Pes Anserine Bursitis: Cause, Symptoms, Treatment, Exercise

 

Pes Anserine Bursitis

What is a Pes Anserine Bursitis?

Pes anserine bursitis is a condition in which the bursa located at the inner aspect of the knee joint becomes inflamed. The pes anserine bursa is a small, fluid-filled sac that provides cushioning and reduces friction between the tendons of the hamstring muscles and the tibia bone of the lower leg.

This condition typically causes pain, tenderness, and swelling on the inside of the knee, just below the joint line. It is commonly seen in middle-aged women and people who are overweight or have osteoarthritis of the knee.

The most common causes of pes anserine bursitis include overuse or repetitive strain on the knee joint, injury, and degenerative changes in the joint due to aging or arthritis. Treatment options for pes anserine bursitis may include rest, ice, compression, elevation, physical therapy, anti-inflammatory medications, and in some cases, steroid injections or surgery.

Related Anatomy

The pes anserine bursa is located at the medial aspect of the knee, just below the joint line. It is situated between the tendons of three muscles:

• Sartorius: a long, thin muscle that runs from the hip to the medial side of the tibia bone. It helps to flex and rotate the hip and knee joints.
• Gracilis: a long, thin muscle that runs from the pubic bone to the tibia bone on the medial side of the knee joint. It helps to adduct and rotate the hip and flex the knee joint.
• Semitendinosus: a long, thin muscle that runs from the ischial tuberosity of the pelvis to the tibia bone on the medial side of the knee joint. It helps to extend the hip and flex and medially rotate the knee joint.

The pes anserine bursa lies between these tendons and the underlying tibia bone. It helps to reduce friction between the tendons and the bone during movement.

Causes of Pes Anserine Bursitis

Pes anserine bursitis can be caused by a variety of factors, including:

• Overuse or repetitive strain: Repeated stress on the knee joint can cause irritation and inflammation of the bursa, leading to pes anserine bursitis. This can occur in athletes who engage in activities that require a lot of running, jumping, or kicking.
• Injury: Trauma to the knee, such as a direct blow or fall, can cause inflammation of the bursa.
• Obesity: People who are overweight or obese are at a higher risk of developing pes anserine bursitis because the excess weight places more stress on the knee joint.
• Osteoarthritis: This is a degenerative joint disease that can cause inflammation and damage to the knee joint, leading to pes anserine bursitis.
• Other medical conditions: Some medical conditions such as gout, rheumatoid arthritis, or diabetes can increase the risk of developing pes anserine bursitis.
• Improper form or training: Poor running or exercise technique, as well as inadequate training or warm-up, can put excessive stress on the knee joint and increase the risk of pes anserine bursitis.

Muscle imbalances: Weakness or imbalances in the hip or thigh muscles can cause abnormal stresses on the knee joint, leading to pes anserine bursitis.

Symptoms of Pes Anserine Bursitis

The most common symptoms of pes anserine bursitis include:

• Pain: The pain is usually felt on the inside of the knee, just below the joint line. The pain may be sharp, dull, or throbbing, and may worsen with activity.
• Swelling: The affected area may appear swollen and tender to the touch.
• Stiffness: The knee may feel stiff or difficult to move, especially in the morning or after prolonged periods of inactivity.
• Weakness: Weakness in the muscles around the knee, especially the quadriceps and hamstrings, may also be present.
• Clicking or popping: Some people may experience clicking or popping sensations in the knee joint.
• Limited range of motion: The range of motion in the knee joint may be limited, and it may be difficult to fully bend or straighten the knee.
• Warmth or redness: In some cases, the skin over the affected area may feel warm or appear red.

It's important to note that these symptoms can also be caused by other knee conditions, so it's important to see a healthcare provider for an accurate diagnosis.

Risk factor

Several factors can increase the risk of developing pes anserine bursitis, including:

• Age: Pes anserine bursitis is more common in middle-aged and older adults.
• Gender: Women are more likely than men to develop pes anserine bursitis.
• Obesity: Being overweight or obese increases the stress on the knee joint, which can lead to pes anserine bursitis.
• Medical conditions: Certain medical conditions, such as osteoarthritis, rheumatoid arthritis, gout, and diabetes, can increase the risk of developing pes anserine bursitis.
• Improper exercise technique: Poor running or exercise technique can put excessive stress on the knee joint, leading to pes anserine bursitis.
• Muscle imbalances: Weakness or imbalances in the hip or thigh muscles can cause abnormal stresses on the knee joint, increasing the risk of pes anserine bursitis.
• Sports and activities: Certain sports and activities that involve repetitive knee movements, such as running, cycling, or dancing, can increase the risk of pes anserine bursitis.
• Previous knee injury: A previous knee injury, such as a ligament tear or fracture, can increase the risk of developing pes anserine bursitis.

