientation followed by a shock-like unconsciousness.

Syncope (faint) is a mild form of heat exhaustion and is precipitated by standing or a long time in a hot environment, e.g. the soldier on the parade ground, and is due to pooling of blood in the heat-dilated vessels of the lower extremities.

Heat exhaustion is more difficult to diagnose than heatstroke, but its prognosis is far better unless circulatory failure is prolonged.

Treatment is aimed at restoring normal blood volumes and improving brain perfusion, thus the patient should be placed flat or with their head slightly down. When they start responding, small amounts of sugar water should be given.

Knee Injuries

The knee is not simply a hinge joint: you bend and straighten it, but you can also turn it slightly in a twisting movement, when the knee is bent. This rotary movement automatically accompanies the bending and straightening movements. As you bend your knee, the shinbone turns inwards slightly relative to the thigh bone. As you straighten, the shinbone rotates outwards. You can only rotate the knee actively and voluntarily when the knee is bent. When you bend your knee against gravity or a resistance, the muscles at the back of the knee contracts to perform the movement. The hamstrings do the main work of bending the knee, but the gastrocnemius tendons help, especially if the movement takes place against a strong resistance. When you straighten your knee in the direction of gravity, for instance while you are lying on your stomach, the hamstrings pay out to control the movement. The quadriceps muscles on the front of the thigh straighten your knee against gravity or a resistance, but they also act to control the movement, when the knee bends in the direction of gravity's influence.

The structure of the knee-joint has two effects. Firstly, the knee is a very stable joint, by virtue of its strong binding ligaments and the protective effect of the muscles which control the joint's movements. Secondly, the joint has quite a wide freedom of movement, because the bones are not closely bound within their own configuration. The knee is one of the three major joints in the leg which transmit loading forces between one's body and the ground. Its stability helps to keep us upright on our feet when we are standing, walking, hopping or jumping.

Knee Pain
This can arise from various causes. The knee can be affected by a spontaneous inflammatory arthritis. Or it can be one of many joints involved in a multiple inflammatory arthritis. Pain referred from the hip or back may be felt as a simple knee pain. Problems in the thighbone may cause knee pain. In older age, the knee, like the hip, may be affected by osteoarthritis, or wear- and-tear degeneration. In children, unexplained knee pain can be a sign of a very serious hip condition, the slipped epiphysis.

Knee Swelling
Joint swelling is an important symptom in knee conditions. Because of the complex and extensive synovial lining in the knee, the joint may distend alarmingly, with swelling right round the joint, reaching about seven centimeters above the knee onto the front of the thigh. However, it can also be more subtle. You may also see a small pocket of swelling, perhaps on one or the other side of the joint; or there may be just a slight puffiness on the front of the joint, on either side of the kneecap. Swelling may occur at the back of the joint, without any visible signs of it at the front. Joint swelling always indicates inflammation. As in the ankle, knee swelling can be caused by gravity bringing the fluid down from some higher tissues: the swelling may track down from the hip joint or some part of the thigh muscles. However, unlike the situation in the ankle, if you have persistent swelling in the knee, which delineates the joint's shape, it is unlikely to be gravitational swelling, and it is very likely to mean that there is something wrong inside your knee.

If the swelling has appeared for no obvious reason, it may indicate that you have an inflammatory or degenerative condition. Your doctor will probably arrange blood tests and X-rays, to decide whether this is so. If the swelling occurs as the result of an injury to the knee, and you are aware of having wrenched it, or fallen on the joint, it is likely that you have damaged one or more of the knee's internal structures, with irritation or damage to the synovial lining. The swelling may come on at the moment of injury, or some hours afterwards.

The knee is very prone to injury, because of its mobility and the variety of stresses we subject it to. The most common type of traumatic injury to the knee is the twisting or wrenching injury. This happens most frequently when your knee is bent, while carrying your body-weight, and you twist awkwardly or unexpectedly. Skiers and footballers are most susceptible to this type of injury, but it can happen to you while walking or running, if you trip and catch your foot, or fall while turning. Any of the knee's structures may be damaged in this type of injury. The full extent of the damage may be impossible to assess immediately after the injury, and may only become evident when the knee subsequently fails to recover its full function.

The knee is also vulnerable to overuse injuries: gradual pains brought on by an activity, which progressively get worse, if you continue the activity. These are the injuries which must be distinguished from the other, more serious, medical conditions which can cause similar pain.

Frontal Knee Pain

1)  Patellar Tendon Strain
The patellar tendon is very short, extending only between the pointed lower end of the kneecap and the tibial tubercle, the prominent bump of bone at the top of the shinbone. However, it acts as the concentrating point for the pull exerted by the quadriceps muscle group during knee movements, so it is an extremely powerful tendon. The tendon works hard whenever the knee bends and straightens under load. It works hardest when knee movements involve a full bend under your body weight and gravity, for instance if you do a full squat exercise in weightlifting, or when you take off from one leg in high jumping or long jumping. The tendon also generates a strong pull when you go up and down stairs, when you run on hilly ground, and when you kick a football.

