PCL Rehabilitation

PCL Injury Rehabilitation Programme In London, Near You

Due to Corona virus contamination risks using selected technology we are able to provide you with a full customised 121 service online catering for all your PCL injury rehabilitation nutrition and weight loss  needs.

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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 !

PCL-Knee-assessment-min-9

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

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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.

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PCL SYMPTOMS

Chronic isolated PCL tears cause:

  • Anterior knee pain
  • Instability while descending stairs.

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

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.

Read more

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:

  1. 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
  2. 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.
  3. 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
  4. 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
  5. 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
  6. 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
  7. 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
  8. 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
  9. Physio-pedia.  Posterior Cruciate Ligament Injury. Accessed 20th of Feb 2018
  10. https://www.nice.org.uk/advice/mib30/chapter/introduction
  11. 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
  12. 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.
  13. 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.
  14. 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
  15. 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
  16. Harner CD, Höher J. “Evaluation and treatment of posterior cruciate ligament injuries.” Am J Sports Med. 1998 May-Jun;26(3):471-82
  17. 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
  18.  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
  19. 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
  20. 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
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