Ligament injuries take time to heal
By: Kenneth Ripp, M.D.
You twist your ankle during dance class or you take a sudden turn during a soccer game and your knee screams out in pain. You have trouble putting weight on the injury and the area begins to swell.
You visit your doctor fearing you’ve broken a bone, but the X-rays show something different. Instead of a fracture, your doctor tells you that you have a sprain, which indicates a stretched or torn ligament.
Ligaments connect bones to other bones and provide support to joints. They allow normal range of movement within a joint, but prevent movement that would make the joint unstable.
In addition to the ligaments in your ankles and knees, there are over 900 ligaments located throughout the body. They do their work wherever two bones are joined together. Ligaments also support many internal organs including the uterus, bladder, liver and diaphragm.
Ligaments are made up of tough, fibrous bands of tissue that consists mainly of collagen. The collagen fibers are arranged in a pattern that resists stress and provides great tensile strength to the ligaments.
While stronger than muscles, ligaments have fewer nerve endings and a poor blood supply. This means they take longer to heal when damaged. A ligament injury occurs when the ligament is stretched too far from its normal position, resulting in damage to the collagen fibers that may or may not include a tearing of the ligament itself. Common areas of ligament injury include the knee, ankle and wrist, although ligament sprains can occur in numerous other areas as well.
Ligament sprains are graded according to the extent of the injury. With a grade one sprain, there is damage to a few collagen fibers and a stretching of the ligament, but no tearing. Symptoms include pain and local inflammation.
A grade two sprain involves more damage to a greater number of collagen fibers, with a partial tearing of the ligament. Pain is usually more intense and swelling greater than with a grade one sprain. Bleeding under the skin may cause bruising.
Grade three sprains are complete tears of the ligament. Mobility is difficult, and there may be significant instability of the joint. Pain, swelling and bruising can be severe. In some cases, surgery may be needed to repair the damage.
In most cases, however, surgery is not needed and minor sprains can be treated with a combination of at-home treatment and physical therapy. The first steps after injury include reducing swelling and pain. Rest the injured body part and elevate it if possible. Apply an ice pack for 15 minutes, and then remove for 15 minutes. Anti-inflammatory drugs such as acetaminophen or Ibuprofen can help with swelling and pain.
Complete healing can take from six weeks to six months, depending on the injury. During this time, your doctor may instruct you to stabilize the injured area by wrapping it in elastic bandages or wearing a strap-on cast or boot. You may be given strength and range of motion exercises to do to aid in the recovery process. Following your doctor’s instructions regarding exercise and activity can help speed your recovery.
It’s difficult to be patient, but don’t try to rush the recovery process. Returning to your former level of activity before healing is complete can cause further injury to the area. Before you do return to your normal physical routine, make sure you feel no pain at the site of the injury, you are able to walk, jog, sprint and jump without pain and all swelling is gone.
There are things you can to do lower your risk of ligament injury or re-injury. Stretch thoroughly before exercising or playing sports. Use strengthening exercises to keep your muscles strong. If you change your workout routine, do it gradually. Avoid abrupt increases in activity level. Avoid sports that have a high risk of ligament injury such as skiing, football, soccer or basketball. Wear a brace during high-risk activities.
A ligament sprain doesn’t have to take you away from your favorite activities forever, but it is important for you to listen to your body and take the time to recoup and recover so that when you do return to the field or court, the game you play is a winning one.
Dr. Ripp is a board certified family practice physician at Raiter Clinic.