Physiotherapy Portal

Knee Injuries in Netball

Posted by Sarah Fossella on Saturday, July 02, 2016


Knee Pain in Netball and Prevention

This amazing article on Netball related knee pain and injury prevention was shown to me by a well meaning patient this week.

We treat loads of netball players and know that it's a super popular sport amongst Cheltenham and Gloucestershire. Off the top of my head I can think of more than a handful of previous patients who have been to see us with Knee Injuries picked up in Netball.

I can also think of loads of you who not only play but are umpires or coaches of local teams.

One thing I have definitely noticed among the Netballers out there is how determined you lot are to stay on the court. The amount of times I've had to tape limbs back on is unreal!

And even though I recommend that you lay off the Netball for a few weeks for your own good...I know that you don't listen to that advice very often :-)

It seems to be one of those super popular sports that the older Athlete 26yrs of age + seem to get back into after perhaps leaving it behind in school many years ago.

One of the most devastating knee injuries associated with Netball is Anterior Cruciate Ligament (ACL) damage. We have covered this kind of injury enough times already in previous Blog pieces and they can be found:


In fact the frequency of injury associated with Netball is actually joked about by the esteemed sports medicine doctor Peter Brukner. He suggests that netball was a game "invented by an orthopaedic surgeon", due to the strain it places on the knee.

"Basically that action of quickly running then stopping and pivoting places high amounts of pressure on the anterior cruciate ligament," he said. "Because the players are jumping and landing awkwardly there is quite a high incidence of ACL surgery compared to other sports."


Well this great resource developed by The Australian Institute of Sport - The Knee Program goes a long way to assist in the prevention of disastrous knee injuries.


The information is relevant for juniors, recreational and elite athletes alike.

The take home advice is to:

  • Undertake appropriate fitness programs with a focus on netball exercises to develop strength, agility and flexibility, especially of muscles around the ankles and feet.
  • Training should Incorporate specific netball exercises in training focusing on enhancing body balance, landing control, change of direction and catching passes.

If you have any interest in playing Netball or coaching it, you really need to grab this free to all guide, and help yourself and teammates avoid Netball related Knee Injuries.

PS - The Rehab of Sporting Knee Injuries is what we do here at Straight Back Physio.

PPS...We've put together this resource of our own to help you with your own Sports Injury

If you’re after more Sports Injury tips like this, go here next:

Or click here: ->


Give us a Reply if you need any advice in the meantime.


Knee Pain in Squatting

Posted by Stuart Fossella on Thursday, June 23, 2016


Knee Pain at the Cheltenham Challenge

We were at the Cheltenham Challenge at the weekend and met some old friends of Straight Back Physio, so it was great to see you all - running for fun or to set a PB.

I'm not sure that there will have been many PB's set as you runners tell me the course was thick with mud, and you generally had the mud on the legs to prove it.

But hey Cheaper than entering a tough Mudder. Now there's an alternative marketing piece for the organisers of the event, hey Cordell :-)

The feedback from those we spoke to was all positive, and the Challenge has the vibe of a family friendly event.

Anyway...Sarah and I were armed with our treatment couches and our new banner and it was great to be able to give some Sports Injury advice to those of you carrying niggles.

We are pretty good at what we do - even if I do say so myself, but a 2 minute assessment isn't really time to accurately diagnose an injury and that's why we give you 45 minutes + in the clinic setting.

Here's Sarah offering some advice on a 3-month old foot related injury (She's a rock star).


Anyway...We were asked a great question by a young lady who has found a love for Olympic weightlifting. To keep things simple this means doing some free weight exercises with the 20kg Olympic Barbell.

She told us that she finds it hard to keep her knees and Ankles aligned when she drops into a deep squat and found that too much 'lifting' caused her Knee Pain. She wondered what she could do to prevent this?

Now, less than 5 minutes of chatting in a car park really doesn't do this ladies problem any justice but...

