PCL Injury Rehabilitation Programme In London, Near You
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To ensure the best rehab results with the best sport injury rehab specialist in the case of grade 1 & 2 PCL knee ligament tears we design for you.
A perfectly customised and successful PCL rehab protocol non surgical tailoring the best PCL rehab exercises to your:
- Diagnosis,
- Current PCL knee injury symptoms,
- Gender,
- Physical signs,
- Goals,
- Postural, muscle, ligament, joints imbalances and dysfunctions
- Lifestyle,
- Prefered location,
- Reahabilitation and training availability,
- Deadline.
Posterior Cruciate Ligament rehab programmes non surgical designed by Jazz Alessi, elite personal trainer in London and his team of London physiotherapists before and after a PCL surgery assure you a quick and sustainable back pain rehabilitation.
We Come To Your London Location
The best part is we can train you at your convenience in the comfort of your home, London office or even neighborhood parks.
Regarded as one of the finest elite personal trainers in London, Jazz Alezzi offers a holistic package for the rehab of Posterior Cruciate Ligament injury.
His rehab plan includes the most customised, effective and unique set of exercises mixed with extremely useful nutritional tips topped with expert advice on technique improvement and confidence building.
Throughout your PCL rehabilitation Jazz will also teach you in customised to your needs manner how to modify your exercise, movements’ and routines thus, you will keep safe, strong, balanced and injury-free throughout your life.
- Knee injuries like posterior cruciate ligament (PCL) injury can just throw your life off gear.
- Simple activities like running to catch a bus, getting in and out of the car or climbing a flight of stairs at the London tube stations can become extremely difficult if you have a PCL injury.
For professional athletes, a PCL injury can result in a career break and for recreational athletes, injury to the posterior cruciate ligament means taking some time off from 5 – a side football matches on the weekends.
- Do you live in London and are suffering from a PCL injury ?
Contact me now through this link HERE for a knee rehab programme that’s effective and made just for you !
All you need to know about Posterior Cruciate Ligament:
Along with the ACL, the PCL forms the central pillar of stability of the knee joint. It extends from the base of the thigh bone (femur) and crosses the anterior cruciate ligament from behind to insert into the top of the shin bone (tibia).1
Considered as one of the largest intraarticular ligaments, the width and strength of PCL is twice that of the ACL. 3
Evidence dictates that, the PCL plays an important role in the stability of the knee and its injury can result in biomechanical as well neuro-receptive disturbance.
Microscopic examination reveals that PCL is rich in mechanoreceptors which are responsible for joint position sense – an important component of balance and coordination and sensory feedback.2
Interestingly a small muscle at the back of the knee – popliteus also acts as an additional restraint to backward glide of tibia during flexion along with the PCL.
Increased contraction of the popliteus muscle has been noted in PCL deficient knees.4
Though its role as a rotatory stabiliser is still unclear, there is weak evidence which shows that PCL acts as a secondary stabiliser during rotation when other ligaments are compromised.1
As regards long term effects in the lower limb as a result of PCL deficiency, there is strong evidence to suggest increased predisposition of patellofemoral pain and osteoarthritis of the medial compartment of the tibiofemoral joint.
Injury to the PCL results in increased compressional forces between the knee cap and the thigh bone and also on the inner side of the joint between the thigh and the shin bone sparking early degenerative changes.1,5
This also forms the basis for early medial meniscus or medial femoral condyle chondral degeneration and structural changes in other ligament soft the knee joint in isolated PCL or posterolateral corner injuries.
This occurs as the other ligaments overwork to provide posterior stability in a PCL deficient knee.1,6
Among other things certain studies have pointed towards weakness in the quadriceps in both legs as a result of PCL injury.
Apart from quadriceps, the calf muscle particularly the gastrocnemius has shown to fire early in an EMG (electromyography) analysis of gait of a person with chronic PCL deficiency suggesting that it may act as an antagonist to the PCL for posterior stabilisation.6
Symptoms of Posterior Cruciate Ligament Injury
A PCL injury is less common as compared to a ACL injury as it is thicker and stronger than the latter.9
Also since the symptoms and knee instability are not as obvious as those seen with ACL injury, the chances of missing the injury are more likely thus, going unnoticed in some cases the knee ligament damage will be greater.
