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Knee Injuries

ACL and PCL Injuries - Anterior and Posterior Cruciate Ligament Injuries

The anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) are the two major ligaments in the knee that work together to provide stability in the knee. They cross each other and form an 'X' which allows the knee to flex and extend without side to side movement. Injuries to these cruciate ligaments of the knee are typically sprains. The ACL is most often stretched, or torn by a sudden twisting motion while the feet remain planted.


Both the ACL and PCL can be injured or torn by a sudden twisting of the knee joint.

PCL injuries are likely with impacts to the front of the knee, or from hyper-extending the knee. The PCL can also be injured by a direct impact from the outside of the knee joint, such as those that occur during football.

ACL injuries, including partial or complete tears, can occur when an athlete changes direction rapidly, twists without moving the feet, slows down abruptly, or misses a landing from a jump. This type of movement may cause the ACL to stretch to the point of tearing.

The degree of injury to the ACL may determine the type of treatment recommended.

Cruciate ligament injuries don't always cause pain, but typically a loud popping sound can be heard at the time of the injury.


Incomplete ACL and PCL tears are treated conservatively to allow the body to heal on its own. Rest, ice, compression and elevation are the immediate treatment. Anti-inflammatory medications can help reduce pain. Physical therapy is often recommended to regain and build muscle strength over time.

For a complete tear of the ACL Arthroscopic surgery and ACL Reconstruction is usually performed.

 Medial Collateral Ligament Injuries

The medial collateral ligament (MCL) is more easily injured than the lateral collateral ligament (LCL). It is most often caused by a blow to the outer side of the knee which occur often in contact sports, that stretches and tears the ligament on the inner side of the knee.

The classic sign of this injury is hearing a "pop" and feeling the knee buckle sideways. Pain and swelling are are immediate. To diagnose a collateral ligament injury, a medical professional will perform several manual tests (applying ressure on the side of the knee to determine the degree of pain and looseness of the joint) and possibly order an MRI to confirm the diagnosis.


Minor sprains of the collateral ligaments will heal with rest and gradual return to activity. R.I.C.E. - rest, ice, compression and elevation help reduce pain and swelling and a knee brace may be used to protect and stabilize the knee. A sprain may take 2 to 4 weeks to heal. A severely sprained or torn collateral ligament may occur along with a torn anterior cruciate ligament, which usually requires repair with Arthroscopic surgery.


Pain in the groin is often the result of a groin (adductor muscle) pull or strain. This is similar to any other type of pulled or strained muscle, but it occurs when the muscles of the inner thigh (the adductors) are stretched beyond their limits. This can result in small muscle tears that cause pain and swelling. The groin muscles include the adductor magnus, adductor longus, adductor brevis, pectineus, and gracilis. 

The adductors are fan-like muscles in the upper thigh that pull the legs together when they contract. They also help stabilize the hip joint. The adductors attach from the pelvis to the femur (thigh bone).

The most common cause of groin pain is a muscle strain that causes localized pain in the inner thigh, or groin. A severe tear can cause a sudden, acute pain and may be accompanied by swelling and bruising. They are painful to the touch, and pain increases with resistance movements, and stretching of the inner thigh and hamstrings.

These injuries often occur during a sudden change of direction while running and quick starts and stops. These injuries are especially common in field or court sports.

Is It a Groin Pull or a Hernia?

The symptoms of sports hernia are sometimes mistaken for a a groin pull or strain. A dull aching pain that intensifies with exercise may be the only symptom of an sports hernia. An inguinal hernia, however, typically creates a bulging protrusion in the lower abdomen or upper groin that is hard to miss. If you suspect a hernia, a visit to your physician is the next step.

Treating a Groin Pull

For immediate relief of a groin pull, use the R.I.C.E. treatment method. Rest, ice, compression and elevation are the best immediate treatment for pulls and strains. Avoid aggravating activities for the first one to two weeks and gradually return to sports.

Once activity is started again, ice the muscle after exercise to reduce any swelling. After applying the ice, wrap the thigh to keep it compressed.

An over-the-counter anti-inflammatory can be helpful to reduce pain and inflammation for up to a week after the injury.

When inflammation subsides, you can start with gentle groin stretching and progress to a strengthening program of low-intensity exercises.

Running may be started during recovery, but it should be gentle, gradual and not include hill or sprint work. Pay attention to signs of pain or increased tenderness, and reduce exercise if any develops. Stretch gently and never force a stretch. A return to activity should be possible within two or three weeks.