We asked her to show us a deep squat there and then...and what we saw was a classic pattern of movement -

Knees knocking together at the bottom of the squat and inside edge of the foot collapsing down.

Have a look at this - A study by Bell in 2008 highlights this position:



Well imagine if you had 50kg, 60kg or 70Kg or more on your back or over your head - do those knees look like they are stable enough to handle that load?

You might end up with some decent Knee Pain if you stress them like that.


From a mechanical point of view it's a potential recipe for Front of the knee pain, Knee Cartilage damage and Cartilage tears, IT band syndrome and plenty more.

That Knee position makes me think of a pestle and mortar - with the thigh bone grinding down on the structures of the knee causing Knee Pain and damage - Not nice.

So what can you do about it?

Consider muscle imbalance around the hip - Think Clamshell exercises for strength gains and consider:

Ankle stiffness or conversely excessive ankle mobility causing the foot to collapse.

The lady who asked us about her knee control had ankle surgery some time back after snapping a tendon - Ouch - So in her case it looks as though the issue of the knees was 'coming from' the ankles!!

Strangely just today in clinic I had a patient who displayed this pattern of a lack of control around the ankles and knees - check out this link.

Showing her before and after knee control -


All after 10 minutes of coaching - Goodbye Knee grinding!!! and maybe Goodbye Knee Pain and further internal damage!




If you’re after more Sports Injury tips like this, go here next:

Or click here: ->


Give us a Reply if you need any advice in the meantime.


My Degenerate Bank Holiday Weekend

Posted by Stuart Fossella on Thursday, May 26, 2016

 Relaxing in the garden

Bank Holiday Knee Woes

It’s very nearly the bank holiday - in my experience this means 1 or 2 things:

1) Cue rain and

2) Cue pain (from gardening, DIY or Cider Fests!)

That’s pessimistic isn't it I hear you groan?

Well let me explain a little more...

Its that time of year when there are more and more people diving into the garden to tidy things up, more runs to the tip and more kneeling to reach the flower beds.

Just this week I’ve seen 2 EXTREME garden injuries ☺

I’ve seen KNEE PAIN, with a likely torn knee cartilage due to scurrying around in the lawn, and an episode of NECK PAIN associated with digging and planting.

So what is going on?

Gardening a fairly passive and sedate kind of activity isn’t it?

Well that’s not the case, because the patients we see here at Straight Back are extreme gardeners!

I don’t mean that you garden while juggling flaming fire poles or that you ‘bed plants’ by somersaulting from the nearest apple tree.

I mean extreme in the sense that you lot seem to do gardening for hours at a time.

You lot seem to go MAD at it.

There doesn’t seem to be the obligatory pausing for a cool drink or a mug of tea among you lot... Its head down and bash on.

I know, we all love to get a job done but here's the thing...

Unfortunately as we age we actually become more fragile ☹ Our joints are a bit more sensitive and no one like to hear it, but body parts become degenerate - especially in the knee.

(That’s why lots of us will end up having a knee replacement in older age).

Now we have mentioned the Meniscus of the knee in other posts and if you want some nice images and info about it, have a look at this:

Find the piece here

The Meniscus is a shock absorbing fibrous piece of cartilage and we have 2 in each knee.

As we age the outer edge of these becomes fragile and prone to damage.

When we kneel and twist and turn on the bent knee - we squash and pull, and put pressure on the entire structure.

(Not to mention the direct pressure on the hard cartilage on the under surface of the Knee cap- that also degenerates naturally with age ☹).

And it’s this kind of sustained pressure of kneeling that can ultimately cause the cartilage to become torn and then cause knee pain.

So what we’re getting at for all of you out there is this…

Knee pain doesn’t need to come about because of a BIG ACCIDENT.

It’s often the most innocuous of Bank Holiday weekend activities that cause the most bother.

If you have a ‘puffy’ or swollen knee and pain when you bend it, you may have some internal damage to the knees internal workings.

So here's our advice to take care of yourself this weekend...