Because the tendon plays such an important part in all movements at the knee, it may be strained simply by overwork. This type of overuse strain is usually due to a repetitive activity, such as long-distance running, or extended sessions of hill running, hopping and bounding, kicking, or squatting exercises. An overuses strain is more likely to occur if the tendon is working inefficiently, because it is fatigued through overwork, or tight due to cold or previous excessive exercise. Bad shoes can contribute to changing the tendon's angle of pull. This is especially true if children and adolescents wear shoes with little support underfoot, or high-heels, during their growth years. The tendon may also be subject to sudden injury.

When the patellar tendon is strained, a few of its many fibers may be torn. This causes pain when you use the tendon, but it does not necessarily stop the tendon from working through its normal range of movement. As a result of a strain, or partial tear, the tendon may become thickened, and tight, because of scar tissue forming in the torn fibers. This limits the tendon's function, and the tendon becomes more painful on movement.

The tendon may tear completely, causing immediate functional disability. When the tendon tears right through, the whole of the quadriceps muscle group on the front of the thigh is incapacitated, as its lower attachment point is destroyed. The kneecap rides upwards over the thigh, as it is no longer held tethered over the front of the knee-joint. There is of course severe pain, and it is impossible to take weight through the leg. A normal patellar tendon can only tear completely if a sudden enormous force is applied to it. However, it may give way under less pressure, if it has been previously weakened by repeated strains which have made its center degenerate. Steroid injection into the center of the tendon can result in severe weakening of the fibers. Following inexpert injections to 'cure' a strain, the tendon may tear under minimal pressure, for instance if you squat down, or if you try to climb onto a higher step.

When the patellar tendon tears completely, you must refer for specialized treatment as a casualty. The tendon will have to be repaired surgically, as quickly as possible after the accident. You will not be able to put weight through your leg, and you should be transported to hospital, keeping the leg as still as possible.

Osteochondritis, a form of degeneration in a bone's growth point, can occur in the lower part of the kneecap, where the patellar tendon attaches to the bone. This complication is called Sinding- Larsen-Johnson syndrome, and it causes severe pain when the tendon is stressed during activity, as well as soreness if you press over the point of the kneecap, or if you try to kneel on it.

2) Prepatellar Bursitis ('Housemaid's Knee")
The front of the kneecap is protected by a fluid-filled pouch, or bursa, which lies between the bone and its covering skin. When the bursa is inflamed, it swells up, forming a large egg-like protrusion over the kneecap. The condition is called 'housemaid's knee', identified in women who had to kneel down constantly to scrub floors and so were particularly prone to suffer from it. The damaged the bursa has a cumulative effect from the repeated pressure on the front of the knee. The bursa can easily be damaged by a single hard blow on the kneecap, for instance if someone kicks your knee, or if you fall onto your knees from a height. The bursa may also swell because of a medical inflammatory condition. Your doctor will be able to differentiate between the various possible causes of the bursitis, if you can give him an accurate account of exactly when and how it first occurred.

Although the bursa may become large and unsightly, it is not necessarily very painful or functionally disabling. It hurts when you press it, and possibly when you stretch the skin on the front of the knee, by bending your knee fully, or squatting down. If it does become painful enough to interfere with your normal activities, it will need specialized treatment. Your doctor may drain off the extra fluid in the bursa, although the swelling may recur after this is done. Otherwise, the bursa may be removed completely by surgery to eliminate the problem and the possibility of recurrence. After surgery, the knee is usually kept immobilized in a plaster, to prevent a secondary bursa from forming in place of the original one. About four weeks after the operation, the surgeon normally allows rehabilitation to start, following removal of the plaster.

3) Knee-cap dislocation
This is a problem which can occur at any age, but which often happens to children. If it starts in pre-teen years, it tends to be a continuing problem, with episodes that gradually get worse over the years. Girls are particularly vulnerable to the problem. When the dislocation is a continuing, chronic problem, the episodes tend to be relatively mild, so that the dislocation is hardly recognizable as such. However, in the older sportsman especially, the dislocation can be severe, with the kneecap remaining out of alignment until it is manipulated back into place.

Specialist care will aim to correct the mechanical defects that contribute to, and are caused by, the kneecap dislocation. You will be set a program of exercises to strengthen the inner part of the quadriceps. If your foot mechanics have contributed to the weakness in your knee, a podiatrist will make up special orthotic foot-supports for you. If the dislocation problem is severe, you may be referred to an orthopedic surgeon for an operation that would aim to strengthen the kneecap from its inner side, and perhaps correct the 'Q-angle' at the knee. In the worst of cases, the surgeon may recommend removing the kneecap to eliminate the problem.