The PCL injury can occur in isolation or in conjunction with other ligaments.
A person with acute PCL injury may present with pain, swelling and stiffness at the back of the knee.8
Sometimes the symptoms may be so vague and minimal that the person himself does not notice the strain.
A full range of motion at the knee, near normal walking pattern with minimal pain and swelling does not set alarm bells ringing in majority of the persons.
Its only when the PCL injury occurs in conjunction with injury to other ligaments or meniscus, that symptoms vary.
There is more swelling around the knee, with increased instability and limited range of motion.
The knee feels loose with difficulty in walking.
There may be visible bruises over the knee.9
PCL SYMPTOMS
Chronic isolated PCL tears cause:
- Anterior knee pain
- Instability while descending stairs.8
Patient may or may not recollect a previous history of trauma to the knee but will report of:
- Long standing discomfort in the knee during activities such as descending stairs, squatting and walking over a long distance.
- Feeling less stable while walking over uneven surface.
- Pain behind the knee cap and on the inner side of the knee may be the other complaints cited by the athlete.9
Do you live in London and are suffering from a PCL injury ?
Contact me now through this link HERE for a knee rehab programme that’s effective and made just for you !
WHAT IS A PCL TEAR GRADE 1, 2, AND 3
The PCL injuries can also be graded depending on the severity (9)
Grade 1: As there are only microscopic tears in the ligament, there is no loss in knee stability.
Grade 2: Since the ligament is partially torn, there is a feeling of instability in the affected knee.
Grade 3: There is completely tear of the ligament with associated injuries to the ACL and probably the collateral ligament. There is increased pain, swelling, stiffness with instability in the involved knee.
CAUSES OF PCL INJURY
As in any injury, the mechanism of injury provides an important clue. It gives us an idea of the probable structures that may have been compromised.
In case of PCL injury, external trauma to the fully flexed knee is the culprit.
This is typically seen in ‘Dashboard Injuries’ occurring as a result of motor vehicle accidents.
The driver’s flexed knee rams into the car’s dashboard when his car is hit from the rear.8
Other less frequently occurring positions are excessive extension of the knee with inward rotation or inward or outward blow to the knee.
These motions are seen in contact sports such as football, soccer and skiing.
A PCL injury is also possible when the flexed knee hits the ground with great force.
Also, a bad landing from a jump, a simple misstep or fast changes of direction can result in a PCL injury.
These may be associated with injury to the ACL and or the collateral ligament as well. 9
In athletics, isolated PCL tears occur as a result of a direct blow to the front of the knee or a fall onto the knee with the foot in a plantar flexed position.8
Interesting facts about PCL injury
The PCL injuries are much less studied as compared to the ACL injuries probably due to the difference in their occurrence.
It’s fascinating to note that the incidence of PCL injury is thought to be one tenth to one twentieth of that of ACL injury.
Also, PCL injuries are present in only 3.3-6.5% of all acute knee injuries.
Furthermore, only 40% of PCL injuries, are isolated injuries.
Some researchers estimate that around 51% of PCL injuries are combined with other ligament injuries of the knee, especially medial collateral ligament (MCL).
Grade 3 injuries are more likely to be combined injuries.
Many isolated PCL injuries go on to be undiagnosed.
A recent study revealed that 2-5% of the participants at a National Football League Combine event were found to have isolated PCL laxity with many of them having no recollection of any significant injury.11
These injuries are more common in males, isolated or combined with other injuries, with significantly higher incidences (97%) compared with females (73%). 11
The reasons are unclear for this.
Do you live in London and are suffering from a PCL injury ?
Contact me now through this link HERE for a knee rehab programme that’s effective and made just for you !
How to diagnose a PCL injury
An accurate diagnosis of PCL injury depends on the combination of mechanism of injury, presenting symptoms, physical tests and radiological evidence.8,9
An important indication of PCL deficiency is a positive Clancy sign. 8
This is a loss of normal bony prominences on both sides of the knee at the upper end of the shin bone when the knee is flexed to 90.