Go steady on the whole –

1) Pace your activities (Check out the couple in the image above, they looked quite relaxed).

2) Remember too much gardening can also aggravate the back and neck.

3) Take regular hydration breaks (Balance out the G&Ts with some H20 breaks ☺).

4) Why not get out of doing the gardening or DIY for a while, and check out some of the local and festivals.

5) And make sure you have the brolly handy, just in case it teams down.

Have a good one, from us over at Straight Back HQ.


Knee Pain and a Train

Posted by Stuart Fossella on Friday, April 22, 2016

Bent knees in sitting

The Joy Of Traveling by Train

I've been up and down to Manchester from Cheltenham in the last 2 days. I never realised it was only a couple of hours away by train. That's because I'm just a soft lad from down south, with poor geography.

In fact if it wasn't for the availability of Sat Nav I don't think I'd get anywhere fast. My ability to read an A-Z map really is bad. Have you ever had an almighty 'domestic' in the car over directions??? Well that's another story.

What I really wanted to get around to talking about was the knee pain I felt while stuck in the seat of the train up to Manchester. Now Virgin trains aren't exactly cramped and I'm not exactly overly tall. A good mate of mine reckons you aren't a real bloke if you aren't at least 6ft tall-rules me out then!

But the point is...if I were 6ft tall I'd probably have been in even more trouble with knee pain. After more than 2hrs of travel my knees were starting to give me some grief.

You too may have noticed knee pain after being cramped up at the cinema, or on the train or plane so what's that all about?

Well...when you are sat down the end of the thigh bone has a groove in it, in which the knee cap sits. Think about cutting a wedge out of a tree trunk and the filling it with a wedge the same shape. That's exactly the kind of contact that is made between the back of the knee cap and the thigh bone.

In sitting the two surfaces come together tightly and essentially rub together causing a build up of pressure-1 surface pushed up against the other. So any activity that involves prolonged knee bending has the potential to cause a build up of pressure and potentially knee pain. Why??

Well...if the 2 surfaces of the knee cap and thigh are pressed upon each other under too much pressure then anatomical structures that can generate pain-might do so, causing knee pain.

So is it normal to feel knee pain in sitting?

Well no of course it isn't, we should all be able to sit on a train, bus or plane without too much bother right? Well yes, have some damage to either of the bony surfaces that of the knee cap or the thigh bone. Or that the 2 surfaces are simply pressed too hard against each other.

So how does that happen?

There are a few factors that can lead to a sensation of pain in the back of the knee cap in Sitting. The usual suspects are damage to the previously super lovely and smooth cartilage ends of the bone of the knee cap and thigh bone.

Simple 'age-related' wear and tear can be responsible for this. As can trauma from sporting or domestic activities. Direct blows, falls on the knee can have this damaging effect. Some people with this condition will swear blind that all the sport they did in their 20's, 30's or 40's are the reason they suffer in the 50's, but this really isn't likely to be the reason for this kind of knee pain. Exercise has great and proven health benefits and probably made the cartilage of your bones stronger rather than more fragile!

The other offender that seems to cause this kind of pressure build up on the knee is tightness through the soft tissues that's surround and encapsulate the knee cap and thigh bone.

If your thigh flexibility is good, you can probably pull your heel to your bum in a thigh muscle stretch. If you can't do it on either leg never mind. Some people can never touch their toes (I can because my legs aren't that long and I'm not a 'real bloke' :-) ) and that's just how it is. If there is a difference in your ability to pull the heel to the bum left and right leg you may have a muscular imbalance that may need addressing.

This potential tissue tension across the thigh can add more compressive tension the knee cap, causing more pressure build up and knee pain.

Now to put it into another context. You may feel this kind of knee pain in sport-repetitious motion such as running or cycling (long term knee bending-as per sitting) can add to pressure build ups and...Knee pain! Strangely I saw one of these cyclists in when I did a bike fit just yesterday

So if you do suffer from knee pain, and specifically knee pain in sitting, running or cycling do a quick test...

