Physiotherapy Exercises for Knee Ligament Injury - Types and Benefits

Introduction:

Ligaments are connective tissues present as bands of tissue around the bone connecting it to the body. The anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL) are the four main ligaments of the knee. Any injury or exertion on the ligaments can cause them to stretch. Post-injury or after surgery, an exercise conditioning program will help in regaining the lost function of the knee and allow the individual to return to their daily activities.

How Do Ligaments Get Injured?

Ligaments get injured due to sudden twisting or bending of the knee. It can also occur due to landing on the floor in an awkward position or overextending the knee. Direct impact on the knee due to falls is also a reason for ligament injuries. Ligament injuries can produce symptoms like pain and swelling. There can be a restricted range of motion too.

What Are the Functions of a Ligament?

Ligaments are important because they help in the following:

• Absorb shock during walking.

• Helps in providing the connection between the lower leg and thigh bones.

• Keep the bones in alignment.

• Preventing the knee while collapsing or twisting.

• Stabilize the knee joints.

• Preventing the knee from moving in unsafe directions.

What Should Be Done After a Ligament Injury?

• A brace should be used to protect the knee for at least three to six weeks, depending upon the severity of the injury.

• The individual should use crutches, and weight-bearing restriction is needed.

• To control swelling, apply an ice pack for 20 minutes a day. While applying ice, use a cloth or towel to place it between the skin and the ice for the prevention of skin injury.

• Keep the legs elevated if there is swelling. It is better to use elastic stockings for the leg.

• Once swelling decreases and the pain diminishes, gradually regain knee motion by doing mild stretching.

• Actions like twisting or pivoting the knee should be avoided as the knee can be unstable.

• Based on progression, patients can gradually lift weights as instructed by the physician.

• Patients can walk without crutches or braces when the limping is gone.

• Exercises like stationary cycling, swimming, and range of motion exercises can be done.

What Exercises Are Recommended for the Medial Collateral Ligament Injury?

Stationary bicycling can be done five to seven days a week, once or twice a day. It will help improve knee flexion. If the individual finds it difficult to pedal all the way around, then place the operated leg on the pedal, and try to pedal back and forth to a point where the knee is bending as far as allowing a full cycle. The following exercises can be done to improve function in the knee:

1. Step Up-Down Exercise: Stand near the stairways and place one foot on the step. Stair height can be eight to nine inches to prevent overstretching. For maintaining balance, hold onto the wall or use a chair for support. While standing sideways, step up slowly on the step and try carefully straightening the knee using the quadriceps muscles. After this, lower the opposite foot to touch the floor gently and repeat the step up. Repeat this exercise three to five times.

2. Single Leg-Wall Slide Exercise: Stand near a wall with a single leg and the back and buttocks touching the wall. Place the affected foot six inches away from the wall. Now while slowly lowering the body, try to bend the knee in a sliding motion in the wall, and the knee makes a 45 degrees angle with the wall while flexing the knee. Hold for five seconds and then return to the starting position. Repeat three to five sets.

3. Single-Leg Squat Exercise: Stand near a chair with one leg and try to lower the buttocks toward the chair by squatting. After this, return to the starting position. Try not to squat fully to the chair by extending more than the comfortable range of motion or until there is pain.

What Exercises Are Recommended for Lateral Collateral Ligament Injury?

Activities should be progressed slowly; for example, instead of running, swimming can be started by the individual. Wearing a brace while engaging in sports. The following exercises are encouraged for rehabilitation of the lateral collateral ligament injury:

1. Heel Slide: Sit straight on the floor with both legs extended. Now slide the heel of the injured leg towards the buttocks while pulling the knee towards the chest. Now return to the starting position. Repeat three sets ten times.

2. Straight Leg Raises: Lie flat on the mat or the floor with the back and the legs extended out. Try to tighten the thigh muscles of the injured leg and lift that foot eight inches off the floor while holding the thigh muscles tight. Gently lower the leg back to the floor and repeat this exercise three times. Ten repetitions can be done.

3. Prone Knee Bends: Lie flat on the floor with the stomach and legs extended out. Bend the affected knee in such a way that the heel reaches toward the buttocks. Relax back to the original position and repeat this three times for ten sets.

What Exercises Are Recommended for Anterior Cruciate Ligament Injury?

The patient should have achieved a full range of motion before starting these exercises. Aerobic exercises like treadmill running and stationary cycling can be done 30 minutes a day. Range of motion exercises can be done four to five times a day. The following exercises can be done to regain the full range of motion:

1. Knee Strengthening Exercises: Lie on the floor with the ankle resting on a towel roll. Slowly pull the ankle towards the buttocks and push the knees against the surface of the floor by tensing the thigh muscles. Hold for five seconds and repeat for three to five sets.

2. Knee Flexion: Lie on the floor or a bed and bend the affected knee slowly, as far as tolerated and hold for five seconds. Relax and repeat. For increasing the movement, use the hands for assistance holding at the ankle. Ensure that both knees are bent equally by lifting the opposite leg.

What Exercises Are Recommended for Posterior Cruciate Ligament Injury?

Refrain from activities that may aggravate the pain. Stretching and strengthening exercises are to be done to restore the normal range of motion. In two weeks of rehabilitation, full recovery can be achieved. The following exercises are advised:

1. Bent Leg Hamstring Stretch: Lie flat on the floor with the back and pull the affected leg straight with the knee slightly bent and the toe facing the ceiling. A mild stretch can be felt, held for a few seconds until there is no pain. Repeat three times after resting for ten seconds between each repetition.

2. Calf Raises: Stand near a raised platform, such as the step. Raise up and down on the toes while keeping the legs straight. This exercise can be done ten to twenty sets three times.

Conclusion:

Ligament injuries of the knee can reduce the range of motion of the knee and create unwanted complications for the individual. Ligament injury can be treated through surgery, and post-surgery rehabilitation is essential to restore the normal range of motion. Even if the treatment does not involve surgery, physiotherapy can be done to regain the lost function.