Differential Diagnosis

There are several conditions that can cause similar symptoms to pes anserine bursitis, so it's important to have a healthcare provider perform a thorough examination to determine the correct diagnosis. Some possible differential diagnoses for pes anserine bursitis include:

• Knee osteoarthritis: This is a degenerative joint disease that can cause pain, stiffness, and swelling in the knee joint.
• Medial collateral ligament (MCL) injury: An injury to the MCL can cause pain, swelling, and instability in the knee joint.
• Patellofemoral pain syndrome: This is a condition that causes pain in the front of the knee, often worsened by activities such as running or going up and down stairs.
• Meniscal tear: A tear in the meniscus, the cartilage that cushions the knee joint, can cause pain, swelling, and difficulty with movement.
• Osgood-Schlatter disease: This is a condition that typically affects adolescents and causes pain and swelling in the knee, especially during physical activity.
• Rheumatoid arthritis: This is an autoimmune disease that can cause joint pain, swelling, and stiffness throughout the body, including the knee joint.
• Gout of the Knee: This is a type of arthritis that occurs when uric acid crystals build up in the joints, causing pain, swelling, and inflammation.
• Infection: In rare cases, an infection in the knee joint can cause symptoms similar to those of pes anserine bursitis.

Diagnosis

The diagnosis of pes anserine bursitis typically involves a physical exam, medical history, and diagnostic tests. During the physical exam, the healthcare provider may check for tenderness, swelling, and range of motion in the knee joint. They may also assess the strength of the muscles around the knee.

A medical history can help identify any potential risk factors, such as recent knee injury or medical conditions that may increase the risk of developing pes anserine bursitis.

Diagnostic tests may include imaging studies, such as X-rays or magnetic resonance imaging (MRI), to rule out other knee conditions such as osteoarthritis or a meniscal tear. Blood tests may also be ordered to check for signs of infection or underlying medical conditions.

In some cases, the healthcare provider may also perform a bursa aspiration, which involves using a needle to remove fluid from the affected bursa for further examination. This can help confirm the diagnosis of pes anserine bursitis and rule out other conditions that may cause similar symptoms.

Examination test for Pes Anserine Bursitis

During a physical examination, a healthcare provider may perform several tests to help diagnose pes anserine bursitis. Some of these tests include:

• Palpation: The healthcare provider may press on the inside of the knee to check for tenderness and swelling in the pes anserine bursa.
• Passive knee flexion: The healthcare provider may flex the knee while the patient is lying on their back, which can help identify any pain or discomfort in the pes anserine bursa.
• Active resisted knee flexion: The healthcare provider may ask the patient to flex their knee against resistance, which can help identify any weakness in the muscles around the knee joint.
• Ober's test: This test is used to assess the tightness of the iliotibial band, which can contribute to pes anserine bursitis. The patient lies on their side with their lower leg extended and their upper leg flexed at the hip and knee. The healthcare provider then lifts the upper leg and allows it to drop back down while keeping the hip extended. If the leg stays abducted (i.e., away from the midline of the body), it may indicate tightness in the iliotibial band.

Treatment of Pes Anserine Bursitis

Treatment for pes anserine bursitis typically involves a combination of self-care measures, physical therapy, and medication. In rare cases, surgery may be required.

• Self-care measures: Resting the knee, applying ice packs to the affected area, and using over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help relieve pain and reduce inflammation.
• Physical therapy: Strengthening and stretching exercises can help improve the strength and flexibility of the muscles around the knee joint, which can help reduce stress on the bursa. The physical therapist may also use modalities such as ultrasound, heat or ice therapy to help reduce pain and swelling.
• Medication: If self-care measures and physical therapy are not enough, the healthcare provider may prescribe stronger pain medications or corticosteroid injections to help reduce inflammation and relieve pain.
• Surgery: In rare cases, surgery may be required to remove the affected bursa.
• Preventative measures such as proper warm-up and cool-down exercises before and after physical activity, maintaining a healthy weight, and using proper technique during exercise can help prevent pes anserine bursitis from developing or recurring.

