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HOW DO KNEE SPRAINS OCCUR?
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The
knee is subject to large stresses and impact forces |
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Damage
can occur during contact with another player (e.g. a blow
to the outside of the knee while the foot is planted on
the ground) or by forces created by the athlete (e.g.
a sudden sidestep or twist while running). |
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WHAT SHOULD YOU DO IF A KNEE SPRAIN OCCURS?
• Apply the RICED procedure...
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RICED
procedure
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REST
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Rest
reduces further damage
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Avoid
as much movement as possible to limit further injury
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Don't
put any weight through the injured part of the body.
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ICE
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Ice
cools the tissue and reduces pain, swelling and bleeding
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Place
ice wrapped in a towel onto the injured area
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Apply
ice immediately for 20 minutes, then for 20 minutes
every two hours for the first 48 hours.
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COMPRESSION
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Compression
helps to reduce bleeding and swelling
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Hold
the ice pack firmly in place with a bandage
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Between
ice treatments maintain bandage compression.
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ELEVATION
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Elevate
the injured area to reduce bleeding and swelling
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Place
the injured area on a pillow for comfort and support.
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DIAGNOSIS
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If
the injury has not improved significantly within 48
hours, have the player assessed by a medical professional
(e.g. a doctor or physiotherapist)
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An
accurate diagnosis is essential for proper rehabilitation
of moderate to severe injuries.
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ALWAYS
seek the advice of a medical professional for an accurate
diagnosis.
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WHAT REHABILITATION SHOULD FOLLOW A
KNEE SPRAIN?
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The
following recommendations serve as a guideline only.
Always seek the advice of a medical professional for
a rehabilitation program specific to you and your injury.
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Range of motion
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Restoring
normal range of motion will allow proper function of the knee. |
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Range
of motion can be improved by light stretching of the muscles
about the knee and by bending and straightening the knee |
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Once
pain and swelling decrease, cycling activity is also recommended. |
Cardiovascular
fitness
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Keeping
fit will ensure a more comfortable return to training and competition |
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Non-weight-bearing
activities such as swimming, cycling and arm ergometry (grinding)
are good options at the beginning of rehabilitation |
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A
return to more specific activities (e.g. jogging) can be made
as joint strength and stability allow. |
Strength
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Lower
leg strength is needed to stabilize the knee and prevent further
injury |
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Following
knee injury, muscle weakness is common and can occur very rapidly |
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Before
starting functional exercises there needs to be adequate strength
in the muscles at the back (hamstrings) and the front (quadriceps)
of the leg, and in the long calf muscle (gastrocnemius).
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Strength
can be measured by contracting against resistance provided by
another person. Ask them to make a comparison of strength between
legs |
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There should
be approximately 70% of pre-injury strength or 70% of
the opposite leg's strength (assuming it is uninjured) before
beginning strength exercises. |
Proprioception
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Proprioception
is the awareness of one's body position and is important
in balance |
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Injury
to the knee joint causes a reduction in proprioception |
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Proprioception
exercises (e.g. balance exercises using wobbleboards), mini
trampolines and uneven/sloped surfaces help to improve joint
stability so the knee can be protected against future injury
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Complaints
of the knee 'giving way' during activity indicate a need for
further rehabilitation |
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Wearing
a knee brace or correctly applied taping may also improve proprioception
as well as provide protection and support. |
Psychological
status
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Reduced
confidence following a knee injury may prevent an athlete from
attempting movements needed for full recovery (e.g. sudden changes
of direction and jumps) |
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Gradually attempting more difficult agility tasks and setting realistic goals and timeframes may help to rebuild sporting confidence |
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Return
to competition is not advised until an individual has 100% confidence
in their playing ability. |
Sport-specific
rehabilitation
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Knee injuries
may cause difficulties in turning and decelerating |
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Rehabilitation
should involve some eccentric training of the quadriceps as
this places greater strain on the injured tissue and is similar
to the demands of sport. Eccentric training of the quadriceps
involves the quadriceps developing tension while it lengthens,
as in the knee bending movement when landing from a jump |
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Running
down hills and stairs, sudden decelerations when running at
speed and hopping are common methods of eccentric training |
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The
ability to run a tight figure of eight, cut at both 45° and
90° angles off both feet (first at 1/2 speed then 3/4 speed,
then at full speed) indicates an ability to return to play. |
Ensure you are completely rehabilitated before returning to competition to minimise the risk of re-injury.
