The Knee; Anatomy, Injury, Care and Prevention

The knee. One of the most important (after the hip but before the ankle) and easy to injure joint for us soccer players. Every one knows at least one team mate or fellow player who has had their soccer playing career cut short or delayed by a knee injury. My biggest fear has to be tearing a ligament in my knee, and it almost happened to me a month ago. Luckily it was just a minor sprain. So what can be done to prevent knee injuries from happening and what can we do to aid in recovery.

I’m going to go over the different injuries that can occur in the knee and cover what can be done to prevent and treat it. First I want to give you a little bit of an anatomy lesson.  So lets get into it!

The Knee – A Very Important Structure

The knee has tendons, ligaments, cartilage and meniscus that form the articulation of the Femur and the Tibia that is commonly known as the knee. While the ligaments hold the bones together directly the tendons of the Quadriceps and hamstrings anchor the muscles to the lower leg further supporting the joint. The meniscus and cartilage help things to move smoothly and also have shock absorption properties . With all these components it is easy to see how many ways the knee can sustain damage. Of course the ratio of injury varies between guys and girls because of anatomical differences.

Guys and Girls

Statistically knee injuries are much more common for female athletes. It all comes down to how the structure of the body varies between guys and girls. Naturally girls have less muscle mass and their pelvic girdles aren’t structured for athletic efficiency. In addition to that they have shorter ACL and there is less space in the knee cavity. Guys have it lucky as we are naturally built to be athletic, with more muscle mass , stronger and more efficient joint structures (hips,knees,ankles).  This vital difference in anatomy also means that girls have to take more care to properly train their bodies to efficiently cut, run, stop, balance, jump and land safely. However at the professional level the players sometimes push their bodies so hard that injuries are just part of the game. As it would happen knee injuries are often what causes a professional athlete to retire early no matter if they are a guy or a girl.

Know Your Tissues, Anatomy Lesson #2

Ligaments connect bone to bone, Tendons connect muscles to bone, Bones are the structures that allow a frame for movement as well as organ protection and the muscles contract and relax in a coordinated effort to create complex or simple movements. The organs run the show behind the scenes. This has been your very basic anatomy lesson. However the tissues that go into each structure is vastly different and heal differently.

Vascularity, or blood supply, is the most important factor when it comes to healing. The highly vascularized tissues such as muscles, bones and skin are quick to heal because they have more veins supplying blood to the cells so when they are damaged the healing process is more efficient. However ligaments, tendons and cartilage are pretty avascular and have little to no blood supply which means that the process is dramatically longer and in some cases indefinite and will never be fully healed. So you are better off breaking a bone than tearing a ligament in some cases! That is why the knee, which has pretty much every kind of tissue besides organ tissue, is a major concern when it undergoes injury. So how do these tissues get injured and what can we do to keep that from happening and treat it when if does?

Ligament Tear/Sprain

What is it? How does it happen?: This is something I have a bit of personal experience with. A sprain is a stretches or torn ligament. There are three grades, a grade one being a partial tear and a grade three being a complete tear. The most commonly sprained ligament in the knee is the ACL which is a major stabilizer of the knee located pretty much inside the structure itself, it keeps the knee from sliding forward. If torn it can cause chronic instability of the knee and even arthritis later on. The same goes for pretty much any ligament. I’ve had experience with an MCL grade one tear myself. What the MCL does is support the inside of the knee to keep it from buckling inward.

Basically you can undergo these injuries by putting yourself into a position where the knee bends in a way that is unnatural. Cutting incorrectly, stopping/slowing down too fast, landing wrong or even getting hit in the knee hard enough to bend it can cause a sprain. You will feel and in some cases hear the “pop” followed by some pretty nasty pain.

Prevention and Care: The thing about the preventative measures is that they won’t totally ensure that you won’t end up with a sprain. Self care can only go so far as well. If it is bad enough you will need surgery and rehab.

Strength training, agility exercises, plyometrics, Neuro Muscular training and practicing proper body mechanics can strengthen the muscles around the joint and prevent a lot of injuries that can happen with knees and not just ligament sprains. Ultra sound therapy may also help strengthen ligaments that have been damaged in the past and are still on the weak side. Cleat wise go for turf or ag cleats when you play on artificial grass, SG cleats on wet grass. I can’t tell you how many times I’ve heard of someone tearing something in their knee because they aren’t wearing the right cleats for the job!

Massage can help with both prevention and care by relaxing the muscles so the ligaments aren’t over taxed and by speeding the recovery process by increasing the efficiency of healing. Massage, more specifically cross fiber friction, can even help lay down extra fibers and align scar tissues that limit mobility. Braces are good for both prevention and care, as long as you get the right brace. KT tape was also helpful with my MCL sprain. But first things come first for ensuring that you recover correctly. See a doctor and listen to what they have to say. Surgery is the last step, all options should be exhausted before it should be considered.

