What is a Ligament?

Ligaments are dense bands of fibrous connective tissue that serve to join two or more bones of the musculoskeletal system. Ligaments cross joints with wide ranges of motion as well as joints with little motion and may appear as long sheets of opaque tissue or short thickened strips in joint capsules.

What do Ligaments do?

Although they vary in size, shape, orientation, and location, ligaments primarily function to provide stabilization of joints both at rest and during normal range of motion. While ligaments were once thought to be inactive structures, they are, in fact, complex tissues that respond to many local and systemic influences.

What’s the difference in Ligament and Tendons?

Ligaments and tendons are both made up of fibrous connective tissue, but that’s about where the similarity ends.

Ligaments appear as crisscross bands that attach bone to bone and help stabilize joints. For example, the anterior cruciate ligament (ACL) attaches the thighbone to the shinbone, stabilizing the knee joint.

Tendons, located at each end of a muscle, attach muscle to bone. Tendons are found throughout the body, from the head and neck all the way down to the feet. The Achilles tendon is the largest tendon in the body. It attaches the calf muscle to the heel bone. The rotator cuff tendons help your shoulder rotate forward and backward.

What happens when you damage a Ligament?

Ligament injuries are among the most common causes of musculoskeletal joint pain and disability encountered in primary practice today. Ligament injuries create disruptions in the balance between joint mobility and joint stability, which can lead to abnormal transmission of forces throughout the joint, resulting in damage to other structures in and around the joint. Knees, hips, shoulders, ankles, elbows, and wrists are among some of the joints most commonly affected by ligament injuries.

While there is a vast body of knowledge available regarding the structure and function of normal ligaments, understanding the structure and function of injured ligaments becomes more complicated due to the variability and unpredictable nature of ligament healing. This may be due to the dramatic physiological and structural changes that ligaments sustain as a result of injury, as well as the complex and dynamic cellular processes that occur during healing. These processes create alterations in the biology and biomechanics of the injured ligament, leading to inadequate healing and tissue formation that is inferior to the tissue it replaces. The incomplete healing and persisting differences in the new ligament tissue result in ligament laxity, which predisposes the joint to further injury. Ligament injury and subsequent laxity cause joint instability, which leads to chronic pain, diminished function, and ultimately osteoarthritis of the affected joint.

Ligament injury Grading

The severity and symptoms of a ligament sprain depend on the degree of stretching or tearing of the ligament.

In a mild grade I sprain, the ligaments may stretch, but they don’t actually tear. Although the joint may not hurt or swell very much, a mild sprain can increase the risk of a repeat injury.

With a moderate grade II sprain, the ligament tears partially. Swelling and bruising are common, and use of the joint is usually painful and difficult.

With a severe grade III sprain, your ligament tears completely, causing swelling and sometimes bleeding under the skin. As a result, the joint is unstable and unable to bear weight.  Often there will be no pain following a grade 3 tear as all of the pain fibres are torn at the time of injury.

Ligament Healing Times

Treatment of a ligament injury varies depending on its location and severity.

Grade I sprains usually heal within a few weeks. Maximal ligament strength will occur after six weeks when the collagen fibers have matured. Resting from painful activity, icing the injury, and some anti-inflammatory medications are useful. Physiotherapy will help to hasten the healing process via electrical modalities, massage, strengthening and joint exercises to guide the direction that the ligament fibers heal. This helps to prevent a future tear.

When a grade II sprain occurs, use of a weight-bearing brace or some supportive taping is common in early treatment. This helps to ease the pain and avoid stretching of the healing ligament. After a grade II injury, you can usually return to activity once the joint is stable and you are no longer having pain. This may take up to six weeks. Physiotherapy helps to hasten the healing process via electrical modalities, massage, strengthening and joint exercises to guide the direction that the ligament fibers heal. This helps to prevent a future tear and quickly return you to your pre-injury status.

When a grade III injury occurs, you usually wear a hinged knee brace to protect the injury from weight-bearing stresses. The aim is to allow for ligament healing and gradually return to normal activities. These injuries are most successfully treated via physiotherapy and may not return to their full level of activity for 3 to 4 months. We strongly recommend that you seek professional advice in these cases.

When to seek help?

As with any injury you should seek professional help if it persists for more than 3-5 days. Sometimes the pains may reduce but lingering injuries can create bad movement patterns resulting in further issues or over loading of protective tissues. Once compensation movements occur it then takes time to reeducate the tissues and develop old patterns, this is why you should always consult your therapist and have a movement assessment post injury to ensure your body is able to go back to its normal routines and sports.

Paul M.