COLLATERAL DAMAGE TO KNEE LIGAMENTS

physical movement, complete healing is more likely. If the person is unable to perform the required exercises by him or herself, it is important to have a therapist assist the person in a full range of motion of the injured part.

Application: Treatment for injuries to the collateral lig- aments of the knee Friction therapy applied to injured collateral ligaments, along with full range of movement of the knee, can be a safe and effec- tive treatment for these injuries. The therapist should also be aware of other treatment options and refer the client to other practitioners when necessary.

TREATMENTS 1. Deep massage and friction therapy This is an effective treatment for medial and lateral collateral knee ligament injuries if done twice a week for three to four weeks. It speeds the healing of the ligament and prevents scar- tissue formation, especially if done soon after the initial injury. In long-standing cases, treatment may take longer and may need to be combined with manipulation by a physiotherapist, chiro- practor or osteopath to free the ligament from the bone.

Friction therapy for the medial collateral ligament Sit on a stool next to the injured knee and place your index finger at the lower pole of the patella. Now trace the joint line with a moderate pressure as you move around the knee toward the table in a straight line medially. Half way down toward the table you will feel the ligament under your finger. It feels about a quarter of an inch wide and a sixteenth of an inch thick. It isn’t that easy to find until you know it. Place your middle or index finger over the liga- ment and apply a friction stroke upwards, then relax as you bring your hand back to your original position. Friction for five or six minutes, take a break and repeat again for five or six minutes. Most often the ligament is injured here at the joint line, but it may be injured as well at the tibial attachment or at the femoral attachment. In that case, those areas must be frictioned also. Friction therapy for the lateral collateral ligament

Sit on a stool next to the injured knee and place your thumb on the head of the fibula just below the lateral knee. Now move supe- riorly toward the condyle of the femur with a moderate pressure. Halfway towards the femur you will feel the ligament under your finger. It feels like a tight band about a quarter of an inch wide. It is sometimes easier to find if the client crosses the leg, placing the ankle of the bad knee just above the opposite knee. This caus- es the lateral collateral ligament to protrude out from the knee. Once you have located the ligament, palpate for where the pain is felt. This is where the primary scar tissue is located. Using your middle or index finger over the ligament, apply a friction stroke upwards, then relax as you bring your hand back to your original position. Friction five or six minutes as described above, take a break and repeat again. Most often the ligament is injured here at the joint line, but it may be injured as well toward the fibula attachment or toward the femoral attachment. In that case, those areas must be frictioned also. After frictioning the ligament, deep massage should be applied to the front thigh and knee area. This will enhance the circulation and speed healing and the removal of waste products. Don’t neglect working on the other leg as it is usually doing double work to compensate for the injured leg.

2. Exercise therapy The knee must be moved under a little stress so that adhesive scar tissue does not reform. As a first exercise have the client sit and swing the leg for two or three minutes several times a day. After three or four treatments have the person lean against a door and do 10 to 20 mini knee squats where the knee bends no more than 45 degrees. As the knee improves the squats should deepen so that the thigh and lower leg are at a 90 degree angle. These exer- cises prevent the re-establishment of adhesive scar tissue while building strength in the muscles and ligaments.

3. Manipulation This is only effective where there is an external adhesion to the femur. This occurs with medial collateral ligament tears only. 4. Anti-inflammatory injection An anti-inflammatory injection is helpful in stopping inflamma-

RESOURCES

■ Cyriax JH. Cyriax’s Illustrated Manual of Orthopaedic Medicine. Butterworth Heinemann 1996. ISBN: 0750632747 ■ Dr Milne Ongley is a leading expert in the field of non- surgical reconstructive therapy. For more information www.ongleyonline.com

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