The posterior sag test (Godfrey test) is performed with the hip and knee flexed to 90 while the examiner supports the leg.
There is a dip in the outline of the knee in case of a PCL tear.
This is the most sensitive physical examination test.
Another test which has a higher specificity for PCL injury is the Quadriceps active test.
Since the quadriceps is said to have a similar function as the PCL ligament, a quadriceps contraction will cause the tibia to move more forward, visibly reducing the dip.
A Dial test helps to differentiate between combined posterior corner ligament injury and isolated PCL injury on the basis of extent of outward movement of the shin bone while the knee is bent at two different positions.
One of the most preferred choice of special test is the Posterior Drawer test.
It can accurately diagnose a PCL injury in a non-inflamed knee.
This test can help to grade the PCL injury.
In an inflamed knee as is the case in an acute tear, the Positive Lachman test is extremely helpful to make a diagnosis.
A reverse pivot shift test assesses the rotational instability in the knee.
Apart from specific tests, alignment of the knee in standing position can tell us a lot.
A knee with a PCL injury will show a bow shaped alignment.
RADIOLOGICAL EVIDENCE – What’s the best?
Radiological examination can give the best clues regarding PCL injury.
Since it has very mild manifestation in case of an isolated tear, there are high chances that a clinician can miss it. In case of multiple ligament injury, the other structures like ACL, MCL and meniscus are given more focus.
When there is an obvious posterior knee instability and a PCL injury is suspected, the best way of diagnosis is a Stress X-Rays of the knee in the kneeling position or active hamstring contraction.
The amount of backward displacement of the shin bone on the thigh bone can help to diagnose and grade the PCL tear.
They can help to plan a treatment strategy based on the extent of damage.19
Normal X-rays can also provide a clue to the injury especially in the sunrise and lateral view of the knee in standing, 45 degree flexion and kneeling positions.
If these are done in acute cases they, can also give an idea about other associated injuries.8,9
If still in doubt, MRI of the knee can diagnose an acute PCL injury with 100% accuracy.
It may not be as accurate as stress radiograph in case of a chronic PCL tear, but MRI can still help to diagnose any missed concomitant meniscal, cartilaginous or ligament injuries.
MRI can assist in identifying the extent of tear as well. 14
Apart from the above, Bone Scans have proven useful in evaluation of patients with chronic PCL (6 months after injury) who complain of pain and instability.
These patients have increased tendency to develop degenerative changes which are visible as increased uptake of dye in the scan.8
Recently, Ultrasound imaging is also being used to detect PCL injury as it is more cost effective than an MRI.
But further research is necessary to establish as a specific or sensitive diagnostic procedure for PCL injury. 20,21
Management of a PCL Injury – Surgery or Non Operative?
It has been agreed by experts that PCL injury can be managed conservatively, especially if it is an isolated grade 1 or 2 injury.
A grade 3 isolated PCL tear, ups the risk of patellofemoral degeneration7 and osteoarthritis in the medial compartment of the knee.7
Thus, it is a common practice to go for operative option in case of an acute isolated grade 3 injury of the PCL with severe posterior subluxation of the tibia (more than 10mm) and instability or concomitant injury to other structures like ACL, meniscus and MCL as well.
In case of associated posterior corner injuries, surgery is the treatment of choice.17
Unlike the ACL, the PCL has an inherent capacity to heal by itself and hence nowadays more and more cases of uncomplicated PCL tears are encouraged to go for bracing and rehabilitation through physiotherapy.12
Do you live in London and are suffering from a PCL injury ?
Contact me now through this link HERE for a knee rehab programme that’s effective and made just for you !
Elite Personal Training Knee Rehab & Physiotherapy after PCL injury - Is it effective?
The PCL rehabilitation programme is fully individualised and it is determined by the symptoms, physical signs, goals and lifestyle to name just a few things which matter thus, it is very complex.
We cannot explain the rehabilitation programme here but, we give you a few heads up.
The field of physical therapy of personal training and physiotherapy lays a great emphasis on improving mobility, reducing pain and returning to preinjury state as early as possible.
