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How to Treat a Knee Sprain

What is a Knee Sprain?

Many people say they have sprained a part of their body or a joint, but what does that actually entail? Often when you hear ‘I’ve sprained my knee’ the person means they have hurt their joint and can still feel the pain.

Knee sprains are a lot more specific that merely ‘knee pain’ however. Medically, a sprain is damage to the ligaments surrounding a joint rather than the joint or bone itself. In the case of a knee sprain, it is the four supportive ligaments that are injured or damaged in some way.

If you sprain your knee it will pay off in the future if you know how best to deal with it there and then. First and foremost you do not want to damage an already weakened area. Any further damage to lead to arthritis or even disability later in life. The following RICE rule for knee sprains should be applied in all situations whilst you wait for professional medical advice.

Disclaimer

The information in this article is provided “as is” and should not be mistaken for or be a substitute for medical advice. While Shane Jackson is a doctor, he is not your doctor, so consult your physician before trying any of the advice presented on this page. Always seek the help of a professional. Neither the author nor www.SurvivalSullivan.com or the company behind the website shall be held liable for any negative effects of you putting into practice the information in this article.

The RICE Rule

Regardless of the severity of your knee injury, you will likely be best served by following the RICE acronym. You may have to amend this depending on whether you are near civilization or not, as ice can’t be found everywhere! Either way something cool is a better substitute than nothing at all.

REST

Rest the joint by taking any weight or strain off it. This of course means not standing or walking in the case of your knee. Putting your full body weight onto the joint when it is weak could worsen the damage and pain exponentially.

ICE

Any injury in the body produces swelling. This is usually a helpful process which aids healing of an affected area. In a small and confined joint such as the knee, however, it can overcontribute to pain due to the build-up of pressure. If you do not have ice, anything cooler than the body, like running water for example, can reduce swelling and inflammation.

COMPRESS

This is best done with an elastic bandage rather than one made of material. This ensures a strong grip and prevents bunching of the compress material which could potentially cut off blood supply to the damaged area.

ELEVATE

Elevation of the limb works best at maximum elevation. This does not mean raise the limb as high as possible. Elevation in the emergency setting always means in relation to the heart. As long as the knee is above the level of the heart gravity will help prevent a painful swelling of the joint.

This video covers the various steps of RICE, and how to properly carry them out :

As a prepper you will want to support the injury and make sure it is left to rest as much as is possible. If you are on your own repeat aggravation of a knee injury could turn something quite minor into a disability.

To repeat, the above RICE steps should always be carried out before medical assessment or attempting to move if you are out on your own with no communication. If you are stranded leave the initial injury to come down slightly and make sure over the course of an hour or so that you can put some slight weight on the joint.

If there is some discomfort but no shooting pain then you are safe to mobilise slowly and with care. A knee brace, whether makeshift or one you have packed if you are lucky should be worn when trying to get help. This will hold the damaged joint in place and act as the new ligament structure while the old ones heal.

The severe injuries, known as grade 3 injuries cannot be repaired out in the wild. A complete tear of any of the cruciate ligaments will require surgery of some sort to bring it back together. The only exception is a grade 3 injury of the medial cruciate ligament. Rehabilitation of the joint through physiotherapy and ibuprofen can be sufficient in the majority of cases.

Unless you truly have no access to medical treatment you should always have a knee sprain seen to. This is because the recovery rates are actually very high when any injury is seen to properly. Leaving any injury to mature could cause problems which would only be apparent further down the line. Even with good rehabilitation ACL and PCL sprains have been known to accelerate the development of osteoarthritis.

Osteoarthritis is arthritis which comes purely from wear and tear. Unlike rheumatoid arthritis there is little active treatment for osteoarthritis apart from simple painkillers.

Why are knee sprains so common?

Compared to other joints in your body, the knee joint is fairly vulnerable. It is a modified hinge joint, with your femur (leg bone) resting on top of you lower legs bones (tibia and fibula). Your knee cap which you can feel on the front of your knee is called your patella and is held in place by muscles on the top and bottom.

The groove that your femur sits and rotates in however is not very deep. Instead of being a ball and socket joint like your hip, the end of your femur bone sits in between a mesh of soft tissue and the top of your tibia. This is why the knee is referred to as a compound joint as well. Instead of being able to flex and extend your knee joint you can also rotate it inwards and outwards.

This ability to rotate the joint and the open groove means the whole area is open to movement. The only thing that stops your knee dislocating isn’t the bone or joint itself but the pattern of the tough ligaments running around the joint.

What is a ligament?

Ligaments are strong connective tissues that connect bones to other bones. They are not to be confused with tendons which connect the ends of muscles to bones. Ligaments are meant to anchor bones and restrict movement. They often hold a joint tightly and are therefore likely to tear if subjected to sudden high impact force.

knee anatomy

“Medical gallery of Blausen Medical 2014”. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. [CC BY 3.0], from Wikimedia Commons

Holding It All Together

The knee joint has one main function – to allow your lower leg to flex and extend. There are two tendons running along the inside (medial) and outside (lateral) of the joint, as well as two ligaments that run across (cruciate) the middle of the joint. The anterior ligament lies in front of the posterior ligament.

This dual set up of ligament pairs gives good stability when running or climbing. Any force from either side however will strain the ligament on the opposite side.