Physiotherapy treatment

Physiotherapy can be an effective treatment for pes anserine bursitis. A physical therapist can design a specific treatment plan based on the individual's symptoms, medical history, and physical examination.

• Range of motion exercises: These exercises help improve the flexibility of the knee joint and surrounding muscles.
• Strengthening exercises: Strengthening the muscles around the knee joint, such as the quadriceps, hamstrings, and glutes, can help reduce stress on the bursa and improve knee stability.
• Manual therapy: Manual therapy techniques, such as massage or joint mobilization, can help improve joint mobility and reduce pain.
• Modalities: Physical therapists can use modalities such as heat or ice therapy, ultrasound, and electrical stimulation to reduce pain and inflammation.
• Gait training: Analyzing and correcting an individual's gait pattern can help reduce stress on the knee joint, which can reduce the risk of bursitis.
• Education: Education on proper exercise techniques, posture, and footwear can help prevent bursitis from recurring.

It's important to work with a qualified physical therapist who can design a customized treatment plan based on the individual's specific needs and goals.

Exercises

Here are some examples of exercises that may be recommended by a physical therapist for pes anserine bursitis:

• Quad sets: Sit on the floor with your legs straight out in front of you. Tighten the muscles at the front of your thigh, and press the back of your knee into the floor. Hold for 5 seconds, and then relax. Repeat for 10 repetitions, and gradually increase to 3 sets of 10 repetitions.
• Hamstring stretches: Lie on your back with one leg extended straight out in front of you and the other bent with your foot flat on the ground. Hold the back of your thigh with both hands and gently pull your leg towards your chest until you feel a stretch in the back of your thigh. Hold for 30 seconds, and then repeat on the other leg. Repeat for 3-5 repetitions on each leg.
• Clamshells: Lie on your side with your legs bent at a 90-degree angle. Keeping your feet together, lift your top knee as high as you can without moving your pelvis. Hold for 2 seconds, and then lower your leg back down. Repeat for 10 repetitions, and gradually increase to 3 sets of 10 repetitions.
• Straight leg raises: Lie on your back with one leg bent and the other straight out in front of you. Tighten the muscles at the front of your thigh, and lift your leg up off the ground until it is parallel with your bent knee. Hold for 2 seconds, and then lower your leg back down. Repeat for 10 repetitions, and gradually increase to 3 sets of 10 repetitions.
• Wall squats: Stand with your back against a wall and your feet shoulder-width apart. Slide down the wall until your knees are bent at a 90-degree angle. Hold for 10-30 seconds, and then slide back up. Repeat for 10 repetitions, and gradually increase to 3 sets of 10 repetitions.

It's important to only perform these exercises under the guidance of a qualified physical therapist to ensure proper technique and to avoid exacerbating symptoms.

How to Prevent Pes Anserine Bursitis?

Here are some tips to help prevent pes anserine bursitis:

• Warm-up and cool-down: Always properly warm-up before exercising, and cool-down afterwards. This helps prepare the muscles for activity and reduces the risk of injury.
• Strengthen and stretch: Strengthen the muscles around the knee joint, such as the quadriceps, hamstrings, and glutes, and stretch these muscles regularly to improve flexibility and reduce the risk of injury.
• Wear proper footwear: Choose appropriate shoes for your physical activities, such as running shoes for running or cross-training shoes for weight lifting.
• Maintain a healthy weight: Excess weight can put additional stress on the knees and increase the risk of injury.
• Use proper technique: Make sure to use proper technique during exercises to avoid putting unnecessary stress on the knees.
• Gradually increase activity level: Gradually increase the intensity, duration, and frequency of physical activity to avoid overuse injuries.
• Avoid repetitive activities: Try to vary your physical activities to avoid repetitive stress on the knee joint.

By following these tips, you can help reduce your risk of developing pes anserine bursitis and other knee injuries.

Pes Anserine Bursitis recovery time

The recovery time for pes anserine bursitis can vary depending on the severity of the injury and the individual's response to treatment. In mild cases, recovery may only take a few weeks, while more severe cases may take several months to fully heal.