REHABILITATION GUIDELINES FOR A KNEE
SPRAIN
| NOTE: This is an approximate guide only. Timeframes for rehabilitation and return to play may vary depending on the nature and severity of the injury. Always seek the advice
of a medical professional for a rehabilitation program
specific to you and your injury. |
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POST-INJURY
Have swelling and pain
settled? |
YES
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| BEGIN
RANGE OF MOTION EXERCISES |
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Passive
extension/flexion (straightening/bending) of knee joint |
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Stretching
exercises |
| BEGIN
STRENGTH EXERCISES |
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Isometric exercises (10-20 seconds) for quadriceps
and hamstrings |
| BEGIN
PROPRIOCEPTION EXERCISES |
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Partial
weight-bearing |
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| PROGRESSION |
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Passive/active flexion and extension of knee joint |
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Continue
stretching |
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Stationary
cycling for increased range of motion - low load |
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Partial
weight-bearing: stand on one leg, mini squats, calf
raises |
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Balancing
exercises: standing on one leg (eyes open/closed) |
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Strength
exercises: leg press, leg curl |
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MAINTAIN
FITNESS
Stationary cycling, Stairmaster, rower - all at low resistance
and low speed.
Swimming with buoy between legs, light kicking |
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| PROGRESSION |
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Stationary cycling for increased range of motion
- increase load |
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Walking
- figure of eight, squares |
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Closed
chain exercises (where the foot is stabilized or fixed as is the case when the foot is
weight bearing on the ground): leg press, squats, calf raises,
step-ups and step-downs, lunges |
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Balance
exercises: wobbleboard/mini trampoline |
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MAINTAIN
FITNESS
Walking, jogging, stationary cycling, Stairmaster |
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| PROGRESSION |
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Continue cycling to your tolerance |
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Sustained
stretches |
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Strength
exercises: various speeds, directions of movement,
contraction types |
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Add
open chain exercises: leg curl, leg extensions |
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Continue
balance exercises: wobbleboard/mini trampoline |
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MAINTAIN
FITNESS
Walking, jogging, stationary cycling, Stairmaster, swimming |
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| IMPROVE AGILITY |
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Jumping,
hopping, twisting, straight line running, figure
of eight running, zig-zag, shuttle runs |
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Increased emphasis on strength, power |
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MAINTAIN
FITNESS
Walking, jogging, stationary cycling, Stairmaster |
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YOU: |
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Run
forwards and backwards? |
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Move
knee through full range of motion? |
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Slow
down and stop suddenly? |
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Jump
and hop? |
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Run
up and down hills? |
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Cut
to the left and right at speed? |
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Complete
all exercises with 100% confidence? |
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YES
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| CONTINUE
TO IMPROVE AGILITY AND SPORT SPECIFIC SKILLS |
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MAINTAIN
Fitness, Range of motion, strength, proprioception |
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HOW CAN YOU REDUCE THE RISK OF
RE-INJURY?
ALWAYS
seek the advice of a medical professional before returning
to sport. Inadequate rehabilitation and a premature return
to sport will increase the risk of re-injury.
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Continue
stretching, proprioception and strengthening exercises
as part of a normal training routine |
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Work
towards a good strength balance in all muscles of the
lower limb, particularly those on either side of the knee |
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Use
good technique when landing from jumps (i.e. knees over
toes), tackling, pivoting, etc |
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Perform
thorough warm-ups and cool-downs |
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Most
braces are not effective in reducing the risk of re-injury
If knee injuries continue to occur, consult a medical
professional for advice on other possible contributing
factors. |
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