In the first of this multi-part series of health articles, we covered some general considerations for injury recovery including the difficulty with removing load from the joints of the lower body. This article will cover some common injuries to the knee and hip areas, their normal recovery time frames and other considerations in recovery. As with the ankle and foot, balancing the load remains one of the most important parts of injury management as load is often both the problem and the solution.
Let’s start this article by looking at the most common injury to the knee – a meniscus tear. The meniscus of the knee has a role in shock absorption and also improves the way the thigh and lower leg bone move together. Injuries to the meniscus can take 8 or more weeks before they start to settle down. Some parts of the meniscus have a limited blood supply and hence the location of your injury can affect the speed of recovery.
In the acute stages of management, it is best to limit twisting movements and deep bending movements of the knee as these will irritate the meniscus. Like many conditions that cause swelling, injury to the meniscus can cause the thigh muscles to reduce their activity and hence rehabilitation exercises should focus on keeping these muscles working. Impact loading is important to manage and as a result planning modifications to movements such as stair climbing or descending may be needed to assist recovery while the areas is irritated.
Moving slightly up the chain, the muscles at the back of the thigh called the hamstrings are another source of injury. There are three sites that injuries tend to occur; a strain to the muscle belly usually due to a sudden movement, or alternatively a strain to the tendon at either the attachment around the knee (called a distal tendon injury) or to the attachment site at the base of the buttock area (called a proximal tendon injury). A muscle strain recovers the fastest of all three, often settling down within 4-6 weeks.
Tendon injuries can take longer to heal as they often take longer to develop. Repeated overload without sufficient recovery time leads to changes within the tendon that reduce its ability to tolerate load. Eventually this leads to pain, although the tendon changes are present well before the pain itself is. If the tendon injury is closer to the knee area it typically settles within 3 months. If the tendon injury is at the base of the buttocks it can take a few extra months to settle and is often more challenging as it will continue to get irritated by the pressure on the tendon with sitting.
Regardless of the injury type, management of hamstring injuries always involves strengthening the muscle and in particular focusing on eccentric exercises. These are exercises where the muscle develops tension while it is increasing its length. An example of this would be keeping your trunk straight and reaching forward towards your toes. The hamstring works to slow or control movement, as well as changing the direction of the leg while walking and running. Unfortunately many hamstring specific exercises strengthen them while they are shortening.
Moving up to the hip, a common injury that we see is bursitis of the hip. Like some of the tendon injuries described above, this type of irritation typically involves a build up of repeated loading stress over time which is beyond the tissue tolerance and is combined with inadequate recovery time. An irritated hip bursa can settle down in just over 6 weeks but more commonly will take 12 or more weeks to settle substantially. Complete resolution of hip bursitis is often much longer.
It is also very common to have an irritated bursa of the hip at the same time as having irritation to the glute muscle tendons that attach to the side of the hip. For this reason many rehabilitation approaches target both areas. Tendon injury to the glute muscles commonly takes 8 or more weeks to settle, and longer still to completely recover. Both conditions will usually require you to modify the way in which you sleep to be more comfortable. Where it is comfortable to sleep on one side, it is best to try and keep a pillow between your knees to reduce the stretch on the side of the hip in this position. Many people find that sleeping on their back is more comfortable.
Early management of these two conditions involves the use of isometric exercises where the muscles are developing tension but not changing in length. An example of this would be standing and pushing the side of your foot against a wall for 5-10 seconds. These type of exercises have been shown to have a good pain relieving effect and allow the muscle to retain its strength while the irritation settles. Once the area becomes less irritated, dynamic exercises to strengthen the hips can begin. Side to side movements such as crab walks are a good exercise to include at this stage.
The final hip injury to discuss is an injury to the labrum of the hip. The labrum is a cartilage ring around the hip socket that deepens the socket, making the joint more stable. The labrum is most commonly irritated over a period of time and injury to the labrum will commonly be described as a sharp and uncomfortable pinching sensation a the front of the hip area, especially as the knee is brought up to the chest while lying down. Sometimes the labrum can become irritated where there is a bony change to the hip around the joint itself (called a cam or pincer).
Injuries to the labrum of the hip usually require 12 or more weeks before the area starts to settle. In the early phases of management, aggressive hip stretching will aggravate the pain and irritation further and should be avoided. Similarly, deep squat and lunge movements often provoke pain and should only be performed within pain free ranges.
In the next article we will move further up again and look at injuries to the back area.