It's important to allow enough time for the bursa to heal completely before returning to physical activity. Continuing to exercise or play sports too soon can prolong the healing process and increase the risk of reinjury.

Working with a qualified healthcare provider, such as a physical therapist or orthopedic specialist, can help ensure an appropriate treatment plan is developed and followed for optimal recovery. Adhering to the treatment plan, including rest, physical therapy, and other recommended interventions, can help speed up recovery time and reduce the risk of recurrence.

Summary

Pes anserine bursitis is a condition characterized by inflammation of the bursa located between the tendons of the hamstring muscles and the shinbone. It typically causes pain and swelling on the inside of the knee and can be caused by overuse, injury, or underlying medical conditions.

Risk factors for pes anserine bursitis include obesity, previous knee injuries, and conditions such as osteoarthritis or diabetes. Diagnosis typically involves a physical exam, imaging tests, and ruling out other potential causes of knee pain.

Treatment for pes anserine bursitis includes rest, ice, compression, and elevation (RICE), medications, physical therapy, and in some cases, corticosteroid injections or surgery. Physical therapy can help improve strength and flexibility in the muscles surrounding the knee joint, and specific exercises such as quad sets, hamstring stretches, clamshells, straight leg raises, and wall squats may be recommended.

Preventive measures include warming up and cooling down before and after exercise, wearing appropriate footwear, maintaining a healthy weight, using proper technique, and gradually increasing activity levels. Recovery time can vary depending on the severity of the injury and the individual's response to treatment, but it's important to allow enough time for the bursa to heal completely before returning to physical activity.

Knee Pain Cause, Symptoms, Diagnosis, Treatment & Exercise

Knee Pain

Introduction

Knee pain is one of the most common complaints in the world. It occurs due to a number of reasons like overuse, injury or arthritis. There are many types of knee pain which can be classified into 4 major categories: 

1. Pain due to overuse:

Pain in the knee is caused by overuse of the joint which can be due to activities like running, jumping or climbing stairs. Overuse of the knee joint may lead to pain and swelling which usually goes away after a few days if it is mild and rest. 

2. Pain due to injury: 

Injury of the knee can occur when there is a sudden impact on the joint like falling down while playing or sports. In this case, there will be swelling and bleeding as well as bruising around the knee area which may last for 1-2 weeks even after proper medical treatment.

3. Pain due to arthritis: Arthritis is the inflammation of the joints which causes pain, swelling and stiffness in them. The condition can be acute or chronic depending on how long it lasts. 

4. Pain due to bursitis: Bursitis is another type of inflammation which can occur in the knee area as well. 

This condition occurs when there is friction between the bones, tendons or ligaments which causes swelling and pain around the joint.

Knee pain cause

Knee pain is a common problem, and it can be caused by many things.

In fact, knee pain isn’t just one thing! 

It can be caused by any number of things:

• A twisted Knee joint, ankle or foot
• A torn ligament or tendon in your knee (particularly the anterior cruciate ligament)
• An arthritic joint (the ball and socket joint) A blow to the knee joint A muscle strain or sprain A condition called chondromalacia (which causes inflammation of the cartilage in your knee)
• Pain and swelling around the knee joint A meniscus tear (a tear to the cartilage in the knee joint)
•  A knee injury from playing sports (such as football, basketball and skiing) 
• A knee injury that causes your kneecap to dislocate (also called a patellar subluxation)
• A knee injury that damages the nerves in your knee joint A knee injury caused by an infection
•  A knee injury that causes damage to the ligaments of your knee joint A knee injury caused by a fall  A knee injury caused by an accident (such as a car crash) A genetic condition called osteogenesis imperfecta (which causes brittle bones)

Knee pain symptoms

The most common complaint of knee pain is a burning sensation in the joint. Other symptoms include:

• Pain in the knee joint when you bend, straighten, or flex the knee
• Pain in the knee joint when walking or running.
• Pain in the knee joint when climbing stairs (or going up and down them)
• Pain in the knee joint while squatting or kneeling. 
• Pain in the knee joint when lying on your back with your legs straight out.
• Pain in the knee joint that goes away after exercise and then comes back later.
• You may also experience swelling around your knee joint if you’ve injured it.

Torn meniscus symptoms include:  Pain in the knee joint when you bend, straighten, or flex the knee. 

You may also experience swelling around your knee joint if you’ve injured it.