And see if you can pull your heel all the way up to your bum.

It's a quick test but might give you an explanation as to why you feel knee pain in running, cycling or when you are sat in the cheap train or plane seats.

So what's the answer to this kind of knee pain?

Go 1st class of course!

or take that pressure away from those bony surfaces with a quick straightening of the knee. It's as good a place as any to start treatment! Go on get up

Or if it persists, get the opinion of a Physio because there a lot of other reasons that your knee could be causing this kind of pain.

Cheltenham Spa beckons and it's time to stretch my short legs :-)

I mentioned this last time out but though I'd mention it again given its significance to this post.

Here’s a staggering stat…

I bet you’re sitting down while having a look at this…

Did you know that the average person spends nearly 9.5 hours a day seated, and around another 7 asleep (less if the kids are playing up ☺).

If you think you know someone suffering with Knee pain, feel free to pass on this simple advice.


Sports Injury Update, The ACL - The What?

Posted by Sarah Fossella on Thursday, February 18, 2016

The ACL - Anterior Cruciate Ligament

The ski season is well underway and we have already had patients limping in to see us on crutches because of ACL injury.

We are NOT SURPRISED because apart from football and netball as a sport we don't see more ACL injuries from any other sporting activity.

What is the ACL then?

Its a vital ligament in the knee that essentially helps to stabilise the joint during dynamic movements, as per those involved in sport.

It is essential to resist the forces associated with rapid changes of direction.

This Little video provides a great visual understanding of its role:

Hopefully you can appreciate how important this ligament is to MAINTAIN CONTROL of the knee joint.

Which is why if you to tear the ligament in a ski injury, you will probably require RECONSTRUCTIVE SURGERY.

In my experience, this injury tends to come from the fact that the skier is not conditioned to the demands of this active form of holiday.

You can not expect to develop the muscular strength and control that skiing demands by having have a sedentary job and not exercising at any other time of the year!

That's a knee WAITING TO BLOW OUT on the piste.

So what can you do minimise the chance of picking up this serious sports injury?

Have a look at this link to some Sports Physio tips that you can take to at least give yourself a chance of avoiding this knee injury.

How to try and avoid skiing injuries

PS, You REALLY do not want to undergo reconstructive surgery. WHY?

Realistically you will be out of contact sport for 9 MONTHS and require an equal amount of Sports Physio, rehabilitation and time in the gym with us!

Take care, happy skiing

The most common Sports Injury we treat

Posted by Stuart Fossella on Monday, February 08, 2016

The Most Common Sports Injury we treat at Straight Back Physio

February 2016 and its been busy. We see a lot of running related injuries at Straight Back Physio.

But that's NOT SURPRISING because I can't think of a sport that doesn't involve running! Alright there's swimming and darts and horse riding...But you know what I mean

So the injuries we treat are either based upon a dramatic moment of misfortune, a crash bang or a wallop. Or are those really irritating injuries that creep up on you for no justified reason (well that's what we all like to think).

So what do we see loads of?

You might be suprised to hear this but the Number 1 injury we treat with Physiotherapy is Low Back Pain and Sciatica. Its so common you wouldn't believe it. Sure, you probably are less likely to suffer from it as a bit of a sportsperson but you can't dodge it all together. Not all of the time.

At Number 2 its good old, damn right persistent Plantar Fascitis. Have a look at this link if you want to read more about the condition.

Plantar Fascitis

Coming in at Number 3 in the TOP 5 Sports Injuries we see its...Patella Tendinopathy. Another stubborn and COMMON SPORTS INJURY. You may know it better as Runners Knee. This responds really well to Physiotherapy treatment and we have massive success in treating this.

Sneaking in at Number 4 its Achilles Tendonitis. Another completely nagging, frustrating and persistent injury that gets right in the way of doing the things you'd like to do.

