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Torn ligaments are painful, activity-limiting and require bespoke rehabilitation programs. In this blog James Ticehurst, Physiotherapist at Capital Physio, explains what ligaments are, what injuries can happen to them and how ligament tears are treated.

 

What are ligaments?

Ligaments are bands of tough connective tissue that connect one bone to another. Their primary function is to support and stabilize the body’s joints. They do this by acting like small pieces of rope, preventing large amounts of movement. Imagine a force pulling on a length of rope; this picks up full slack and pulls, preventing further movement. Ligaments act in the same way and are essential for keeping joints – for example, knees, shoulders, elbows and ankles – strong and stable.

What happens when ligaments tear?

When movement or forces exceed the limits of a ligament’s strength it can become strained or torn. This can happen during sports and from accidents in daily life as well as wear and tear. The degree of damage to the structure can be classified from grade one to grade three. Grade one refers to mild injuries where a few of the fibres that make up the ligament are torn. Grade two indicates a moderate injury, for example a partial tear of the whole structure. A grade three, or severe, injury is a full tear or rupture of the structure.

As joints are supported by groups of ligaments it is possible to damage more than one at once.

Symptoms of torn ligaments

The most common symptoms of a torn ligament are pain, sound, swelling, weakness and instability.

  • Pain: Pain can be sudden and range in its severity.
  • Sound: You may hear a pop, snap or tear. However, this can sometimes be confused with a normal joint click.
  • Swelling: Swelling, inflammation and bruising are typical, especially in the first 72 hours. This phase is known as the ‘acute phase’ when inflammation and pain are at their worst.
  • Weakness/instability: The area surrounding the ligament damage can feel ‘loose’. You may experience some pain or apprehension when transferring weight through the joint.
  • Tenderness: Localised tenderness to touch can also be a sign of injury.

Treatments for torn ligaments

Treatment for torn ligaments varies according to the severity of the injury. In general, if damage is mild or moderate the ligament is managed conservatively. In cases of severe injury, surgical intervention may be required. Treatment plans also depends on factors including age, activity level, lifestyle and long-term goals of the individual.

Acute phase management

Initial management in the first 72 hours is usually the same, however severe the injury. Professionals recommend ‘PRICE’: Protect, rest, ice, elevation and compression. If you experience a lot of pain, an appointment with the GP for an assessment and management plan may be necessary. The GP may prescribe some pain relief and anti-inflammatory medication. However, inflammation at the sight of the injury in the first 72 hours is actually a helpful, protective response. Therefore, it is better to delay anti-inflammatory medication until after the acute phase.

If the pain is very severe and the patient is unable to weight bear or experiences bleeding, open wounds, headaches, consciousness problems or breathing issues, a visit to A&E is highly recommended. Fractures may be associated with ligament injuries and may sometimes go unrecognized, leading to ongoing symptoms which may worsen with time.

Ongoing management

After the acute phase, we recommend booking to see a physiotherapist who is trained in assessing and diagnosing these types of injuries. They will be able to determine the extent and severity of the ligament damage. You’ll receive advice and a treatment plan to help you return to normal function as fast as possible. Treatments will include exercises to help you strengthen the joint and regain range of motion. Manual therapy techniques will help to desensitize the structure. Your physiotherapist will also help you understand what has happened and give you advice on ongoing management.

Recovery

A mild/moderate ligament injury typically takes between four and six weeks to heal structurally. The length of time for which you experience pain varies greatly; sometimes it will go away quickly but it may linger for longer than six weeks. This depends on the individual and their individual bio-psycho-social factors.

Surgical treatment

If the ligament is severely injured or if there is a rupture, surgery might be recommended as the best treatment. After surgery, your physiotherapist will give you a comprehensive rehabilitation program focusing on regaining range of motion, function and strength. Depending on the ligament and the extent of the injury, rehabilitation programs vary in timeframe from person to person.

The stats (because who doesn’t love them?)

Ligament injuries occur in about 40% of all knee injuries. Of these, 49% are injuries to the anterior cruciate ligament (ACL). Trauma to the medial collateral ligament (MCL) comprises 29%.

Looking at sports-related injuries, 15 to 20 % are to the ankle ligament. Of these, 80% are lateral ankle sprains (on the outside of the ankle). Lateral sprains incurred greater charges than medial ankle sprains. Hospitalizations were more common following high ankle sprains than lateral ankle sprains (just 6%). Medial or inside sprains make up 20% of all sports-related ankle sprains.


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