Knee pain diagnosis

Knee pain diagnosis can be difficult. Your doctor will ask you about the symptoms you’re experiencing and what activities trigger them. They may also examine your knee joint to see if they can find a cause for the pain. If they suspect that you have a torn meniscus, they may order an MRI scan or x-ray to confirm this diagnosis. 

Knee pain treatment

Treatment for knee pain is a combination of rest, ice, compression and elevation (RICE). This treatment can be done at home by yourself or with the help of a physical therapist. The goal is to allow your body time to recover from the injury so that it doesn't worsen into something more serious later on.

Physical therapy is another important part of your treatment. A physical therapist can help you strengthen the muscles that support your knee, as well as improve flexibility and range of motion. They can also help you identify any biomechanical issues that may be causing pain in your knee.

If the pain is severe and long-lasting, your doctor may suggest that you see an orthopedic surgeon. This is because they have more experience of treating knee injuries than general practitioners or family doctors. 

The type of treatment you receive will depend on how severe your Knee pain or injury is.

 If you have a torn meniscus, your doctor will recommend few treatment options. You may be given pain relief medication to help manage the symptoms of your injury.

Use of RICE Principle to Relive Knee pain:

• Resting and icing your knee as soon as possible.
• Elevating your leg above heart level when resting or sleeping.
• Using a knee immobilizer to keep the joint stable while it heals. 
• Using crutches to help support your weight while walking. 
• Wearing a brace that stabilizes the knee joint to prevent further injury.

Knee pain exercise

Knee pain exercise 

Knee pain exercises are important to strengthen the muscles around the knee. Knee pain exercises can help you to recover from knee pain and prevent it from occurring again in the future.

Knee pain exercises can also improve your condition and make it more comfortable, which can give you more energy as well as make moving easier, so there's no reason not to do them!

As well as being useful for preventing injury, knee pain exercises can also help to make your knee stronger and more flexible. This is important because it means that you are less likely to injure yourself again in the future.

Knee pain exercises can also be useful for helping to prevent other injuries in the future. For example, if you have knee pain and then start doing regular exercises, your knee will become stronger and more flexible over time. This means that it is less likely to happen again.

How to prevent Knee pain?

• Modify your lifestyle. If you’re overweight or obese, losing weight can help reduce knee pain. 
• Reduce the amount of alcohol you drink and stop smoking—both of these habits can increase your risk for osteoarthritis. 
• Try to exercise regularly, even if it’s just walking around your neighborhood. Exercise strengthens muscles around joints, making them less likely to be injured during everyday activities.
• Wear sports shoes with good support.
• Limit the amount of time you spend sitting, especially in a low chair or on a couch.
• Exercise regularly to strengthen your muscles and improve joint movement.
• Consider changing jobs if you’re often on your feet all day at work.

Conclusion

Knee pain is a common problem among people. Knee pain can be caused by various reasons like arthritis, injury or even due to physical exertion. If you are suffering from knee pain and want to know more about it, then you must read this article thoroughly. 

We have discussed here about what causes knee pain in detail and also how can treat it effectively with some tips and tricks that might help you out with your condition.

POPLITEAL CYST

INTRODUCTION

A popliteal cyst, also known as a Baker’s cyst, is a fluid-filled swelling that causes a lump at the back of the knee, leading to tightness and restricted movement. The cyst can be painful when you bend or extend your knee.It is named after the surgeon who first described it, William Morrant Baker (1838–1896). It is not a "true" cyst, as an open communication with the synovial sac is often maintained.

                
        Baker's cyst formstion

CAUSES

Synovial fluid is a clear liquid that normally circulates through the cavities in your knee joint. Sometimes the knee produces too much of this fluid. The increasing pressure forces the fluid to the back of the knee via a one-way valve, where it creates a bulge. This severe swelling of the knee causes a popliteal cyst to form.
The most common causes of a popliteal cyst are:

• Damage to the knee’s cartilage (meniscus)
• Arthritis of the knee
• Rheumatoid arthritis
• Other knee conditions that causes joint inflammation

SYMPTOMS

You may not feel any pain with a popliteal cyst. In some cases, you may not notice it at all.