With PCL injury, it has been seen that customised personal training exercises and physiotherapy rehabilitation can help an athlete or an individual with uncomplicated PCL injury to return to preinjury fitness levels within 1- 4 months.13
The aims of rehabilitation after a PCL injury are reducing pain and inflammation, improving extension range, initiating early full weight bearing and strengthening the lower limb musculature and this is where one of the best elite personal trainer in London Jazz Alessi, fits in.
Corrective exercise, new movement patterns, massage, acupuncture can restore muscular, nerves and joint balance and we guide you achieve a functional outcomes for your specific rehab goals through one to one customised personal training rehab.
Since the action of quadriceps assists the PCL action, quadriceps strengthening is begun earlier.
A stronger hamstring works opposite to the PCL hence isolated hamstring exercises could be dangerous in the initial phase.1,13
An athlete with a grade 1 or 2 injury can return to sports within 2-4 weeks of injury following a successful PCL injury rehab programme.
Similarly, an athlete with grade 3 injury with the help of a rehabilitation coach, elite personal trainer in London (in this case) can return to his sport within 4 months of an uncomplicated PCL injury. 13
The surgical management involves reconstruction of the ligament.
A double bundle reconstruction is preferred over the single bundle as it simulates the PCL which also has two bundles.
The reconstruction is done using the patellar or the hamstring tendon (autologous tissue graft), or the Achilles tendon (allograft).
Results of these procedures have shown that using the Achilles tendon reduces the surgery time and also has lesser post op complications.12
An individual managed by operative technique does require extensive expert personal training supervision and physiotherapy for the next 6 months.
If he is a professional or recreational sports person it may take around 9 months for full return to sports.9,12
These 9 months are divided into various phases with the immobilisation phase which is the first phase lasting for around 4 weeks.
The PCL rehab aims at reducing the swelling and pain and improving ROM at the knee.
An injury to the posterior cruciate ligament is best managed by bracing the knee in full extension for the first 4 weeks followed by a functional brace that allows limited bending at the knee.
In the following weeks, emphasis is laid on achieving full active knee extension and around 60-90 degrees of active flexion.
As Quadriceps is considered a PCL agonist and Hamstrings as PCL antagonist, isolated strengthening of the quadriceps is encouraged.
Whereas hamstring – quadriceps co-contraction is developed through exercises in weight bearing positions.
Normalising the walking pattern is also one of the key objectives in the early phases.12
Once this is achieved the complexity of the exercises is increased and based on the symptoms and physical signs neuromuscular coordination exercises could be introduced.
A lot of varied types of proprioception, trampoline activities that stimulate balance reactions and joint position sense are practised.12
As the individual shows improved coordination, flexibility, endurance, balance strength in the quadriceps (90% of good side) etc, isolated hamstring strengthening, running and agility drill are started.
Lower body strengthening is stressed in the safe phase.
An athlete wishing to return to sports after a PCL injury is encouraged further to perform sports specific drill like cutting, sudden start and stop, plyometrics, landing etc.
- Do you live in London and are suffering from a PCL injury ?
Contact me now through this link HERE for a knee rehab programme that’s effective and made just for you !
If you are in London and looking for a PCL Injury rehab specialist, you are in the right place.
I, Jazz Alessi specialise in knee rehab and have a special expertise in the management of knee ligament tears and injuries.
With more than 20 years of experience as an elite personal trainer in London and having managed around 20 – 30 cases of knee injury every year, for the past 10 years, I have a vast skill set, experience and deep understanding of the PCL, ACL and meniscus injury.
A ligament injury like an isolated PCL injury is always the last to be diagnosed.
No memorable mechanism of injury, milder symptoms as compared to an ACL injury, delay its diagnosis.
Having worked with hundreds of knee cases, I have learnt to appreciate the symptoms of a PCL deficient knee accurately.
This helps me to begin the most effective knee rehab programme for my client almost immediately.
In cases where the client has undergone surgery, I work closely with his sport, medical doctor, physiotherapist and surgeon to ensure that you will use the best pcl rehab protocol non surgical containing the most suitable pcl rehab exercises for speedy recovery.
