Sports Injuries: PCL, Ankle Sprains & Sever's

This assignment delves into the research surrounding three common sports injuries: Posterior Cruciate Ligament (PCL) injuries, ankle sprains, and Sever’s disease. It examines various aspects of these injuries, including diagnosis, management techniques, and preventative measures. Articles discuss the historical perspectives of PCL bracing, the effectiveness of exercise interventions in preventing sports injuries, and the evidence supporting rest-ice-compression-elevation (RICE) therapy for ankle sprains. Additionally, the assignment explores the complexities of Sever’s disease, including its complications and treatment strategies.

Running head: SPORTS INJURIES
SPORTS INJURIES
Name of the Student
Name of the University
Author Note

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Table of Contents
Introduction......................................................................................................................................2
Posterior Cruciate Ligament injury grade 2.....................................................................................2
Risk factors..................................................................................................................................3
Mechanisms of injury..................................................................................................................3
Signs and symptoms....................................................................................................................4
Pathophysiology of the healing process......................................................................................4
Prevention strategies....................................................................................................................5
Sever’s disease.................................................................................................................................5
Risk factors..................................................................................................................................6
Mechanisms of injury..................................................................................................................6
Signs and symptoms....................................................................................................................6
Pathophysiology of the healing process......................................................................................7
Prevention strategies....................................................................................................................7
Conclusion.......................................................................................................................................7
Reference List..................................................................................................................................9

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Introduction
Although exercising and playing sports are important and plays a significant role in the
maintenance of health of individuals but sports or exercising can sometimes cause injuries. There
are various factors that can cause this. These are accidents, use of improper sports gear or
carrying out of poor training practices. Some of the common sports injuries are sprains, knee
injuries, injuries of the Achilles tendon, rotator cuff, fractures, dislocations, among others
(Lauersen, Bertelsen and Andersen 2014). Treatments involve the use of RICE, which are rest,
ice, compression and elevation (van den Bekerom et al. 2012).
Posterior Cruciate Ligament injuries are associated with the knees. Sports that can give
rise to these injuries are soccer, football, skiing and baseball (Årøen et al. 2013). Sever’s disease
on the other hand is associated with heel pain and particularly is associated with children
between the age group of 8-15 years. Various activities that involves overusage of the heels can
give rise to this medical condition. These activities include running, jumping, among others
(Hussain et al. 2013).
This report will provide information about Posterior Cruciate Ligament injuries and
Sever’s disease. It will include the risk factors, mechanisms of the injuries, signs and symptoms,
pathophysiology, physiological responses to healing and the prevention strategies.
Posterior Cruciate Ligament injury grade 2
The posterior cruciate ligament is present in the knee and connects the femur, which is
the thigh bone to the tibia, which is the shin bone. The Posterior Cruciate Ligament injuries can
be classified based on the severity of the damage. Grade 1 is when the Posterior Cruciate

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Ligament undergoes a partial tear, grade 2, when the Posterior Cruciate Ligament undergoes a
partial tear but is looser than grade 1, grade 3, when there is complete tearing of the ligament and
grade 4, when the ligament along with other surrounding ligaments of the knee are damaged
(Curley, Pelton and Postma 2017).
Risk factors
The risk factors for Posterior Cruciate Ligament injuries involve playing contact based
sports like soccer, football, skiing and baseball. These sports predisposes an individual to the
development of such injuries. These sports are associated with the risks of falling with a bent
knee. These sports are also associated with sudden twisting of the knee, sudden changes in
directions and speed, overextension of the knee and abrupt turning. Moreover, motor vehicle
collisions, where the knee gets hit against a dashboard, results in the shin bone being pushed
downwards resulting in tearing of the Posterior Cruciate Ligament (Curley, Pelton and Postma
2017; Anderson et al. 2012).
Mechanisms of injury
The most important function of the Posterior Cruciate Ligament is providing resistance to
posterior translation, which thereby preventing the movement of the proximal tibia on the distal
femur. It also helps to provide restraint on external rotation and the various stresses associated
with the tibia. The most common mechanism associated with Posterior Cruciate Ligament
injuries is the contact mechanism. This involves the application of a posteriorly directed force on
to a flexed knee. Additionally, hyperextension mechanisms may also be involved. Dashborad
injuries or falls associated with a flexed knee results in tearing of the said ligament. Falling on a
flexed knee in addition to a plantarflexed foot results in a high amount of force on the tibia,
thereby causing rupture and eventual tearing of the ligament. Hyperextension results in avulsion