Achilles Tendonitis

Fortunately we've got a solution to this that doesn't involve loads of rest and painkillers.

Luckily for you lot we don't see too many ruptured Achilles. But Francesca did diagnose one only last week, and we are sorry to hear that after the patient was sent off to A&E, its 10 weeks on crutches and in a cast up to the knee. Season over :-(

At joint Number 5 its got to be the acute and long term calf and hamstring strains. Both easily as common as each other from any explosive or repetitive sport.

These are the injuries we see time and time again at Straight Back Physio and have MASSIVE SUCCESS in treating with skilled Sports Physiotherapy treatments. And that's why we end up treating patients who have had previous failed treatments.

And how are we able to get you better? Because we treat outside of the box that is the treatment room, and get you in the gym and working hard.


The Biomechanical Cliff

Posted by Stuart Fossella on Tuesday, April 15, 2014

Running off a cliff

We are really pleased to be able to bring you this article from our good friend and great Physiotherapist Simon Lack. Hope you enjoy the piece.

How far can our body go with all our compensatory movement patterns until break down?

By Simon Lack, Physiotherapist and PhD student

You only need to look at the Kenyan Olympic marathon runner Priscah Jeptoo, who finished second in London 2012 and then won the London marathon in 2013, to realise that you do not need wonderful mechanics in order to be a world class athlete and run injury free. Possibly more interesting, however, is that some people have been hanging on for such a long time with such poor mechanics without injury, and others with great mechanics are still getting hurt.

It therefore raises the question, what are the reasons behind some people falling off the biomechanical cliff and getting injured, and others hanging on? Furthermore, should we be intervening in a preventative fashion to address these suspected biomechanical faults and does screening for biomechanical faults aid injury prevention? .

The reason for writing this article and thinking about this problem is that over the last couple of months a unique handful of serious runners have come into my clinic. Guys (yes they were all men) who over a 3-4 year period, have been competing in marathons, ultra marathons and ironman events, but who have all ended up seeing me as their world has coming crashing down around them (metaphorically speaking…in most cases at least) after having picked up some sort of significant lower limb injury.

On all of these occasions the injuries have been exacerbated through ‘repetitive overload’, where there was not one single, large event, but a cumulative build up of discomfort, which on one run resulted in a tip from tolerable to unbearable. Or, from non-performance affecting, to significantly impacting on the athletes ability to train let alone race. Following an examination that looked at movement patterns, running styles, muscles strengths and lengths, on every single occasion, I was genuinely shocked as to how poor these guys biomechanics were. p>

It made me therefore wonder several things….

  • 1. If we had optimised their biomechanics from an early stage in their running career, could these injuries have been prevented?
  • 2. Is it in fact just a problem with training load, as all these recreational athletes had been running with these mechanics for many years without problems?
  • 3. If runners have been surviving with these mechanics for so many years without problems, do we really know what optimal mechanics really are?

The scientific literature is definitively out there in the public domain indicating that certain movement patterns do predispose you to developing lower limb injuries. Furthermore, neuromuscular warm-ups, designed to assist in encouraging good lower limb alignment pre-running, have been shown to reduce the risk of injury.

Despite these findings, to my knowledge, no robust study has investigated the effects of an intervention programme designed at optimising biomechanics and subsequently looked at its ability to reduce injury risk. It does seem logical however, that doing what you can to improve your biomechanics relevant to your sport will help you to perform.

With running being a combination of hops from one leg to the other repeated multiple times, your ability to control the body during this activity is essential. Using sessions in the gym to train aspects of single leg stance and associated balance and control can be time well spent.

Training load and volume is in my opinion as critical, if not more so, than optimising biomechanics. If Ms Jeptoo is anything to go by, biomechanics might not need to be perfect, but if you go too hard too soon, ramp up too quickly or don’t recover effectively, you are opening yourself up to potential injury. Every body has a threshold. A tipping point.

