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Knee Injuries and Recovery

Brad Farra - Friday, October 09, 2009

This is a good follow up from my last blog. I read this from Wikipedia and I thought I might pass it along.

The knee is a core tool for an athlete; it allows football and basketball players to run, cut, and jump. Baseball players use their knees to push off when they throw. The flexibility and rotational ability of a knee is what helps make some tennis players superstars. It’s difficult to return to competitive athletics after any serious injury, but knee injuries takes a lot longer to get over and often end a career. While having a good physical rehab process is very important, the athlete’s ability to overcome the mental hurdles that are created with a knee injury will determine whether or not he will be the same player that he was before the injury.

The words “it’s an ACL” strike fear in the heart of an athlete. The immediate mental translation is will I ever play again and if I do play will I ever be as good? Why do knee injuries cause so much fear in competitive athletes? According to the Brown University Biology and Medicine Web site, athletes in contact sports are 10 times more likely to have a serious knee injury than in non-contact sports, with knee injuries accounting for approximately a quarter of the injuries and generally taking two to three times longer to recovery than injuries to other parts of the body[2][3]. Knee injuries are also increasing, “over the last 15 years, ankle sprains have decreased by 86% and tibia fractures by 88%, but knee ligament injuries have increased by 172%”

What cause knee injuries and what is the prognosis for total rehabilitation? Leg bones are connected to the kneecap by four strong ligaments: Anterior Cruciate Ligament (ACL), Lateral Collateral Ligament (LCL), Medial Collateral Ligament (MCL), and Posterior Cruciate Ligament (PCL). The ACL provides stability and controls stress across the kneecap and keeps the knee from rotating too much or moving too far forward. Around 60% of ligament tears are ACL, most occurring in basketball, skiing, football and soccer. When an ACL tears it unravels like a rope and will not heal on its own. For competitive athletes treatment is almost always surgery. It normally takes 6 to 9 months to recovery from an ACL reconstruction surgery, at which point most athletes had returned to between 80% and 100% of their full level of previous play with about 90% returning to competition [4]. After the first ACL injury, there is a 5 to 15% risk of repeated injury [5]. MCL and LCL ligament tears are less frequent then ACL injuries accounting for about 25% with LCL injury being much less frequent than MCL injuries [6]. MCL injuries are normally caused when a significant force is applied to the side of the knee while the lower leg is held in a fixed position. The MCL is the only ligament that has enough of a blood supply to heal partial tears without surgery [7] PCL injuries account for between 3% and 20% of all tears [8]. Most often the cause is a blow to a bent leg. Because of the type of blow, PCL tears are often accompanied by ACL tears. While conservative treatment is still controversial in some sports for both PCL and MCL tears, it has proven to be as effective in returning an athlete back to his playing condition as has surgery [9]

Why or why not surgery? If an athlete wants to play competitively ACL tears require reconstructive surgery. During surgery the old ACL is removed, a graft from the patellar tendon or the hamstring is prepared, holes are drilled in the tibia and femur and the graft is attached with screws to the bones. Now the tough part begins, surgery is followed by 6 to 9 months of rehabilitation. This rehabilitation is crucial to strengthen the areas surrounding the graft so that it does not fail. Athletes may accept that injuries are part of their lives and may know how to deal with physical rehabilitation, but few are prepared for the emotional pain, fear and anger that also result from injury. Athletes are used to being part of a team. When they are injured they are suddenly on their own. Their teammates will continue on but they now have a new job, physical and emotional rehabilitation of their bodies and much of the work will have to be accomplished on their own. In Sidelines, Psyched Up or Psyched Out? David Doermann describes a University of Utah pamphlet that is given to all student athletes to help them understand what to expect if they are injured. It describes the emotional process that happens when someone is injured as similar to the five stages of grief [10] The first stage is denial. Athletes by their very nature believe that they are superior physically and therefore do not accept the fact they can be injured. When an athlete realizes an injury is real his reaction may be to isolate and blame himself. Denial is followed by anger, particularly at himself for allowing the injury to occur. During the third stage the athlete tries to make bargains with coaches, trainers or God, such as if I spend 2 hours walking every day I can play again in 2 months.

Very often these bargains are unreasonable dreams. The competitive athlete will now move to a period of depression, feeling sorry for themselves, withdrawing or simply giving up. This stage particularly can put an athlete’s rehab off track. To be successful an athlete must finally get to the acceptance stage when he realizes that the only way to handle the injury is to focus on his physical rehab which could result in returning to competition. The factors that contribute the most to helping an athlete reach psychological acceptance and recovery are education, social support, psychological skill training and goal setting; traits that many athletes use in their pre-injury training [11]

Understanding an injury and their reaction to it helps athletes cope with the problems that naturally arrive along with the injury. Support and understanding of team mates, family and friends can also be a critical factor in recovery. Knowing and understanding how others have coped gives athletes mechanisms for starting to construct their own recoveries. While having social support that listens and appreciates the seriousness of an injury is necessary, too much sympathy from family or friends can impair the athlete’s acceptance level which can slow or derail the recovery process. A study done by the Aristotle University of Thessaloniki, Greece concludes that “psychological intervention techniques can aid significantly to the rehabilitation process. In particular, the goal setting process seems to have positive clout in the athletic injury recovery, in the attitude of the injured athlete, in the successful confrontation of the injury, in the recovery of confidence and in the adherence to the rehabilitation program” [12]

[edit] References

  1. ^ Soligard T, Myklebust G, Steffen K, et al. (2008). "Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial". BMJ 337: a2469. doi:10.1136/bmj.a2469. PMID 19066253.
  2. ^ (Lysaght)
  3. ^ (Lysaght)
  4. ^ (Lysaght)
  5. ^ (Lysaght)
  6. ^ (Lysaght)
  7. ^ (Selesnick)
  8. ^ (Lysaght)
  9. ^ (Cluett)
  10. ^ (Doermann)
  11. ^ (Armatas)
  12. ^ (Armatas)

Armatas, V.1, Chondrou, E., Yiannakos, A., Galazoulas, Ch., Velkopoulos, C. Physical Training 2007. January 2007. 21 March 2009 <http://ejmas.com/pt/2007pt/ptart_galazoulas_0707.html>. Cluett, Jonathan M.D. Medial Collateral Ligament Treatment. 29 May 2006. 16 April 2009 <http://orthopedics.about.com/cs/kneeinjuries/a/mclinjury_2.htm>. Doermann, David. Continuum, The Magazine of the University of Utah. Spring 1998. 19 March 2009 <http://www.alumni.utah.edu/continuum/spring98/ sidelines.html>. Lysaght, Michael J. Knee Injuries and Therapies in Competitive Athletes. 20 March 2009 <http://biomed.brown.edu/Courses/BI108/BI108_2004_Groups/Group06/Group6project/ Homepage.htm>. Selesnick, Dr. Harlan. Sports Injuries ESPN. 4 October 2007.

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