PCL Tear Injury Treatment
Posterior Cruciate Ligament (PCL) Injuries
What Is The PCL
The Posterior Cruciate Ligament (PCL) is located in the back of the knee joint. It forms an "X" with the Anterior Cruciate Ligament (ACL) inside the knee joint. The PCL works with the ACL to control the back-and-forth movements of the knee. It also prevents the shinbone from moving too far back in the knee joint.
The PCL is one of several ligaments in the knee that connects the shinbone to the thighbone.
The PCL is the strongest ligament in the knee and is harder to injure than the other knee ligaments. It is often injured along with other structures in the knee, such as the meniscus, other ligaments and even bone. The majority of PCL Injuries are mild and can be healed without the aid of surgery.
An injury to the PCL usually requires a lot of force. The most common cause of a PCL Injury is a fall onto a bent knee, usually during contact sports such as hockey, football and rugby. PCL injuries are often the result of a hard tackle. Another top cause is the knee hitting the dashboard in a car accident. PCL Injuries can also occur due to a twisting movement or from overextending the knee.
PCL Injuries are broken down into three categories, called grades, with Grade 1 being the last severe and Grade 3 being the most severe.
- Grade 1 - This is a mild sprain of the PCL, which has caused it to be slightly overstretched. You should not experience any instability of the knee joint.
- Grade 2 - The PCL has been torn, but only partially. There will likely be some degree of instability.
- Grade 3 - This is a complete tear of the PCL (also known as a rupture). You may be unable to bear weight on the affected knee.
Signs & Symptoms
Signs and symptoms associated with PCL Injuries include:
- Knee swelling and pain
- Feeling of instability in the knee
- Knee feels stiff
- Limping or difficulty walking
- Pain in back of calf
Some mild PCL Injuries can go undetected, as the symptoms associated with a PCL injury can be more subtle than with other knee injuries.
You will need to see a healthcare professional in order to receive a formal diagnosis. During the appointment, your doctor will ask you how and when the injury occurred. They will also ask you to describe the symptoms you've been experiencing. You dcotor will want to examine the affected knee to check for swelling and tenderness. They may also move your leg into different positions to check your range of motion.
Your doctor may perform a test called the Posterior Drawer Test. Your doctor will ask you to lie back, with your injured knee bent at 90°. Your doctor will push back on your shinbone to see if it sags at all. If the PCL is healthy, it will not let the shinbone go back that far. If the shinbone does sag, this is a sign of a PCL tear.
You may be sent for imaging tests, such as x-rays or an MRI, to confirm the diagnosis of a PCL Tear. Imaging tests also help rule out other injuries or conditions, such as bone fractures. If you have injured multiple structures within the knee, your doctor will want you to undergo an MRI to determine the full extent of the damage.
The majority of PCL Injuries can heal with conservative treatment. This means treatment methods that are not surgery. A PCL Tear should not require surgery unless it is a severe tear or there are other structures in the knee that have been injured as well.
Rest, Ice, Compression and Elevation is one of the easiest ways to quickly bring down the swelling and help with the pain. By resting the injured knee, you are ensuring that no further damage is done. Applying ice along with compression will work to control the swelling and relieve the pain. Elevating the affected leg above your heart will help alleviate inflammation. You can do this by propping up your leg on a pillow.
In order to achieve both cold and compression at the same time, you should use a knee wrap with cold gels. This will provide you with targeted, more comfortable cold therapy. Alternatively, you can use a bag of peas or ice from home. Just make sure you do not apply something from the freezer onto your bare skin. You should always use a barrier to protect your skin from cold burns, such as a towel or layer of clothing.
Depending on the severity of your PCL Injury, your doctor may advise you to immobilize the knee for the first several weeks of recovery. This is done by wearing a brace or splint. The purpose of immobilizing the knee joint is to help you avoid doing any further damage to the PCL. While you are wearing the brace or splint, you will need to use crutches to help you get around.
Painkillers like NSAIDs and analgesics can be used to temporarily relieve the pain. It should be noted, however, that painkillers are dangerous when used while you're physically active. This is because painkillers completely block the pain signal, making us unaware of any potential re-injury that could be happening. Painkillers should only be used when you're off your feet. Using painkillers during physical activity will only result in further injury and a longer recovery time.
While analgesics (like Tylenol) only work to alleviate pain, NSAIDs (like Advil) help relieve pain and inflammation.
Improved Blood Flow
Improved blood flow is not usually easy to achieve when you're injured. Normally, it is advised to keep active in order to improve blood flow circulation. When you're injured, however, you need to rest in order to avoid re-injury. There is a solution -- there are devices on the market that allow you to rest while you receive additional blood flow. These devices are designed for the body part and stimulate blood flow deep below your tissue to accelerate the healing process. Healthy, high-quality blood flow is exactly what your PCL needs to get on the fast track to healing.
