PHYSICAL THERAPY

COLLATERAL DAMAGE TO

KNEE LIGAMENTS By Dr Ben Benjamin, PhD

INTRODUCTION I worked as a therapist for 14 years before I truly got to under- stand the injury process. It was while obtaining my PhD in sports medicine that I came across the theories of Dr James Cyriax and Dr Milne Ongley and this revolutionised my thinking. After study- ing and testing Cyriax’s theories on several hundred people, I had to put aside many of his assumptions and long-cherished beliefs. Muscles, muscle injuries and muscle tension were only one small part of understanding the pain and injury process.

The first important fact is that the formation of adhesive scar tissue in the tendons, ligaments and joints is often the primary culprit in long-term pain. Although muscles get injured most frequently, they also heal more easily on their own. Tendons, ligaments and joints, on the other hand, may take months or years to heal and often stay injured for a lifetime. There are hundreds of discrete injuries to muscles, tendons, ligaments, bursas, nerves and joints that could be precisely assessed, understood and successfully treated. I learned an effective hands-on technique called friction therapy, which can be used to break down adhesive scar tissue in muscles, tendons, ligaments and fascia.

Therapists who work with pain and injury problems must gain an understanding of what I term the ‘essential principles’ - the under- lying principles that govern effective assessment and treatment. If this information is mastered then the most inscrutable symptoms, conditions and pain patterns presented by clients can be under- stood, including the most difficult pain cases. What follows are

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There are many approaches to the treatment of pain and injury problems. It is best to have a full and clear understanding of what the problem is before a person is treated. In this article the author outlines some of the principles that are essential to a therapist’s overall understanding of the injury process, and demonstrates how to apply these principles to two com- mon knee injuries.

some of these important concepts that will help to provide an understanding of the body and its pain in a new way. I will use as an example, two common knee injuries - the lateral and medial collateral ligaments - to show how the application of these ‘essen- tial principles’ can help you clearly assess and effectively treat your clients.

PRINCIPLE: THE NATURE OF INJURY An injury, often called in medicine ‘a lesion’, is present when there is tissue damage. The damage could manifest as a swelling in a bursa or a joint; pinching of a nerve or a tendon; micro-tears in a muscle, tendon, ligament or fascia; or a major disruption of tissue like a broken bone or a ruptured tendon. When there is an injury, a part of the body has lost its structural integrity.

Application: Injuries to the collateral ligaments of the knee The collateral ligaments of the knee link the leg by connecting the femur to the lower leg on the medial and lateral sides of the knee.

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