Pain in the back of the knee

Popliteal Bursitis
There are many bursea, or fluid-filled sacs for friction-free movement, at the back of the knee.

Any of these bursae may become inflamed and swollen. If an inflamed bursae becomes very enlarged, it may push sideways into the space at the back of the knee called the popliteal fossa. You will then be able to see a defined, soft swelling protruding from the back of the knee. It need not necessarily be very painful, but by taking up space it may limit full movement at the knee. You should refer to the doctor for an assessment of the swelling, as this type of swelling can be disease-related. If it does prove to be simply a bursitis caused by friction, perhaps because you have changed your style in distance running, or changed boats in rowing, it may not be necessary to have any treatment for the swelling. The definitive cure is to have the swollen sac removed surgically by an orthopedic surgeon. After surgery, your knee is usually kept held still in plaster for some weeks, after which you have to re-strengthen the muscles, and then regain full movement.

Pain inside the knee joint

Any of the knee's internal tissues can be damaged by a severe injury, but the cartilage (menisci) and the cruciate ligaments are those most commonly harmed in sportsmen.

1) Cartilage tears
The knee's soft-tissue cartilages can be damaged by pressure from the bones of the joint when an abnormal force twists the bones against each other unusually. In the normal way, the cartilages move slightly, backwards and forwards, during knee movements. In this way, the cartilages act as buffers throughout the whole movement, although the joint surface of the thighbone is bigger than the receiving surface on the shinbone. However, with abnormal pressure, the cartilages may be jammed between the two bones: if the bones then twist on each other and apply a shearing stress on the cartilage, the tissue splits.

The most common cause is an abnormal twist in your knee while your weight is on the leg. In each case, your knee is bent at the moment of injury. A sudden stress with the knee bent, even when you are not standing on the leg, can be enough to tear the cartilage. Cartilage tears can also be caused by a sudden over- stress when your knee is straight, for instance if you miss a drop kick in rugby.

This injury gives instant pain, to the extent that you may not be able to move the knee at all, let alone take weight through your leg. Immediate swelling will inhibit movement further, although the swelling may not appear until some hours later, in which case the knee will feel weak rather than stiff in the first instance. Visible swelling may extend right round the knee, making the joint look bloated, or it may be only a small patch, barely visible over the line of the joint. At the moment of injury, it is impossible to tell, from the outside; exactly how much damage has been done. First aid for the swollen knee must be applied (see "treatment of acute sports injury").

The only external sign that you might have torn a cartilage is the so-called 'locked' knee. More often, the knee is too painful to move immediately, and this 'locking' feeling only becomes evident when the knee has recovered enough for you to be moving it. Once you have applied first-aid measures and made the knee comfortable, you must be taken for specialist help as quickly as possible.

The sooner an accurate assessment of the extent of the damage is done; the better off you will be in the long-term. If you are taken to a casualty department in a hospital, your knee will probably be X-rayed, to see whether there is any bone damage. You may also have arthrograms done, in which dye is injected into your knee, so that soft-tissue damage shows up on X-ray. You may even be admitted to hospital so that an orthopedic surgeon can perform arthroscopy.

Once a specialist has diagnosed a cartilage tear in the knee, there are two possible courses of action. Either the torn part of the cartilage must be removed surgically, or the problem must be treated with rehabilitation only. The one certainty is that the torn cartilage will not heal, or mend itself, naturally. If the specialist decides on immediate surgery, it is because he deems that the torn cartilage will create functional problems in the knee.

The cartilage removal operation is called a meniscectomy. Recovery from the surgery can take a varying time, according to individual circumstances. It is possible to be back to full sporting activities within two weeks of removal of the cartilage through the arthroscope.

If a specialist decides not to remove the torn cartilage, after diagnosing the tear, it is because he believes that the damage is slight, and the knee can recover functionally without any need for surgery. Your leg may be immobilized in plaster, to protect the knee, if the injury was severe; or you may simply be given a supporting bandage to control the swelling.

In either case, you must start straight-leg exercises immediately, to maintain knee stability. You progress to gentle mobilizing exercises to bend the knee as soon as your specialist allows, when the knee is no longer acutely painful and swollen.

2) Cruciate Ligament Tears
The cruciate ligaments are two strong bands that bind the shin- bone to the thighbone, across the center of the knee. It takes a strong force to damage them; they can be torn in a severe twisting injury, for instance in a blocked kick or a sliding fall in a tackle during football; or by excessive pressure forcing the knee to 'bend backwards' when it is straight, for instance if an opponent falls across your extended leg in rugby or hockey.