Tendon Tear/Strain/inflammation or Muscle Injury

What is it? How does it happen?: The thing about strains is that it can take place in the tendon or the muscle. Obviously if you strain a quadriceps or hamstring muscle you are going to have issues bending your knee. It is an injury that we see happen often in professional players. A tear or strain happens when the muscle is contracted or overstretched to the point where the fibers tear. Sometimes it happens to the tendon which can be worse. The tendon sometimes even tears away from the bone taking a piece with it! There are a few tendons that cross the knee joint.

The Patellar tendon which is home to the patella/knee cap and attaches the quadriceps to the tibia the second group are the tendons that attach the hamstring to the tibia and fibula is the biggest tendon that crosses the knee. A tear can happen once again if the muscle is too tight. Muscle fatigue, not warming up before activity ( I can attest to this one, pulled my hamstring a few years back) and over taxing the muscle like lifting a heavy object can cause a tear in either structure. Tendonitis in the knee happens when the patellar tendon gets inflamed. It is also called jumpers knee because frequent jumping can cause it as well as running. In severe cases it is called tendonosis where there can be micro tears which will cause the tendon to thicken during the healing process. Worse case scenario is when the tendon tears.

I remember when I pulled my hamstring it felt like I got stabbed in the back of the leg, I heard a  faint tearing/popping/squelching noise and I couldn’t bend my knee. Tearing a tendon has a pop to it just like when you tear a ligament and is pretty similar in sensation except it usually is more painful. In some cases of tendons tearing completely the muscle may roll up on itself like a window shade!

Prevention and Care: Prevention would be to warm up well and stretch before every activity, and stretch after every activity. Yoga and massage are also good for prevention as they are great for muscle health, I swear by both and there is tons of research proving that both are important for healthy muscle activity. Braces and wrapping can help to a degree with compression gear being pretty effective. I found KT tape really helped out with my jumpers knee. When you do strength training with weights don’t lift more than you can handle. Foam rollers can help break up adhesion and knots in the muscle which in turn make them more efficient. Strength training will strengthen the bones where the tendons attach reducing the chances of separation. Also when you are ever in pain or can’t get a muscle to stretch take time off so you can heal. I know it stinks to be out of the game but staying on and getting injured will mean you are off the field for longer than you would like. Hydration is also very important for muscle function, dehydrated muscles are unhappy muscles. Also eat protein after a game or training of any sort so the muscles can heal appropriately.

Care is pretty simple since it isn’t a challenge for muscles to heal. If it is a tendon injury more must be done and in cases of complete tears surgery must be done. It is kind of ironic but there is an ACL surgery where they take a piece of a hamstring tendon and repair/replace the ACL with it. Back on topic, tendons tears will have different approaches to care depending on severity. In all cases of minor muscle and tendon injuries R.I.C.E. and heat are called for. In more serious cases consult with a doctor as should be the case with any injury that is out of control care wise.

Meniscus Tear

What is it? How does it happen?: The meniscus is basically a cushion in your knee to cushion, stabilize the joint and create smooth movement. If minor it may only cause mild swelling and discomfort but more severe cases will cause alot of pain, swelling, muscle, joint instability and stiffness or catching in the knee joint.

It can be caused by the joint moving in a way it isn’t supposed to such as twisting. It is sometimes accompanied by a ligament tear especially if it is severe.

Prevention and Care: For prevention and care the steps taken are very similar to ligaments because there isn’t much you can do to strengthen it since it is avascular. Wear a brace if you are in danger of a tear. Strength training as you would do for ligament damage prevention as well as agility, plyometrics, proper body mechanics. Once again wear the right cleats for the surface!

Of course the Meniscus is even less vascular than the ligaments so it sometimes doesn’t heal at all. First off see a doctor! If it is severe surgery or physical therapy will be the only options for now.

Overall Prevention and Care

There are some very simple injury prevention and care steps that can be taken. When you are in pain or in pain that won’t go away take a break or you’ll end up “taking a break” in the literal sense. If things are really bad see a doctor, if things aren’t working the way they are supposed to there is something very wrong. If you have a history of knee issues always wear a brace, find one that works for you. Get the right cleats! Turf or AG for turf, SG for wet grass, hard ground cleats for hard ground and by now you get my drift. Do some yoga, get a massage, strength train and condition yourself, however don’t over do it and get injured that way. When injury does happen R.I.C.E. (rest ice compression and elevation alternate ice with heat in later stages of healing) and if things are really wrong see the doctor. Check out more overall and general steps to take in my Injury Prevention article.