Most people can start a physical therapy program after 4-6 weeks of healing have been accomplished. The objective of physiotherapy for a PCL tear is to build up the muscles around your knee in order to regain strength, as well as to restore full range of motion to the knee joint. If any part of your physical therapy program causes pain, tell your physiotherapist. This could be a sign that your PCL is not healed enough to begin physiotherapy.
Taping an injury like a PCL strain or tear can help provide your damaged tissue with support and protection. It can also help relieve swelling throughout the day and is even thought to improve movement during physical activity.
It's best to try several different taping applications for your PCL injury before settling on one. This will help you figure out which one works best for you. There are many examples online, including instructional videos. Here's a PCL taping application we found effective:
1. Take a full length piece of tape (about 10 inches long) and cut it in half, rounding the corners, so you have two pieces that are each about 5 inches long.
2. Bend your knee to 90° and take one of the 5 inch strips, tearing the backing in the middle and peeling it away so you're holding onto the two anchor ends.
3. Apply the tape horizontally just below your kneecap, using 80% stretch in the middle and no stretch at the ends.
4. Take the other 5 inch strip and tear the backing in the middle, peeling it away so you're holding onto the two anchor ends.
5. Apply the tape horizontally just below your kneecap, directly over top of the first piece you applied, using 80% stretch in the middle and no stretch at the ends.
6. Take a full length piece of tape and measure it from the right side of your kneecap up to your thigh.
7. Tear the backing off the end at your thigh and anchor it onto your quad muscle, using no stretch.
8. Using 25% stretch, pull the tape down along the outside of your kneecap.
9. Once the tape is even with your knee, use 50% stretch and let the tape follow the bottom of your kneecap, around to the opposite side of your knee.
10. Lay down the end of the tape with no stretch, then rub the tape in to ensure it sticks.
11. Use the technique described in Steps 6-10 for the left side of your knee.
Mechanism Of Injury
Physicians often are familiar with the clinical presentation and management of collateral ligament and anterior cruciate ligament (ACL) strains or ruptures because these injuries occur somewhat frequently in active persons. They may be less familiar with injuries of the posterior cruciate ligament (PCL) which is an important stabilizer of the knee. The PCL is injured far less frequently, but when it is disrupted in isolation the injury may have a subtle presentation that can elude even the experienced examiner. In addition, patients who sustain isolated PCL injuries may continue to function at a competitive level, because the symptoms may develop until long after the original event, and the natural history of the isolated PCL deficient knee remains unclear.
The length of your recovery time will depend on how severe your PCL Injury is, and whether or not you injured other parts of your knee at the same time. The more severe the tear, the longer it will take to heal, and the more structures within the knee you've injured, the more healing you have to do.
The majority of people who sustain PCL Tears will eventually get back to their regular level of activity with no issues. Doing physiotherapy goes a long way towards shortening recovery times.
People who have injured their PCL along with other structures in their knee are more likely to experience lasting issues like occasional knee instability. They are also more likely to develop arthritis of the knee.
Full recovery after PCL surgery usually takes between 6 months to a year, but physiotherapy will start as soon as a week or two after surgery.
Recovery times without surgery vary, and depend on your commitment to rest and rehabilitation. If you have a Grade 1 PCL injury, you should be able to resume most of your usual activities in 2-4 weeks. If you have a Grade 2 PCL Tear, it will probably take 6-8 weeks of rehabilitation before you're ready to get back to your regular routine.
Yoga poses that will help strengthen everything from your calves to your core.
Bridge - Strengthens leg muscles, gluteus and knee joints
Lie on your back. Bend both knees and walk your ankles directly beneath your knees keeping your feet straight. Extend your arms along your body, palms face down. Press evenly into the soles of your feet, lift your pelvis off the ground, walk your shoulder blades towards one another and underneath your back. Puff your chest towards your chin. Roll your thighs inward and down. Keep your knees directly above your ankles throughout the duration of the exercise. Hold for 20 seconds. Add 10 seconds every other day until your reach one minute. Then, build to two minutes.
Bridge with Leg Lift - Strengthens all leg muscles, keeps the knee joint mobile, helps stabilize the knee joint
Assume bridge position as described previously. Elevate one leg directly above your hip so that your foot points towards the ceiling. Hold for 20 seconds. Add 10 seconds every other day until you reach one minute.
