Ossi Schmidt: ankle and knee questions

Q: Hi Ossi.

I had a bad fall off balance onto my knee back at the start of June while playing astroturf. I continued training and did additional damage when turning quickly and felt pain in the outside of my knee. A physio diagnosed it as a Grade 2 PCL tear – so I undertook a programme. It improved; I can run in straight lines but a quick jerk of the leg, turning sharply or even sprinting at full tilt causes me a lot of pain.

It feels like there is something out of place or something very tight in the knee when sprinting - with the quick jolt of the leg I get a prolonged severe pain that takes a few minutes to pass. Is there more to this than just a PCL tear? What should I do from here or is there any better strengthening exercise I can do?

CB11

A: Dear CB11,

That sounds like a lateral meniscus injury to me. But it’s Ddfficult to be certain without an examination. One thing I'm missing from your description is a locking of your knee joint. That's good, cbeause you'd be going for an arthroscopy then. Conservatively - i.e. without surgery - strengthening is an excellent form of therapy. Quads and hamstrings are the main protectors and stabilisers of the knee joint. Keep in mind that the ratio between quad and hamstring strength is 3:2 in favour of the quad.

Now to the possible strain of the lateral meniscus. Turning, swivelling and squatting would be the main irritants of the meniscus. Astroturf I suspect can at times be a sticky surface, causing strain on turning to travel up the leg from the foot through the ankle and into the knee joint. Therapy of the strain to the ligamentous attachment of the meniscus (Lateral Coronary Ligament) consists of (a) deep transvers frictions of the lateral joint line at the site of pain (b) avoidance of turning, swivelling and squatting and (c) strengthening of the quads & hamstrings. A Chartered Physiotherapist can do this for you.

Hope this helps,

Ossi

Q: Hi Ossi,

I have fierce problems with my right calf muscle. I haven't been able to run more than three or four miles on the road since running a marathon about ten years ago. It gets tight and there's a bit of tingling or pins and needles in my ankle, so I have to just stop. Any ideas?

istabraq

Dear Istabraq,

Thank you for your question. In a one-on-one situation I would ask you a load of questions regarding the behaviour of your pain, the history, the kind of investigations you've had to date, the treatments you've tried, how your shoes wear, what mileage you run etc.

In the absence of these answers the following comes to mind: your calf tightens because your ankle joint is unstable or injured. The calf muscles are trying to stabilise and protect your ankle joint from excessive anxilliary movements and wear during forward movement such as running. I suspect that running on the spot or skipping will take longer to provoke the same symptoms.

My suggestion would be an MRI of your ankle joint to establish if there is any bony or soft tissue injury. Your GP or a consultant can refer you, provided you have private medical insurance. Without insurance, a Chartered Physiotherapist can refer. Depending on the outcome of the MRI you might be able to resume weight bearing exercise with an emphasis on stabilisation of the ankle joint. You might require assistance from a Chartered Physiotherapist or a Personal Trainer. I suspect this will mean a lengthy rehabilitation and conditioning programme for you. It's not going to be a quick fix I'm afraid.

All the best,

Ossi

To ask Ossi a question just send fire it off to shout@joe.ie with 'Sports Injury Q&A' in the subject line, or alternatively leave a comment below.

Ossi's practice, Brookfield Physiotherapy & Sports Injury Clinic, is located at Ardmanning Avenue, Togher Road, Cork. Get in touch at 021-4962268.