I don’t just focus on the PCL injury alone, but also on its effects on the whole body.
If you are looking for an effective and sustainble weight management to help you to easy the body weight effects on your knee, spine and joints.
This customised knee rehab programme I will design for you will help you to lose weight, and become balanced, flexible, get rid of knee pain, feel heathy and very strong again.
Do you live in London and are suffering from a PCL or other type of knee injury ?
Contact me now through this link HERE for a knee rehab programme that’s effective and made just for you !
An old posterior cruciate ligament injury that has gone unnoticed for some time affects weight bearing pattern in that knee.
There is more weight transmission though the inner side of the knee.
The knee cap is also seen to move more outward which affects the normal movement of the knee cap during walking or running.
Both these factors can result in early onset arthritis of the knee.15
Research has also found increased medial meniscal strain in a PCL deficient knee.16
A longstanding posterior cruciate ligament can also affect the length and functioning of the lateral collateral ligament and the popliteus muscle.18
Thus, if you have a clear diagnosis when I plan my rehab plan, I do a thorough fitness assessment to check the integrity of all the surrounding structures in that leg that might have been affected due to injury. I focus on recovery as well as avoidance of re-injury.
My evidenced based pcl rehab protocol non surgical is fully individualised as it is determined by your sport doctor diagnosis, current symptoms, physical signs lifestyle and goals.
It will address all these issues to ensure the that my client is pain free in every exercise, movement and in all positions.
Apart from being a long term accredited Rehab Trainer and knee rehab expert, I pride myself in being one of the few 2nd generation Pilates Trainers in London.
I customise Pilate’s exercises appropriately and I also use selected and safe Yoga, Martial Arts, gymnastics movements and nutrition diet plan if you want to recover faster or want to lose weight.
As one of the best personal trainer in London the combined knowledge from all these fields helps me, to choose the most effective exercise to rehabilitate my client based on assessment, symptoms and physical signs.
I work on the fitness technique, correct posture, weight, and nutrition diet plan and confidence levels to get the best results in the comfort of your place at the time of your choice.
Do you live in London and are suffering from a PCL injury ?
If you are in London and suffering from a posterior cruciate ligament (PCL) injury contact me now through this link HERE for a knee rehab programme that’s very effective and made just for you !
REFERENCES:
- Christopher G. Stevens, Keith Jarbo, Kostas Economopoulos and Anikar Chhabra, Anatomy and Biomechanics of the Posterior Cruciate Ligament and Their Surgical Implications, Posterior Cruciate Ligament Injuries- A Practical guide to Management, GC Fanelli ed 2015, XVII, 360p ISBN 978-3-319-120713
- Katonis P, Papoutsidakis A, Aligizakis A, Tzanakakis G, Kontakis GM, Papagelopoulos PJ. “Mechanoreceptors of the posterior cruciate ligament.” J Int Med Res, 2008 May-Jun;36(3):387-93.
- J. Dargel, M. Gotter, K. Mader, D. Pennig, J. Koebke, R. Schmidt-Wiethoff “Biomechanics of the anterior cruciate ligament and implications for surgical reconstruction”. Strategies in Trauma and Limb Reconstruction, 2007 April;2(1), pp1–12
- K-T. Kang, Y-G. Koh, M. Jung, J-H. Nam, J. Son, Y.H. Lee, S-J. Kim, “The effects of posterior cruciate ligament deficiency on posterolateral corner structures under gait- and squat-loading conditions A computational knee model.” Bone Joint Res, 2017 Jan; 6(1): 31–42. Published online 2017 Feb 10. doi: 10.1302/2046-3758.61.BJR-2016-0184.R1
