By Tomás Ryan BSc.AHS,Ph.Th. MIAPT, Registered Physical Therapist(MIAPT) based in Thurles
Many people suffer knee pain on a sudden twisting motion such as when turning suddenly when gardening or when playing sport. Very often this pain is due to a straining or a tear to the coronary ligament of the knee joint. The coronary ligaments are situated on the outer perimeter of the knee joint as they connect the medial and lateral meniscus to its underlying tibial bone. The medial (inside) coronary ligament is more frequently injured than the lateral (outside) coronary ligament. The meniscus is a fibrocartilage material that sits within the joint and acts as both a shock absorber and knee joint stabiliser during knee movement. The medial (inside) meniscus may also be torn. However if the medial meniscus is torn there will be swelling present, a difficultly in the patient being able to fully straighten the knee joint, sharp pain on twisting and weight bearing knee bending activities.
Signs & Symptoms of Coronary Knee Ligament Strain / tear
Sudden knee Pain on the inside area of knee joint after a twisting movement
Persistent achy and twinging Pain on the inside (medial) joint line region
Patient can often pin-point this joint line tenderness on the inside area of knee joint
Possible Pain on the inside knee joint line when suddenly turning the foot outwards
Very little swelling is present with the patient being able to walk as normal
The injury is similar to a meniscus injury due to its attachment point but is of a lesser severity and it can diagnosed by the Physical therapist when he/she attempts sudden bending and straightening of the knee joint. In addition the coronary ligament sprain is irritated when the joint line is rotated or twisted in an outwards direction.
Treatment & Management
When the coronary is torn or strained, this leads to scarring of the ligament as the healing process attempts to strengthen its weakened attachment point to the meniscus. This scarring process leads to a restricted meniscus and hence a reduced rotational or twisting ability in the knee joint. The treatment process consists of the application of ultrasound to the site of the medial coronary ligament followed by graded manual transverse friction to the ligament. Strengthening of the quadriceps and hamstrings is very important and horizontal strengthening exercising to the lateral (outside) knee joint. Finally balance exercises to improve proprioception as prescribed by the Physical therapist are important in order to return to playing sports without the risk of re-injury.
Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy (MIAPT) and is based in Thurles.
Contact Number: 0504 26672
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