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injuries to the femoral region of the Posterior Cruciate Ligament (Webb et al. 2013; Curley,
Pelton and Postma 2017).
Signs and symptoms
Posterior Cruciate Ligament injuries are usually classified into grades 1, 2, 3 and 4.
Grade 1 is a mild injury involving microscopic tears, grade 2 is a moderate injury and is
associated with partial tearing of the ligament and the knee becomes unstable when performing
activities like walking, standing, among others. Grade 3 and 4 are highly severe, which involves
complete tearing of the ligament or separation from the bones. Symptoms involve mild swelling
of the knee, loss of stability of the knee during standing and walking as well as limitations in
motions. Other symptoms include mild pain, which intensifies at the time of kneeling. Apart
from pain at the back of the knee, pain can also occur at the front of the knee at the time of
running and slowing down. Another symptom is a wobbly sensation of the knee (Harvard Health
2018).
Pathophysiology of the healing process
The physiology of the healing process is divided into 3 phases. These are the
inflammatory phase, proliferative or reparative phase and the remodeling phase. The
inflammatory phase involves the formation of hematoma, which occurs immediately after
succumbing to injuries. The duration of the inflammatory phase is a few weeks. This is followed
by the proliferative or reparative phase, which involves proliferation of the fibroblasts and
production of a matrix consisting of collagen and proteoglycan. The type III collagen and the
proteoglycans helps to form a bridge between the torn ends. The duration is approximately 6
weeks, which involves formation of a highly organized matrix consisting primarily of type I
collagen. This step is also associated with cellular proliferation. The remodeling phase is

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associated with alignment of the collage fibers and increased maturation of the collagen matrix.
This phase can continue for many years. The steps in scar tissue formation involves
angiogenesis, formation of granulation tissue and remodeling of the connective tissue.
Maturation and subsequent reorganization of the connective tissue helps in the production of a
fibrous scar (Hauser et al. 2013).
Prevention strategies
The prevention strategies involve the use of proper alignments and techniques while
performing physical activities, stretching to maintain a high range of motion, performing muscle
strengthening exercises for stabilization of the joints and maintaining caution while carrying out
sports like football, tennis, soccer, among others. Moreover, use of Posterior Cruciate Ligament
braces helps to prevent injuries by providing protection to the reconstructed Posterior Cruciate
Ligament, prevent graft elongation, assist in rehabilitation and provide external stability (Jansson
et al. 2013). Other prevention strategies including warm up exercises, balance and core stability
training.
Sever’s disease
Sever’s disease is caused as a result of injuries to the heels. Overusage of the heels as a
result of playing various sports like running or jumping in sports like soccer, gymnastics or
basketball gives rise to Sever’s disease. These activities put extra pressure on the tendons that are
attached to the heels. This condition is primarily observed among young and active children
involved in a wide variety of sports that puts pressure on their heels (Hussain et al. 2013).

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Risk factors
Sever’s disease generally occurs among children who have reached their puberty because
this age is associated with their heel growth. It is mostly associated with athletic children, who
are involved in carrying out sports, which involves jumping and running. Boys are found to be
more affected by Sever’s disease than girls are. Some of the risk factors associated with sever’s
disease involves the occurrence of pronated feet, flat feet, short leg syndrome, high arches, use of
ill fitting shoes and obesity (Agyekum and Ma 2015).
Mechanisms of injury
Sever’s disease also called calcaneal apophysitis is associated with pain in the heels of
children aged between 7-14 years. Sever’s disease is associated with children who are involved
in high impact sports like football, soccer, basketball, gymnastics, among others. The Achilles
tendon inserts into the calcaneal apophysis and repeated strains and pulls during various forms of
physical activity results in the buildup of microscopic tears in the calcaneal apophysis, resulting
in pain and inflammation. Growth and development makes the apophyses also called secondary
ossification centers to be prone to injuries. Muscles attached to the apophysis causes lengthening
and compression and additional forceful traction due to physical activities causes microtrauma in
the secondary growth centers (Marchick, Young and Ryan 2015).
Signs and symptoms
The signs and symptoms of Sever’s disease involves inflammation in the heels, pain,
redness in both the heels, swelling of the heels. Other symptoms include tightness and tenderness
felt at the back of the heels and this symptom is worsened when pressure is applied on the heels
or is squeezed. It is also associated with problems in walking and also involves limping during

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running and walking. Sever’s disease is associated with heel pain while wearing stiff and hard
sports shoes like soccer cleats (Hussain et al. 2013).
Pathophysiology of the healing process
Calcaneal apophysis develops into a independent ossification center. During puberty,
which is associated with rapid growth, the apophyseal line is weakened due to increase in the
fragile calcified cartilage. Microfractures occur due to shear stress, thereby leading to a normal
progression associated with fracture healing. The healing process is associated with resorption,
fragmentation and enhanced sclerosis, which eventually leads to union of the fractures (Mustapić
et al. 2014).
Prevention strategies
The prevention strategies for Sever’s disease involve stretching exercises in order to
maintain good flexibility, avoiding repeated running and jumping on hard and stiff surfaces and
wearing shock shoes that are well fitted with shock absorbing soles. Strengthening exercises as
well as stretching helps to strengthen the Achilles tendons, hamstrings and calves, thereby
preventing recurrence of the condition. Use of supportive shoes with orthotics as well as padded
socks help to reduce stress on the calcaneal apophysis as well as on the Achilles tendon (James,
Williams and Haines 2013),
Conclusion
This report provides information about two soft tissue injuries associated with sports.
These 2 injuries are the Posterior Cruciate Ligament injury grade 2 and Sever’s disease. Both
these injuries are associated with sports like soccer, football, basketball, among others. Posterior
cruciate ligament injuries are associated with the knee, while Sever’s disease is associated with