Preventing a Groin Pull

Proper warm up and stretching is helpful to prevent groin pulls

Hamstring injuries are common among athletes who play sports that require powerful accelerations, decelerations or lots of running. The hamstring muscles run down the back of the leg from the pelvis to the bones of the lower leg. The three specific muscles that make up the hamstrings are the biceps femoris, semitendinosus and semimembranosus. Together these powerful knee flexors are known as the hamstring muscle group. An injury to any of these muscles can range from minor strains, a pulled muscle or even a total rupture of the muscle.

Symptoms of a Hamstring Injury

A hamstring injury typically causes by a sudden, sharp pain in the back of the thigh that may stop you mid-stride. After such an injury, the knee may not extend more than 30 to 40 degrees short of straight without intense pain. Like most sprains and strains hamstring injuries are usually caused by excessive stretching (tearing) of muscle fibers or other soft tissues beyond their limits.

Severity of a Hamstring Injury

Hamstring strains are classified as 1st (mild), 2nd (moderate), or 3rd (severe) degree strains depending on the extend of the muscle injury.

Mild (Grade I) Hamstring Injury

  • Muscle stiffness, soreness and tightness in the back of the thigh.
  • Little noticeable swelling.
  • A normal walking gait and range of motion with some discomfort.
  • Flexing the knee to bring the heel up

Moderate (Grade II) Hamstring Injury

  • Gait will be affected-limp may be present .
  • Muscle pain, sharp twinges and tightness in the back of the thigh.
  • Noticeable swelling or bruising.
  • Painful to the touch.
  • A limited range of motion and pain when flexing the knee.

Severe (Grade III) Hamstring Injury

  • Pain during rest which becomes severe with movement
  • Difficulty walking without assistance.
  • Noticeable swelling and bruising.

 Common Causes of Hamstring Injuries

Hamstring pulls or strains often occur during an eccentric contraction of the hamstring muscle group as an athlete is running. Just before the foot hits the ground, the hamstrings will contract to slow the forward motion of the lower leg (tibia and foot). Less commonly, a hamstring injury is the result of a direct blow to the muscle from another play or being hit with a ball. Some of the factors which may contribute to a hamstring injury includes:

  • Doing too much, too soon or pushing beyond your limits.
  • Poor flexibility.
  • Poor muscle strength.
  • Muscle imbalance between the quadriceps and hamstring muscle groups.
  • Muscle fatigue that leads to over exertion.
  • Leg Length Differences. A shorter leg may have tighter hamstrings which are more likely to pull.
  • Improper or no warm-up.
  • History of hamstring injury.

Treating Hamstring Injuries

Treatment for hamstring injuries depends upon the severity of the injury. Due to the pain and limited ability to use the muscle, a third degree strain usually results in a visit to a physician for evaluation and treatment. Less severe hamstring strains may be treated at home. These general treatment steps are commonly recommended for mild or moderate hamstring injuries.

  • After an injury it's important to rest the injured muscle, sometimes for up to two or three weeks before you can return to sports after your injury.
  • R.I.C.E - Rest, apply Ice and Compression. Elevate the leg if possible.
  • An anti-inflammatory can be helpful to reduce pain and inflammation.
  • A stretching program can be started as soon as the pain and swelling subsides.
  • A strengthening program should be used to rebuild the strength of the injured muscle in order to prevent re-injury. Make sure you increase this gradually.
  • A thigh wrap can be applied to provide support as the muscle heals.

Preventing Hamstring Injuries

  • Warm up thoroughly. This is probably the most important muscle to warm-up and stretch before a workout.
  • Stretching after the workout may be helpful.
  • Try adding a couple sessions per week of retro-running or backward running which has been should decrease knee pain and hamstring injuries.
  • Follow the "Ten Percent Rule" and limit training increases in volume or distance to no more than ten percent per week.
  • Other ways to prevent injury are to avoid doing too much, too soon, avoid drastic increases in intensity or duration, and take it easy if you are fatigued.


A hip pointer injury is extremely painful, acute injury to the iliac crest of the pelvis. The injury causes bleeding into the abdominal muscles, which attach to the iliac crest. The bone and overlying muscle are often bruised, and the pain can be intense. Pain may be felt when walking, laughing, coughing, or even breathing deeply.


Hip pointers are the result of a direct blow to the iliac crest, whether from a direct hit from a helmet, or a hard fall. Hip pointers are common in contact sports such as football, and soccer.


For immediate relief, follow the treatment plan. Rest from aggravating activities for the first 1 to 2 weeks, is the only real way to heal a Hip pointer. Ice and medication can be helpful to reduce pain and inflammation for the first 7 to 10 days after the injury.

It's important that the athlete not return to quickly to activity. If he still has pain or tenderness, he is liable to compensate by altering his gait and technique. The result is another injury to another body part.


Proper protective equipment is key. Additionally, developing appropriate skills and techniques may help avoid a hip pointer. Ultimately, however, there isn't much an athlete can do to prepare for such a blow.

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