July 14, 2021

What are ligaments and how can physiotherapy help in the treatment of ligament injuries?

By lumb@admin

Ligaments are fibrous bands which are present near two or more bones and connect adjacent bones to provide stability to the joint. They might be tough but they are very flexible and stretchable and provide good range of gliding motion at the joint and at the same time they also prevent the abnormal movements at the joint.

Types of ligaments-

1)- According to their composition-

A) Most ligaments in human bodies are made up of collagen fibres. These ligaments are non elastic and unstretchable.

B) There are few ligaments like the ligamenta flava and ligament of auditory ossicles which are made up of elastin fibres predominantly and hence they are elastic in nature.

2) According to their relation to the joint

These types of ligaments are intrinsic ligaments that surround the joint and maybe extracapsular or intracapsular.

Morphology- Ligaments are usually considered degenerated tendons of the related muscles. Tibial collateral ligament is degenerated tendon of adductor magnus muscles. Sacrotuberous ligament is degenerated tendon of long head of biceps femoris muscles. Long plantar ligament is part of peroneus longus.

Functions- The main function of ligament is to provide stability at the joint and prevent any abnormal gliding or movement further. They also act as sensory reflex organs so that their joint stabilisation role is far more efficient.

Injuries-there are three grades of injuries to ligaments.

grade 1 – In this injury, only few fibres are broken and the injury is very mild and there is very less pain or swelling at the joint and hence the activity of the patient is not hampered and the pain may go away by application of ice pack and little bit of rest.

grade 2-in this type of injury, more than half of the ligament fibres are torned apart and hence there is significant swelling and pain at the site of injury and the patient is unable to move.

grade 3- in this injury, three fourth of the ligament fibres are torn apart and the patient is immobile and there is severe pain and swelling. Usually grade 3 injury of ligament requires grafting through surgery and physiotherapy rehabilitation of 6 weeks.

Causes of ligament injury- Usually twisted injury, fall, external trauma, blow from the outside and certain times walking on uneven surfaces may also lead to injuries to ligaments. At times overstretching or over gliding of joints may also lead to injuries in certain ligaments of human body.

Treatment- usually grade one injury of ligament heals up with rest and application of ice packs. At times patient is prescribed analgesics as well.

2) grade 2 injury requires lot of attention to heal. The patient is immediately advised rest and application of ice pack. Protocol of P.R.I.C.E.is also followed i.e, prevention, rest,ice, compression, and elevation of the limb is done to counter the swelling occurring at the site of the injury. Patient is given analgesics and at times pain relieving injections are also given to give the patient immediate pain relief.

grade 3 injuries are very severe and hence after radiodiagnosis immediate surgery suggested and after surgery, 6 weeks of physiotherapy is must.

Physiotherapy rehabilitation of ligament injury- In the first few weeks the patient is advised prevention, rest, ice, compression and elevation. Slowly and steadily limb movements are started with strengthening of the quadriceps muscles and stretching of calf muscles and hamstring muscles. Heel sliding is advised to the patient so that the knee range of motion can be regained. Only after 4 weeks the patient is advised to do any active exercises. In the first four weeks the physiotherapist assists the patient in doing all the the exercises of strengthening and stretching. The patient is also advised to use Walker, stick in the first few weeks so that there is no full weight wearing on the feet if the ligament of the feet and the lower limbs are injured.