The determinants of this threshold are multiple and specific to the individual, but volume and intensity are large components of the equation. The ability to listen to your body, modify your training to allow for appropriate adaptation to occur and then sensitively grade your return to normal training or racing can be the difference between injury or injury free running.

Structure represents a further component of the athlete that needs to be considered if you are breaking down. Compared with mechanics and volume, structure is less capable of change. How your bones are formed, how strong your ligaments are and how resilient your cartilage is to load is largely underpinned by genetics.

Dependent on how much you wish to attribute your athletic successes or failures to your parents, gene expression is not only biology, but represents a combination of biology and environment, nature and nurture. Bone, ligaments and cartilage do all have the capacity to adapt to load given the right environment, but this capacity does appear to vary between individuals.

Providing an environment for optimal loading comes back to the biomechanical and volume elements we have discussed earlier. Time is critical, compared with muscle these more dense tissues require longer for adaptation to occur. Being patient, building slowly, sleeping well, eating well and drinking well all play their part in helping this process to occur.

The premise of what represents poor biomechanics, and thus where a biomechanical cliff may exist, has stemmed from the observation of individuals who get injured and comparing them to those who are injury free. The overriding average of these observations is athletes who exhibit muscle weakness, poor control of lower limb alignment, decreased flexibility and reduced awareness of the limbs position in space, are at significantly greater risk of getting injured compared to those who demonstrate none of these characteristics.

As with all things that we don’t fully understand, but believe we at least have a better understanding of than no understanding at all, the problem is likely to be contributed to by a multitude of factors…finding which factors are the key ones for you comes down to the skill of being able to listen to your body, or the skill of somebody being able to listen to you and you being receptive to take the advice they offer on board and act on it appropriately. In doing so you have the ability to prevent falling off the cliff and continuing to enjoy your running and achieving your goals.

Structure Volume Biomechanics

Food for thought by a man who knows his stuff.

We’re off to London for more learning on the art of running, so our foot and ankle specialist Eric is holding fort.

  • Get treatment on your Running Injuries NOW
  • Get in contact to Book in.



    Simon Lack is a PhD student at Queen Mary University London (QMUL), studying the interaction of hip and foot biomechanics in the presentation and management of patello-femoral pain. He graduated from Brunel University in 2005 with a degree in physiotherapy, and has gone on to study an MSc in Sports and Exercise Medicine at QMUL in 2010. Simon works as a physiotherapist in two London based private clinics, having previously worked over in New Zealand with professional golfers, local rugby and football teams.

    For more information:

    Simon's great resource and running rehab App Rehabrunning

    The knees of the week

    Posted by Stuart Fossella on Wednesday, March 20, 2013

    anatomical image of the knee including ligaments and cartilage

    The Week in Review-Knees of the week

    Great news. Sarah has been back in clinic this week offering am and middle of the day appointments. Ideal for those of you who work in the middle of town. Or simply prefer daytime to weekend or evening appointments!

    This week has unfortunately seen more potentially serious knee injuries in clinic, boo.

    Sporting injuries all too commonly result in meniscus and ligament damage. People probably associate these injuries with great big collisions, or tackles between opponents.

    In truth a great number of serious injuries that actually end up requiring surgery are not related to huge collisions. But occur because of the forces transmitted though the knee in awkward landings from jumping.

    Landing from a jump with a bent and twisting force transmitted through the knee is more than enough stress to damage and completely rupture the fibro cartilage shock absorbing meniscus and/or the ligaments of the knee.

    Ligament damage can occur at those that run longitudinally across the outside of the knee joint. Or often more concerning is damage to the ligaments inside the joint itself which cross from to back to front (Cruciate-Latin for cross!).

    So what are we finding in clinic? Some clients are coming in complaining of pain at the outside of the knee after increasing mileage. In one case after changing running shoes, others because on paper they are over training and under resting.

    Most people have probably heard of sportspeople or even have friends that have ruptured the Cruciate and gone on to have either conservative treatment-Physiotherapist led rehabilitation or reconstructive surgery.

