LIGAMENT SPRAIN

  
 What is a sprain?
A sprain is an injury to a ligament and is often caused by a wrench or twist. Sprains often affect the ankles, knees, or wrists. Treatment includes P.R.I.C.E. - Protection, Rest, Ice, Compression, and Elevation. If the ligament is torn, surgical repair may be necessary.

  • Ligaments link bones to other bones and provide support to joints.

  • They allow a normal range of movement to occur within a joint, but prevent unwanted movement that would render the joint unstable. In order to fulfill this function ligaments must possess immense mechanical tensile strength.

  • Ligaments are classified as dense connective tissue, and they consist of a protein substance called collagen. The organization of collagen fibers gives the ligament its tensile strength.

  • Ligaments provide proprioceptive input to the brain that allows a person to know what position the joints are in, without having to look. This helps to perform the complex coordinated activities needed for sport.

Ligament sprains are classified as follows:

  • GRADE 1: There is damage to a few collagen fibers, producing a local inflammatory response. This is characterized by pain over the affected ligament.

  • GRADE 2: There is damage to a more extensive number of collagen fibers. This produces a more marked inflammatory response characterized by intense pain and joint effusion (swelling).

  • GRADE 3: The damage to collagen fibers is such that there is a complete rupture of the ligament. This produces intense pain, joint effusion and marked joint instability. Surgery may be necessary to restore joint stability.
 The Repair Process
As with other soft tissue injuries, ligament healing consists of inflammation followed by repair and then remodeling.
Inflammatory Phase

  • Trauma to collagen fibers for 3-5 days, depending on the severity of the injury.

  • Chemicals are released which produce pain and bleeding in the tissues. This, together with fluid from damaged cells, produces swelling within the joint, putting pressure on nerve endings and causing more pain.

  • Rehabilitation time can be greatly reduced by appropriate treatment in this acute stage. This consists of protecting the injured part from further damage. Treatment includes P.R.I.C.E. and anti-inflammatory medication.
Repair Phase

  • Blood clotting over the damaged tissue. Blood platelets form a mesh to initiate healing.

  • Also present in the blood clot are fibroblast cells, which proliferate and begin to lay down Type 3 (immature) collagen tissue, between 3-21 days after the injury.

  • The use of electrotherapy in this phase has been shown to encourage fibroblast activity that ultimately provides a structurally stronger ligament.
Remodeling Phase
The remodeling phase follows the repair phase and can last for up to a year.

  • Maturation of collagen tissue from Type 3 to Type 1 and realignment of collagen tissue.

  • When it is first laid down, the collagen tissue is haphazard and does not possess a lot of tensile strength. The ligament gradually becomes stronger through being subjected to controlled strain in a functional pattern, which aligns the fibers in a longitudinal fashion.

  • Physiotherapy, in the form of controlled exercises progressing to functional activity, aid this process of remodeling.

Because the remodeling phase lasts for up to a year, there is a potential weakness in the ligament and a risk of re-injury. This risk is reduced by:

  • Providing additional stability with a strapping, increasing the strength of muscles which also provide support to the joint

  • Doing proprioceptive exercises to increase the patient's sense of joint positioning.

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