The 4 supportive ligaments of the knee are:

  • The Anterior Cruciate Ligament (ACL)
  • The Posterior Cruciate Ligament (PCL)
  • The Medial Collateral Ligament (MCL)
  • The Lateral Collateral Ligament (LCL)

Each of these ligaments, and indeed any ligament in the body can be placed on the below injury scale. This grading system allows healthcare professionals to decide on the best course of treatment both in the short and long term.

Types of Knee Sprains

Grade 1

The least serious of sprains, grade 1 injuries will resolve in under two months. On examination the affected ligament is stretched out of shape but has not lengthened so much that the joint is no longer stable.

Studies have shown that the collagen which makes up the ligaments is restored to full strength in 6 weeks. This of course depends on good treatment and rest. Continuing exercises will also help strengthen the muscles and ligaments in the area, protecting against future injuries.

Grade 2

A worsening of the strain to the ligament in Grade 1, at this stage the joint is now unstable. For a ligament to stretch this much there is likely some evidence of a partial tear.

Recovery usually requires the use of a weight bearing brace or supportive taping. This helps take the strain off the ligament and promotes healing. As with grade 1 injuries physiotherapy helps speed recovery. Despite the greater degree of injury, physiotherapy, massage and strength training can mean full strength is still possible within the 6 week window.

Grade 3

While the first two grades are similar both in injury and outcome the final grade is full step up. Grade 3 classification is given to ligaments tears which are complete. This means that the remaining ligaments are left to support the joint on their own. To be able to walk on this joint without causing even more damage you must wear a full weight bearing brace such as a hinged knee brace. This would allow basic function of the joint and a return to normal life.

Physiotherapy again is vital in ensuring that the recovery happens as efficiently as possible. Instead of a short 6 weeks, grade 3 tears often require surgery to fix and it can take patients up 16 weeks to recover fully.

Beyond Grade 3

When assessing the severity of an injury you need to hold in your mind the worst case scenario. This will help to make sure you don’t miss any emergencies or an opportunity to save somebody’s limb or life.

If you suffer a severe injury to your leg, such as falling from a great height or being hit by a vehicle then you need to consider other factors beyond simply ligaments.

In the first place there may be multiple ligament tears. This will make the joint exceptionally unstable. This will then place great strain on the soft structures inside your knee. This includes your blood supply and the nerves to the bottom half of your leg. Nerve damage may be apparent immediately, with a key sign being a ‘dropped foot’.

Blood vessel damage is much more serious and is not always as noticeable as you may think. Arteries within the joint can rupture and bleed into the leg rather than out of it. This will be harder to notice but is still an emergency. In a worst case scenario late treatment could lead to amputation rather than recovery.

Due to the inherently unstable nature of multiple ligament tears surgeons will want to operate sooner rather than later. This will also mean that some damage to nerves and vessels can be repaired at the same time. The downside to these types of injuries and quick surgeries is arthrofibrosis later in life. This is scarring that forms in the joint as a result of the injury and can cause pain and joint sysfunctiojn as the scar forms.

Years of surgical advancement mean that recovering from more severe ligament injuries is now possible. Until fairly recently multiple tears often resigned someone to a partially functioning knee. Today, however, many athletes return to the top of their profession and lay people recover full daily function.

More Serious Conditions

Dislocated Knee Cap / Patella

This is a common sports injury but can happen in the wilderness during a fall or other accident. We list it here as it is a related injury but also because knowledge of the injury could save someone’s limb or life.

The rush here is for two reasons. Firstly a dislocated patella implies there has been a good amount of trauma which has caused this injury. This raises the risk of the blood supply being damaged or even cut off. Leaving the injury untreated could lead to an ischaemic limb, i.e. one that has no valid blood supply.

An ischaemic limb may have to be amputated once in hospital to try and save the victim’s life. The second reason to treat as soon as possible is simply that it is much easier to push the knee cap back into place as soon as the injury has occured. This is for a number of reasons but the majority of swelling has not had a chance to come up within the initial seconds and minutes.

Patella Dislocation Treatment Method:

  1. Rest your hand on the outside aspect of the knee
  2. Your fingers should be behind the knee
  3. Place your thumb against the knee cap / patella
  4. With your other hand straighten out the lower part of the affected leg
  5. As you straighten it push with your thumb against the knee cap
  6. This should pop the knee cap / patella back into the right place
  7. Splint the knee at 30-45 degrees
  8. Follow RICE as above

Reminder Warnings

When you are out on your own and fending for yourself, it can be easy to think that if you just push through the pain you can make it. While there are many cases of mind over matter a grade 3 tear is not one of them. Do you have:

  1. Extreme pain
  2. Massive swelling
  3. Complete inability to bear any weight?

If your knee injury relates at all to any of the above points you may have a grade 3 injury. Make sure to not aggravate it and wait for medical help. In extreme situations with no possibility of rescue coming you would have to bind your joint with any makeshift knee brace possible.

Current recommendations suggest splinting the leg behind the knee, whilst maintaining the knee at a 20-30 degree angle. Only then may you be able to mobilize far enough to get help without doing massive further damage.

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About Shane Jackson (MBChB - Bachelor of Medicine, Bachelor of Surgery)

Shane Jackson (MBChB - Bachelor of Medicine, Bachelor of Surgery)
Shane is a medical doctor with over 8 years experience in both hospital medicine and surgery. He's completed over 2 years of surgical work focusing on trauma & orthopaedics alongside maxillofacial surgery. He has been involved in education since medical school and have written courses and taught classes. Having trained in Advanced Trauma and Life Support he is at the forefront of practical, out-of-hospital medicine which can be applied by the public to save lives.

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