    Unfortunately if you end up damaging either the meniscus or ligaments of the knee you can consider the knee to be 'unstable'. This is why serious sports people will often end up having surgery to reconstruct and stabilize the knee.

    These injuries are not only related to sport-we see them when people slip on wet grass or mud. The mechanism or action causing injury is exactly the same.

    It's proven and a fact that most people do not want to undergo the surgeon’s knife. Luckily for these folk, if the severity of damage is not too great, a conservative approach to rehabilitation is often enough to restore a return straight back to regular day to day activity or even top-level sport.

    Partial tears to ligaments are often best left untouched by the surgeon, as the time required to return to full activity is greatly reduced. This has been nicely proven by a local professional footballer returning to full action after undertaking a great and purposeful rehabilitation programme!

    If things really are that bad we have links with great local surgeons who specialize in the knee. In fact we can be found on the list of approved therapists for Mr Harminder Gosal The Gosal Knee Clinic.

    Another surgeon forging a great reputation for his work in knee surgery is Mr Robert Gleeson Gloucestershire Knee Clinic.

    If you have suffered a severe knee injury, don't be down beat-a decent rehabilitation action plan is all you need to get straight back to those activities you love. Get in contact and find out how we can help you in your recovery.

    Book in now for your Physio assessment and let us get you going again. Straight back to sport, work or just a regular pain free life style Book an appointment.

    Stuart & Sarah

    Let's get you going again…Straight Back

    Cruciate ligament Injury

    Posted by Stuart Fossella on Sunday, February 10, 2013

    Anterior Cruciate Ligament (ACL) injury

    Words you really don't want to hear your Physio mention

    The good folk of Cheltenham all seem to be packing up their skis and snowboards....

    So it must be that time of year when the crisp clean air of the mountain ranges is calling us with the promise of the white stuff. But have you prepared yourself properly for the 6 plus hours of intense exercise a day that you are about to undertake?

    Are you one of these people that in truth drives a desk for 50 weeks of the year, doesn't take meaningful, regular exercise, and then pushes yourself hard either skiing or snowboarding for one, or if you are lucky two weeks of the year?

    If so then you should be prepared for your physiotherapist to tell you that you might have torn or ruptured your Anterior Cruciate Ligament (ACL). Why is this the case then??

    Well let’s discuss some Anatomy and help you to understand what all the fuss is about.

    The following link provides a 3D image of the ACL and provides you with some further reading regarding anatomy Healthline

    The ACL is one of the four main ligaments of the knee that help to keep the joint stable. It runs from the front of the shinbone and heads up and backwards to attach to the back of the thighbone. As with all ligaments it 's role is to provide stability between bones and resist external forces to prevent the knee from collapsing.

    In reality the ligaments don't do all of the work, strong and accurate muscle control aids to keep the knee aligned, but the role of the ACL cannot be underestimated. This can be demonstrated by the fact that in most cases it will be surgically reconstructed, it 's that important!

    Unfortunately without the ligament the knee is considered unstable, and the joint is at risk of developing secondary arthritic changes, and nobody wants that do they?

    So now you hopefully have an understanding why the ligament is so important and realise why you don 't want to damage it.

    Oh, and we haven't even mentioned that the rehabilitation after surgery will take up to 9 months before a return to contact sport is allowed by your surgeon!

    So what 's the relationship with skiing, snowboarding and the ligament??? Tears of the ligament normally occur when the knee is subjected to a twisting force whilst the foot is fixed. So using skiing and snowboarding as an example.... fixed foot (bindings), twisting force through the knee joint when the body heads of in the opposite direction to the knee in sharp or awkward turns or falls.

    It can be the most minor of movements, but if it’s in the wrong position, that can be enough to over stretch, tear or rupture the ACL. It is important to stress that everyone 's anatomy is different, and some of you will unfortunately, naturally be more prone to damaging your ligament.