- P. MacDonald, A. Miniaci, P. Fowler, P. Marks, B. Finlay “A biomechanical analysis of joint contact forces in the posterior cruciate deficient knee” Knee Surgery, Sports Traumatology, Arthroscopy March 1996, 3(4), pp 252–255
- Cristián A. Fontboté, Timothy C. Sell, Kevin G. Laudner, Marcus Haemmerle,Christina R. Allen, Fabrizio Margheritini, Scott M. Lephart, Christopher D. Harner, “Neuromuscular and Biomechanical Adaptations of Patients With Isolated Deficiency of the Posterior Cruciate Ligament” AM J Sports Med, Vol. 33(7) DOI: 10.1177/0363546504271966
- Parolie JM, Bergfeld JA. “Long-term results of nonoperative treatment of isolated posterior cruciate ligament injuries in the athlete.” Am J Sports Med. 1986 Jan-Feb;14(1):35-8. DOI:10.1177/036354658601400107
- Santiago Pache,Zachary S. Aman, Mitchell Kennedy, Gilberto Yoshinobu Nakama, Gilbert Moatshe, Connor Ziegler,Robert F LaPrade, “Posterior Cruciate Ligament: Current Concepts Review KNEE POSTERIOR CRUCIATE LIGAMENT REVIEW” THE ARCHIVES OF BONE AND JOINT SURGERY, ABJS.MUMS.AC.IR VOLUME 6. NUMBER 1. JANUARY 2018
- Physio-pedia. Posterior Cruciate Ligament Injury. Accessed 20th of Feb 2018
- https://www.nice.org.uk/advice/mib30/chapter/introduction
- Alfonso Vaquero-Picado and E. Carlos Rodríguez-Merchán “Isolated posterior cruciate ligament tears: an update of management” EFORT Open Rev. 2017 Apr; 2(4): 89–96. Published online 2017 Apr 18. doi: 10.1302/2058-5241.2.160009
- Agolley D, Gabr A, Benjamin-Laing H, Haddad FS.“Successful return to sports in athletes following non-operative management of acute isolated posterior cruciate ligament injuries: medium-term follow-up.” Bone Joint J. 2017 Jun;99-B(6):774-778. doi: 10.1302/0301-620X.99B6.37953.
- Chandrasekaran S, Scarvell JM, Buirski G, Woods KR, Smith PN. “Magnetic resonance imaging study of alteration of tibiofemoral joint articulation after posterior cruciate ligament injury.” Knee. 2012 Jan;19(1):60-4. doi: 10.1016/j.knee.2010.11.010. Epub 2011 Jan 12.
- Ruediger von Eisenhart-Rothe1, Ulrich Lenze, Stefan Hinterwimmer, Florian Pohlig, Heiko Graichen,Thomas Stein, Frederic Welsch and Rainer Burgkart “Tibiofemoral and patellofemoral joint 3Dkinematics in patients with posterior cruciate ligament deficiency compared to healthy volunteers.” BMC Musculoskeletal Disorders 2012, 13:231
- Albert W. Pearsall, J. Marcus Hollis, “The Effect of Posterior Cruciate Ligament Injury and Reconstruction on Meniscal Strain” AmJ Sports Med 2004 Vol 3 Issue 7
- Harner CD, Höher J. “Evaluation and treatment of posterior cruciate ligament injuries.” Am J Sports Med. 1998 May-Jun;26(3):471-82
- Michal Kozanek, Eric C. Fu, Samuel K. Van de Velde, Thomas J. Gill, Guoan Li, “Posterolateral Structures of the Knee in Posterior Cruciate Ligament Deficiency” Am J Sports Med. 2009 Mar; 37(3): 534–541 Published online 2008 Dec 16. doi: 10.1177/0363546508325664
- Garavaglia, Anne Lubbeke, Victor Dubois-Ferrière, “Accuracy of Stress Radiography Techniques in Grading Isolated and Combined Posterior Knee Injuries A Cadaveric Study Guido.” Am J Sports Med, Vol 35, Issue 12, 2007
- Bergenthal G, Schwarz W, Gerngross H, Friemert B. “Functional ultrasound examination of the posterior cruciate ligament — a new method of detecting ligament instability in the knee joint.” Ultraschall Med. 2005 Apr;26(2):120-6. DOI: 10.1055/s-2005-858062
- Chung-YuanWangTiffany, T.F.Shih Hsing-KuoWang,Ya-NingChiu, Tyng-Guey Wang “The Accuracy of Ultrasonographic Examination of Injured Posterior Cruciate Ligament” Journal of Medical Ultrasound 2009 17(4),:187-192