• Mild to severe Knee pain
• Knee Joint Stiffness
• Limited range of motion
• Swelling behind the knee and calf
• Bruising on the knee and calf
• Rupturing of the cyst

 
   Swelling in affected leg

DIAGNOSIS :

Your doctor will examine your knee and feel the swelling. If the cyst is small, they may compare the affected knee to the healthy one and check your range of motion.A Baker's cyst is easier to see from behind with the patient standing with knees fully extended. It is most easily palpated (felt) with the knee partially flexed.

Your doctor may recommend noninvasive imaging tests if the cyst rapidly increases in size or causes severe pain or fever. These tests include an MRI or ultrasound. An MRI will enable your doctor to see the cyst clearly and to determine if you have any damage to the cartilage.
Diagnosis is confirmed by ultrasonography.

               
              MRI

TREATMENT

A popliteal cyst often doesn’t need treatment and will go away on its own. However, if the swelling becomes large and causes severe pain, your doctor may recommend one of the following treatments.

                          
                             Knee Compression for rest

Fluid draining

Your doctor will insert a needle into the knee joint and may use an ultrasound to help guide the needle to the correct place. They’ll then draw the fluid from the joint.

Physiotherapy treatment :

• Avoiding activities such as squatting, kneeling, heavy lifting, climbing, and even running can help prevent pain
• Regular, gentle exercises may help increase your range of motion and strengthen the muscles around your knee.

                              
                     Knee bending exercise

• Stretching of hamstring muscle and Strengthening of the quadriceps and/or the patellar ligament.

                                               
                                                 qudricepes strengthening exercise

• Crutches may help alleviate the pain.
• You can also help reduce pain by using a compression wrap or placing ice on the joint.

                       
                                ice therapy

• Ultrasound therapy on the back of knee joint.
• Interferential Therapy (IFT) also useful in relieving pain.

Medical Treatment :

Your doctor may recommend a Pain relieving medicine mainly NSAIDs are useful, such as Aceclofenac / Diclofenac. 

Your doctor will also inject this drug into the joint, and the medication will flow back into the cyst if medicine are not effective. Though it may help relieve the pain, it doesn’t always prevent a popliteal cyst from recurring.

Treating the cause of the cyst is very important to prevent the cyst from returning. As a general rule, if the cyst is left alone, it’ll go away once the underlying cause is treated. Should your doctor determine that you have damage to the cartilage, they may recommend surgery to repair or remove it.

                                                 
                           surgical treatment

If you have osteoarthritis of knee , the cyst may persist even after your doctor treats the underlying cause. If the cyst causes you pain and limits your range of motion, your doctor might recommend surgery to remove it.

COMPLICATIONS

Complications associated with popliteal cysts. Complications are rare, but they may include:

• prolonged swelling
• severe pain
• complications from related injuries, such as torn cartilage
• the calf region may become red
• there may be a sensation of water trickling down the calf

POSTERIOR CRUCIATE LIGAMENT

POSTERIOR CRUCIATE LIGAMENT

The posterior cruciate ligament is located in the back of the knee. It is one of several ligaments that connect the femur (thighbone) to the tibia (shinbone). The posterior cruciate ligament keeps the tibia from moving backwards too far.

An injury to the posterior cruciate ligament requires a powerful force. A common cause of injury is a bent knee hitting a dashboard in a car accident or a football player falling on a knee that is bent.

The anterior and posterior cruciate ligaments form an "X" in the center of the knee.

While a posterior cruciate ligament injury generally causes less pain, disability and knee instability than does an ACL tear, it can still sideline you for several weeks or months.

DESCRIPTION

Injuries to the posterior cruciate ligament are not as common as other knee ligament injuries. In fact, they are often subtle and more difficult to evaluate than other ligament injuries in the knee.

Many times a posterior cruciate ligament injury occurs along with injuries to other structures in the knee such as cartilage, other ligaments, and bone.
A complete tear of the posterior cruciate ligament, back view.

Injured ligaments are considered "sprains" and are graded on a severity scale.

Grade 1 Sprains. The ligament is mildly damaged in a Grade 1 Sprain. It has been slightly stretched, but is still able to help keep the knee joint stable.

Grade 2 Sprains. A Grade 2 Sprain stretches the ligament to the point where it becomes loose. This is often referred to as a partial tear of the ligament.

Grade 3 Sprains. This type of sprain is most commonly referred to as a complete tear of the ligament. The ligament has been split into two pieces, and the knee joint is unstable.

Posterior cruciate ligament tears tend to be partial tears with the potential to heal on their own.
 People who have injured just their posterior cruciate ligaments are usually able to return to sports without knee stability problems.

