Ligaments are bands of tough fibrous connective tissue that connect one bone to another to form a joint. They are made of collagen, and should not be confused with “Tendons” which connect muscle to bone.
Ligaments hold the joint together, limit the unwanted movements in a joint and sometimes completely prevent a particular movement. Ligaments are elastic (Like a rubber band) and can lengthen to allow the required movement in a joint and then come back to normal length. But if they are overstretched repeatedly (like repeated ankle sprain) or for a long period of time, they lose their ability to come back to their original length. An over lengthened ligament will no longer be able to fulfil its function of protecting the joint from excessive movement and this may cause recurrent twisting/ buckling putting the person at risk of falls. Some people are born with extra long/ stretched ligaments giving them “hyper mobility” in all joints. This is called “Hyper laxity”.
Each joint has several ligaments and they restrict movements in various directions. Some of these are crucial to the joint stability and some are relatively less important. A completely torn ligament may sometimes need to be repaired/ reconstructed especially in the knee joint. Most ligament injuries take place in the lower body (eg. Ankle sprain, ACL / PCL/ MCL injury in the knee to name a few). This is because these are weight bearing joints and are hence prone to injury in a loaded position. But sometimes overused joints in the upper limb (eg. Wrist and thumb) can also get sprained. In most ligament injuries, if proper care is taken, healing is expected between 3 to 12 weeks (depending on the extent of injury).
Once a joint is sprained, it needs immediate rest. This is so that further injury/ “over-lengthening”/ repeated lengthening does not take place (Remember, we said that if a ligament is over lengthened it may never regain its original length). This rest can be in the form of a splint, or a plaster cast, or a tape or a support/ bandage of some kind (your doctor may decide this depending on extent of injury, material available, and his experience). Sometimes you may be advised to not take weight on the joint for 3 days to up to 2 weeks. At this stage it is also important to settle any swelling (inflammation) and you may be given medicine and asked it apply ice.
Long term rest also may be harmful to the joint, as this may cause loss of muscle power, joint stiffness and may delay return to full activity. As soon as pain and swelling reduce, gentle movements in pain free range, light strengthening with elastic bands, and mobility with minimum splinting may be allowed.
Return to normal activity will depend on professional demands and extent of injury. An athlete may decide to play with taping for an important match, or may need to strengthen for 3 to 6 weeks before resuming play. This will have to be decided by the rehab team along with the individual after considering all aspects of the case.
All ligament injuries will do well with a planned and progressive exercise regimen. Exercises and rehab should be planned to reduce pain and inflammation, prevent recurrence and strengthen the muscles around the joint in a balanced way. Stretching and strengthening should be followed by proprioceptive and balance training in all lower limb injuries. This will train the joint to recruit correct muscles in movements. This is especially important in athletes, and no rehab can be complete without this training. Some court/ field drills mimicking the sport should be added towards the end of rehab, preparing the athlete for competitive sport.
While planning rehab, the athlete and trainer/ physio must understand that all stages of rehab are equally important and hastening through one phase or missing one phase may cause long term harm to the athlete’s career.