A major shearing force can tear both cruciates together, usually tearing one or both of the cartilages at the same time. A moderate injury may tear one of the cruciates completely, without damaging the second, and with or without accompanying cartilage damage. At the moment of injury, it is totally impossible to assess the extent of the internal damage through outward signs. The only certainty is that, if your knee has swollen painfully, some of its internal structures have been damaged. If you do not have an accurate diagnosis at the time of injury, it may only become apparent that the cruciate ligaments have been damaged much later when you have started doing sport again. Then you may find that in certain positions your knee feels loose and instable. It may feel as though it is 'rolling' on itself, backwards or forwards, usually giving a 'clunking' sound, with a sharp pain. This makes running and turning difficult. This unstable feeling is an external indication that there is some damage to the cruciates. If your knee locks as well, then there is also likely to be cartilage damage.

At the moment of injury, the knee should be made comfortable in applying the first-aid measures for the swollen knee. It is essential to obtain a specialist opinion as quickly as possible. If the surgeon finds that both cruciate ligaments are completely torn, he will probably perform an immediate operation to try to repair the damage. If there is partial damage to one or both of the cruciates, the surgeon will choose whether to operate, or whether to allow the knee to recover enough for you to resume sport, and see whether there is any residual disability when you use the knee.

Whether the repair is done straight away, or after residual disability has shown up, there are various methods that the surgeon may choose to mend the damage. Some procedures involve mending the cruciates themselves, either by re-attaching a torn end to the bone from which it has snapped off, or by replacing the whole ligament with a synthetic substance. Other methods of stabilizing the knee involve tightening up the capsule and tissues around the joint, to compensate for the internal instability. Whichever method the surgeon chooses, rehabilitation is a slow process; full recovery may take up to a year. It is vital to follow the surgeon's rehabilitation program to the letter, as recovery phases differ according to the particular operation done.

Knee Surgery

The knee joint is the most complicated joint in the body. It consists of three joint surfaces that are covered with articular cartilage. There are two menisci (cartilages) between the joint surfaces, and four ligaments that stabilize the joint. When a person walks, the load exerted on the knee joint is approximately four times the body weight; with running it is eight times the body weight.

The Clinical Examination

In order to make an accurate diagnosis it is important to have a complete medical history of the knee problem. This includes the details of the mechanism of injury, the type and location of the discomfort and symptoms such as swelling, giving way, locking, etc. The medical history is followed by a careful clinical examination of the joint, after which the surgeon should be able to make a provisional diagnosis. This provisional diagnosis is further confirmed by diagnostic tests.

Diagnostic Tests

Routine X-rays should show any abnormality in the bone itself and will also show up wear and tear on the joint surface. It is, however, not possible to see soft tissue structures such as cartilage and ligaments on X-rays. In special cases MRI (magnetic resonant imaging) is done, as this does show up soft tissue. An arthroscopic examination can also help with the diagnosis.

The Arthroscope

An arthroscope is an instrument similar to a telescope. It is approximately as thick as a pencil, and has a lens on the one end. The arthroscope is placed into the joint through a small puncture wound. A small video camera is attached to the back of the arthroscope, allowing one to visualize the inside of the joint.

Arthroscopic Surgery

This is usually done on an outpatient basis. The patient would come to the hospital on the day of the operation and be discharged on the same day. No food or drink may be taken in for six hours before the operation. On the morning of the operation, the patient should report to the hospital reception, from where he or she would be directed to the outpatient department.

Three small puncture wounds are made in the joint while the patient is under general anesthesia. The scope and other necessary instruments are inserted into the joint through these wounds, and the necessary procedure is performed. Surgical procedures such as the removal of loose bodies, meniscectomies, repair of joint surfaces and even ligament reconstructions can be performed through the scope.

In most cases the patient will be able to take full weight on the joint by the time he or she leaves the hospital. In a small percentage of cases it might be necessary to use crutches for a day or two.

REMEMBER: One is not allowed to drive a car for the first 12 hours after anesthesia.

Postoperative Care

The following should be observed after arthroscopic examination/surgery:

  • It will usually be possible to walk without crutches. However, if the joint causes discomfort, crutches should be used for as long as necessary.
  • The sutures are soluble and beneath the skin, and do not have to be removed.
  • The bandage around the joint can be removed after three days, by which time the wounds should have healed to such an extent that baths or showers would be possible.
  • If the knee is pain-free after four weeks, it is not necessary to make a follow-up appointment, unless the doctor has indicated otherwise. It will be approximately four to six weeks before the knee is completely pain-free.
  • The doctor will be available to discuss any questions or problems.
  • There are a number of exercises that could be done at home. The exercise routine should be started as soon as the knee is pain-free. If physiotherapy is indicated, the doctor will prescribe it.
  • There should not be severe discomfort. Light analgesics will be prescribed, and they should control any pain. If there is severe pain, swelling of the calf or any other problems, the doctor should be contacted.