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injuries to the heels. Sever’s disease mainly occurs among children who have reached their
puberty. While Posterior cruciate ligament injuries occurs as a result of contact on hard surfaces
and hyperextension, Sever’s disease is associated with strain on the heels resulting in the
formation of microfractures. This report provides a risk factors, symptoms, mechanisms of
injuries, physiology of healing and the prevention strategies. Thus, it can be concluded that
although sports is essential, proper training and prevention strategies are essential in order to
prevent injuries.

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Reference List
Agyekum, E.K. and Ma, K., 2015. Heel pain: A systematic review. Chinese Journal of
Traumatology, 18(3), pp.164-169.
Anderson, C.J., Ziegler, C.G., Wijdicks, C.A., Engebretsen, L. and LaPrade, R.F., 2012.
Arthroscopically pertinent anatomy of the anterolateral and posteromedial bundles of the
posterior cruciate ligament. JBJS, 94(21), pp.1936-1945.
Årøen, A., Sivertsen, E.A., Owesen, C., Engebretsen, L. and Granan, L.P., 2013. An isolated
rupture of the posterior cruciate ligament results in reduced preoperative knee function in
comparison with an anterior cruciate ligament injury. Knee Surgery, Sports Traumatology,
Arthroscopy, 21(5), pp.1017-1022.
Curley, A., Pelton, M. and Postma, W., 2017. Posterior Cruciate Ligament: Injury, Diagnosis,
and Management. Ann Sports Med Res, 4(3), p.1112.
Harvard Health (2018). Posterior Cruciate Ligament (PCL) Injuries - Harvard Health. [online]
Harvard Health. Available at: https://www.health.harvard.edu/knees/posterior-cruciate-ligament-
pcl-injuries- [Accessed 12 Jan. 2018].
Hauser, R.A., Dolan, E.E., Phillips, H.J., Newlin, A.C., Moore, R.E. and Woldin, B.A., 2013.
Ligament injury and healing: a review of current clinical diagnostics and therapeutics. The Open
Rehabilitation Journal, 6(1).
Hussain, S., Hussain, K., Hussain, S. and Hussain, S., 2013. Sever's disease: a common cause of
paediatric heel pain. BMJ case reports, 2013.

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James, A.M., Williams, C.M. and Haines, T.P., 2013. Effectiveness of interventions in reducing
pain and maintaining physical activity in children and adolescents with calcaneal apophysitis
(Sever’s disease): a systematic review. Journal of Foot and Ankle Research, 6(1), p.16.
Jansson, K.S., Costello, K.E., O’Brien, L., Wijdicks, C.A. and LaPrade, R.F., 2013. A historical
perspective of PCL bracing. Knee Surgery, Sports Traumatology, Arthroscopy, 21(5), pp.1064-
1070.
Lauersen, J.B., Bertelsen, D.M. and Andersen, L.B., 2014. The effectiveness of exercise
interventions to prevent sports injuries: a systematic review and meta-analysis of randomised
controlled trials. Br J Sports Med, 48(11), pp.871-877.
Marchick, M., Young, H. and Ryan, M.F., 2015. Sever’s Disease: An Underdiagnosed Foot
Injury in the Pediatric Emergency Department. Open Journal of Emergency Medicine, 3(04),
p.38.
Mustapić, M., Borić, I., Lepur, D., Zadravec, D. and Višković, K., 2014. Sever’s disease
complicated with osteomyelitis. Acta Clin Croat, 53(2), pp.252-5.
van den Bekerom, M.P., Struijs, P.A., Blankevoort, L., Welling, L., Van Dijk, C.N. and
Kerkhoffs, G.M., 2012. What is the evidence for rest, ice, compression, and elevation therapy in
the treatment of ankle sprains in adults?. Journal of athletic training, 47(4), pp.435-443.
Webb, J.M., Salmon, L.J., Leclerc, E., Pinczewski, L.A. and Roe, J.P., 2013. Posterior tibial
slope and further anterior cruciate ligament injuries in the anterior cruciate ligament–
reconstructed patient. The American journal of sports medicine, 41(12), pp.2800-2804.

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