    The point we are trying to make is that if your muscles are not suitably conditioned and fitness is low, then the less control you have over the muscles around your knee. Remember, that these muscles add reinforcement to ligaments. If you don't have the muscle control it's going to put you at greater risk of sustaining this type of injury.

    And what is more concerning is that it is not always a painful injury. So you might not even realise you have sustained it. help prevent an unwanted holiday horror....

    • Do conditioning, strengthening and balance exercises of the thigh muscles, hamstring and knee joint before the ski season starts. This is your number one means of protection against ligament injury.
    • Try exercises such as squats, lunges, single leg dips and hamstring curls.

    And any other advice can we offer you...

    • Ski / Ride easier at the end of the day, when you are typically fatigued.
    • Avoid difficult trails, big air, lots of moguls, and speed on ice.
    • Take it easy in the late afternoon
    • Be careful getting on and off chairlifts.
    • Do regular stretching exercises for the hamstrings, quadriceps, hip, back, shoulder. The more you stretch, the less likely you are to snap.
    • Use gear that is fit to you and is tuned up.
    • Check your bindings for release tension. Do not set them too tight!

    If you are unsure or need a pointer in the right direction regarding what exercises are suitable for you? Contact Us, and see how Straight Back Physiotherapy can help prevent ski injury.

    If you still have time before your trip why not try to make a visit to Gloucester's very own dry ski slope for a warm up. Check it out Gloucester Ski & Snowboard centre.

    We have seen it all first hand and too many times that we care to remember when we were working out in New Zealand on the ski slopes. It's enough to make a grown man cry, hobbling in on a swollen knee "that doesn't feel quite right".

    Remember: preparation is prevention!!!!

    Knee Ligament Injuries

    Posted by Stuart Fossella on Thursday, January 10, 2013

    ligaments of the knee that provide stability

    Knee Ligament Injuries

    Ligaments of the knee are strong structures that connect bone to bone.

    They add stability to prevent excessive movement of the thigh bone on the shin bone. Either in side to side movements (medial and lateral collaterals known as the MCL & LCL).

    Or in backwards/forwards and twisting movements (the Cruciates either Anterior or Posterior).

    The following link provides a 3D image of the Knee joint with further reading regarding anatomy Healthline

    The ligaments are strong structures so generally require an accident or big force on the knee joint to cause damage to them. This is generally associated with sporting blows, twists or tackles.

    Injuries sustained in skiing, football, rugby and netball are all culprits causing damage.

    The ligaments can also be damaged because of big slips and twists of the knee joint. Like those occuring on icy or slippery surfaces. Generally the knee goes one way, while at the same time the body goes the other and the damage is done.

    If left untreated a sprained knee can result in chronic pain, and joint stiffness, causing a loss of function.

    Assessment of a sprained knee is also advised to rule out other causes of knee pain such as cartilage tears or ruptures to the surrounding muscles and tendons

    Clinical Signs

    • Sudden onset of pain after a slip, tackle, ski crash or fall.
    • The knee may swell a little or a lot.
    • Walking and bending the knee may be very difficult and painful.
    • The knee may feel like it will give way, and you may not trust your knee or feel that you can rely on it.


    With the help of Physiotherapy treatment and advice we will make sure that your recovery is fast and appropriate to prevent re-injury.

    • If a ligament is completely torn and you are young and sporty, the chances are it will need to be surgically repaired.
    • If a ligament is partially torn, rest and rehabilitation is vital to allow a full return to sport or pain free everyday activity.
    • In the acute stages of damage Physiotherapy will help to reduce pain and swelling and restore function with: electrotherapy, taping, exercise.
    • Specific rehabilitation drills including sport specific drills will ultimately allow a return to full activity.

    At Straight Back Physiotherapy we have rehabilitated people from week one after surgery, right back to a regular lifestyle.

    So get in contact if you think you have damaged a ligament and we will get you going again.

    Registered treatment provider for members of BUPA, AVIVA, AXA PPP and all other major insurance groups.