CAUSES

An injury to the posterior cruciate ligament can happen many ways. It typically requires a powerful force.

• A direct blow to the front of the knee (such as a bent knee hitting a dashboard in a car crash, or a fall onto a bent knee in sports)
• Pulling or stretching the ligament (such as in a twisting or hyper-extension injury.
• Simple misstep

Sports are a common cause of PCL injury. These injuries are especially common in:

• Football
• Soccer
• Baseball
• Skiing

SYMPTOMS

The typical symptoms of a posterior cruciate ligament injury are:

• Pain with swelling that occurs steadily and quickly after the injury
• Swelling that makes the knee stiff and may cause a limp
• Difficulty walking
• The knee feels unstable, like it may "give out"
• Swelling (mild to severe)
• Knee pain
• Wobbly sensation in the knee
• Trouble walking or bearing weight on the knee

Over time, a PCL tear can lead to osteoarthritis in the knee.

TREATMENT

 RICE. When you are first injured, the RICE method - rest, ice, gentle compression and elevation — can help speed your recovery.

Immobilization. Your doctor may recommend a brace to prevent your knee from moving. To further protect your knee, you may be given crutches to keep you from putting weight on your leg.

Physical therapy. As the swelling goes down, a careful rehabilitation program is started. Specific exercises will restore function to your knee and strengthen the leg muscles that support it. Strengthening the muscles in the front of your thigh (quadriceps muscles) has been shown to be a key factor in a successful recovery.

Surgical Treatment

PCL problems can be acute or chronic. Acute PCL problems are due to a sudden injury. Chronic PCL problems involve an injury that develops over time.

DIAGNOSIS

X-rays and MRIs are also helpful in clarifying the diagnosis and detecting any other structures of the knee that may be injured. It is common to find other ligament injuries or cartilage damage when a PCL tear is found.

PHYSIOTHERAPY AND REHABLITATION MANAGEMENT

The goal of the rehabilitation for individuals undergoing a conservative program is to control the initial inflammatory phase and regain ROM with muscle function as quickly as possible.
PCL TEARS

Apply the rest, ice, compression, and elevation (RICE) method several times a day, in addition to any other modalities incorporated by the physical therapist to control pain and swelling (eg, electrical stimulation, cold whirlpool).

Patients with grade I and grade II injuries can bear weight as tolerated immediately, though some may require axillary crutches initially. Axillary crutches and a long leg brace are recommended for grade III injuries and with other associated ligamentous laxity (ie, posterolateral corner injury) or intra-articular damage.

  FUNCTIONAL ELECTRICAL STIMULATION (FES) may be used to stimulate the quadriceps muscle, but it is probably necessary only if the quadriceps muscle is shut down secondary to pain.

• The physical therapist should instruct the patient in exercises for                                                                                                 
• QUADRICEPS AND HIP STRENGTHENING
• QUADRICEPS SETS
• STRAIGHT LEG RAISES

•  HIP ABDUCTION/ADDUCTION

( multi-angle quadriceps isometrics). At this time, all open kinetic chain (OKC) hamstring exercises should be avoided since they impart posterior tibial translation at the knee.

Initial Exercises

These initial exercises should generally be performed 3 times daily:                     

HEEL-SLIDES OR KNEE BEND TO STRAIGHT                                                                                                                                              
                          
Begin this exercise by lying on your back . Bend and straighten your knee as far as you can go without pain and provided you feel no more than a mild to moderate stretch. Repeat 10 - 20 times.

STATIC QUADRICEPS CONTRACTION
                                                                                Begin this exercise in the position demonstrated  Tighten the muscle at the front of your thigh (quadriceps) by pushing your knee down into a towel. Put your fingers on your inner quadriceps (VMO) to feel the muscle tighten during contraction. Hold for 5 seconds and repeat 10 times as hard as possible without increasing your symptoms.

RISK FACTORS

Men are more likely than are women to injure their posterior cruciate ligament. Participation in sports such as football and soccer also may increase your risk.

COMPLICATIONS

In many cases, other structures within the knee — including other ligaments or cartilage — also are damaged when you experience a posterior cruciate ligament injury. Depending on how many of these structures were damaged, you may experience some long-term knee pain and instability. You may also be at higher risk of eventually developing arthritis in your affected knee.