Moving Warrior - Strengthens all leg muscles, keeps the knee joint mobile, helps stabilize knee joint
Stand with your legs one legs distance apart, feet parallel. Pivot your right foot out to 90 degrees. Line your right heel up with your left arch. Engage your core by lifting your navel towards your chin. Keeping your chest and hips open, elevate your arms to shoulder height. Bend your right knee so that it is directly over your ankle. Hold for 10 breaths. Then straighten your leg making sure not to lock your knees and bend it again to come back to warrior. Repeat 10 times per side. Complete two sets.
Reclined Leg Raises - Strengthen the quadriceps
Lie down on your back, supporting yourself on your forearms. Bend your left leg and place the sole of your foot on the floor. Keeping it straight, elevate your right leg to the same height as the knee of the left making sure isometrically hug your quads (upper thigh muscles) into your thighbone. Lower the leg to an inch above the ground and then repeat the lift. Do 25 of these and hold the last one for 10 seconds. Add 10 reps every other day until you reach 50 leg lifts with a hold of 1 minute at the end of each set.
Tree - Stretches MCL of the bent knee, stabilizes the knee joint and strengthens the muscles surrounding the knee of the standing leg.
Stand with your feet together, toes all facing forward, hands on hips. Elevate your rightknee to hip height. Turn out your right hip and place the entire sole of your foot onto your left calf or inner thigh (grab your ankle to hike the foot up to the thigh). With an MCL tear, you might not be able to turn your hip/leg out a lot at first. Ease into this external rotation over time. It can take months to get a full turnout. Keep your gaze steady on a single focal point. Hold for 5 breaths. Build to 10 breaths and ultimately one minute. Repeat with the left leg.
Leg Slides - Helps reduce swelling, keeps the knee joint mobile and helps improve knee flexion
Lie down with your legs up the wall. Cross your ankle and bend your knees. Slide your heels up and down the wall working between flexion and extension. Do 20 reps. Complete 3 days. Switch the crossing of your ankles and repeat.
Seated Staff Isometric Quad Engagement - Helps quadriceps begin to fire again after the injury and assists in stabilizing the knee joint
Sit with your legs straight in front of you. Keep your shoulders aligned over your waist and keep your spine tall. Gently press your legs against the ground and hug your quadriceps (thigh muscles) into your thighbone. Release your muscles to neutral. Do 20 reps. Complete three rounds.
Child's Pose - Stretches the MCL and helps regain flexion limitations due to ACL injuries
Very slowly test sitting back towards your heel and bringing your forehead to the floor. Hold yourself up with your hands to control how far you go. Stop when you feel any sign of slight discomfort. Over time, gradually increase your range lowering your buttocks closer to your heels. It can take many months to assume the full child's pose position.
Moving High Lunge - Strengthen all leg muscles and the knee joint, stabilizes the knee
Stand with your feet together. Place your hands on your hips. Step your left foot back as you bend your right knee over your ankle. Straighten and bend your right knee very slowly, making sure not to lock the knee when you extend the leg. Repeat 10 times. Switch sides. Do three sets.
Most Grade I and II PCL Injuries can be successfully healed using conservative treatment methods, but if you have a Grade III PCL Tear, surgery may be your only option. Surgery is appropriate for people who are below 40 years of age and are planning on maintaining a fairly high activity level. People who are over 40 and who don't plan on being as active usually aren't recommended to go through with surgery.
The type of surgery required will depend on the severity of your PCL Tear. If you have sustained injuries to other parts of your knee, these may be repaired or reconstructed at the same time as the PCL.
Arthroscopic Procedure - Arthroscopic surgery involves a tiny tube with a camera at the end being inserted into a small incision in the knee joint. This allows the surgeon to see the inside of your knee joint. Other small incisions will be made for the surgical tools.
Open Procedure - An open procedure involves a larger incision. Open surgery is more invasive and would be appropriate for more complex PCL Tears, or for performing surgery on multiple structures in the knee.
PCL Repair - If you have only partially torn the PCL, it can be sewn back together through repair surgery. This is usually an arthroscopic procedure, unless there are other tear or injuries in your knee that need to be repaired at the same time.
PCL Reconstruction - If you have completely ruptured the PCL, this means the tissue is in two separate pieces and cannot be healed by sewing it back together. In a PCL Reconstruction, a tissue graft is used to restore the torn ligament. This will either be taken from another area of your body, or from a donor.
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meniscus tear and cochlear implantsRe: meniscus
Thank you for your post.
If you are wondering whether the BFST Wrap will at all interfere with a cochlear implant, we don't have any specific testing related to cochlear implants as they are still fairly rare. But, we would not expect the Energy Web® to interfere with the implant in any way. The BFST® units do not have any magnetic field associated with their operation; the emitted energy is photonic in nature.
If you have any further questions, please don't hesitate to ask.
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