Many of us know the feeling of picking up a ligament or muscular injury, commonly referred to as soft tissue injuries.
They are often the result of sudden unexpected or uncontrolled movements overloading the ligament or muscles. An common example of a ligament injury is miss stepping off or onto the sidewalk and rolling the ankle, putting excessive force through the ligaments of the foot and ankle resulting in immediate pain and swelling.
Ligaments and muscles do distinctively different jobs in the body
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- Muscles consists of contractile tissue that makes us move and has attachments over one or two joints to aid joint movement.
- Ligaments however are flexible fibrous tissue that connect bones to other bones giving joints support to move through their respective ranges of motion. Damage to a ligament is referred to as a sprain.
As already mentioned above we can damage a ligament when suddenly overloaded and the body could not effectively counter the motion to stabilise. One of the aspects that makes training to prevent injuries difficult is the mechanism of injury is often faster than what the central nervous system can respond to
the change in body position.
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Repairing ligament damage(sprains) depends on which ligament is damaged and to what degree
Ligament sprains are categorised in 3 groups;
Grade 1 sprain
– damage to a few ligament fibres causing local inflammation, giving a local pain response over the affected ligament.
Grade 2 sprain
– damage to considerably more fibres electing a more marked inflammatory response with joint pain and swelling, often a partial tear in the ligament.
Grade 3 sprain
– a complete rupture of the ligament intense pain, swelling of the joint and marked instability of the joint
The rehabilitation process will be determined by the grade of the sprain, historically the advice with grade 1 and 2 sprains is rest and treating the inflammation with ice or anti inflammatory drugs.
Current research however shows it might be better to stay away from inhibiting inflammation and letting the body heal itself
. The rehabilitation after injury could possibly also be quicker if ice was not
applied. The debate on icing still continues and if you want pain relief anti-inflammatories is an option.
Healing times are between 6- 8 weeks for a grade 2 sprain and grade 1 sprain should be better within a week or two once the inflammation has died down.
A grade 3 sprain will require surgery, these days surgical advances allows us to use arthroscopy for a lot of the procedures resulting in faster recovery times. For more complex procedures like a ACL repair full surgery might be the only option available.
Recovery times of complete rupture repair varies greatly in relation to the joint affected, with recovery of up to 4 to 6 months.
After the reconstruction the affected area has to be trained to be stable and strong enough through the full range of motion so that normal activity can safely be resumed.
Initially the focus is on obtaining full range of motion pain free of the affected joint combined with full control. The next step is to start with strengthening through the full range of motion, lastly activity specific training has to be performed to ensure the soft tissues can stand up to the loading forces they will be subjected too.
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1. Am J Sports Med. 2010 Nov;38(11):2218-25. doi: 10.1177/0363546510373570. Epub 2010 Jul 1.
Mechanisms for noncontact anterior cruciate ligament injuries: knee joint kinematics in 10 injury situations from female team handball and basketball.
Koga H1, Nakamae A, Shima Y, Iwasa J, Myklebust G, Engebretsen L, Bahr R, Krosshaug T.
2. Emerg Med J. 2008 Feb;25(2):65-8. doi: 10.1136/emj.2007.051664.
Is ice right? Does cryotherapy improve outcome for acute soft tissue injury?
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