Ligaments & Cartilage

Ligaments are strong structures which join two bones together, giving the skeleton strength and structural integrity. Because ligaments are so important in the stabilization of joints, they are also highly susceptible to injury. Ligaments are composed strands of collagen fibers. Injured ligaments and other connective tissue may not heal properly after minor or repetitive motion injuries. Partial tears are usually much more painful than full tears, which can sometimes be painless. If ligaments are stretched, either by injury, excess strain on a joint, or by improper stretching techniques, the joint will become weaker, as the elongated ligaments are unable to properly support it. Because connective tissue such as ligaments must withstand a great deal stress in day to day activities and have a relatively low blood supply, injuries can take a very long time to heal. Injured ligaments tend to be less flexible, and more prone to repeat injury.

Degrees of Ligament Instability back

Type 1. Stable.

The ligaments are structurally sound, coping well with day to day activities.

Type 2. Partial Instability.

The ligament become weak/ injured and the muscles try to compensate to function properly. If the muscles fail to work effectively with the ligament pain and weakness will be experienced during daily activities.

Type 3. Complete Instability.

The ligaments are unable to support the joint and this gross instability cannot be compensated by muscle function. Severe pain and disability, unable to perform daily activities. Pelvic girdle instability can coexist with instability of the sacroiliac joints.

Some Causing Factors of Ligament Damage back

Ligaments are damaged by a joint moving beyond its normal range of motion such as the excessive motion associated with whiplash. Ligaments also heal very slowly and are often left weaker post-injury. Tendon damage is often a later consequence of inefficient muscles, poor ergonomics and consistent abuse. Muscles and ligaments work together to stabilize joints and when one of them fails to work efficiently, it shifts the load to the other. An under-active set of muscles will shift more of the joint stability load to the ligaments. If the strain or instability isn't treated properly, scar tissue can form and limit the range of motion, which may contribute to further damage.

Common Causes

Overuse.

Unaccustomed repeated minor trauma.

Unprepared for activity.

Violent contraction.

Excessive forceful stretch.

Sudden movement.

Ligament and Scar Tissue back

If scar tissue gets in the way of proper healing, then the fibers do not line up and painful adhesions can develop that can lead to additional damage or myofascial trigger points, sprains or additional strains. Too much movement can lead to aberrant motion and excessive cartilage wear. Eventually incapable of stabilizing the joint and painful "clunking" joint develop.

Cartilage back

Cartilage is a type of connective tissue in the body. It is made of cells called chondrocytes embedded in a matrix, strengthened with fibers of collagen and sometimes elastin, depending on the type of cartilage. There are three different types: hyaline cartilage, elastic cartilage, and fibrocartilage. Cartilage serves to provide structure and support to the body's other tissues without being as hard or rigid as bone. It can also provide a cushioning effect in joints. Cartilage is avascular, meaning that it is not supplied by blood vessels thus limiting repair capabilities. The healing response of cartilage is poor; the defects fill with fibrous tissue or fibrocartilage that soon breaks down.

Injury Process of Cartilage back

First Stage

Disruption of collagen network through trauma and/or hormones decrease in proteoglycan and an increase in water content that result in cartilage swelling and softening.

Second Stage

Is characterized by a repair response in which the body attempts to repair the damage with increased anabolic (constructive metabolism) and catabolic (breaking down of tissue), activity within the cartilage as well as with proliferation of chondrocytes which form clusters of cells. This stage might last for years and can result in increased thickness of cartilage.

Wear Types back

Abrasive: Irregular hard surfaces moves on a softer surface and ploughs grooves in it.

Corrosive: Follows the disruption of the protective surface oxide layer of metals.

Adhesive :Repetitive sliding movements fragments are pulled from one surface and adhere to the other.

Muscle back

Muscle contraction is important to regulate bone loading. They can neutralise tensile load and allow bone to carry increased load. Muscle attachment to the bony skeleton is a type of fibro-osseous junction, and can be thought of as another type a ligament. These muscle-bone attachment points are not strictly classed as ligaments anatomically, but they can act in a similar way to sprained ligaments after an injury. Myositis is a general term for inflammation of the muscles.

Piriformis Muscle

This pear shaped muscle is located in the posterior pelvis and functions to laterally rotate and abduct the thigh. It originates from the 2nd and 4th sacral segments and inserts on the greater trochanter of the femur. The piriformis and obturator internus play similar roles in moving the femur.

Puborectalis

The fibers which form a sling for the rectum are named the Puborectalis or Sphincter recti. The fibers arise from the lower part of the symphysis pubis, and from the superior fascia of the urogenital diaphragm. They meet with the corresponding fibers of the opposite side around the lower part of the rectum, and form for it a strong sling.

Pubococcygeus

The pubococcygeus muscle or PC muscle is an important muscle in the human body. It is a hammock-like muscle, that stretches from the pubic bone to the coccyx (tail bone) forming the floor of the pelvic cavity and supporting the pelvic organs. It controls urine flow and contracts during orgasm. It surrounds the rectum, the vagina and bladder openings. It aids in urinary control, and childbirth. For some women who have pain and/or dysfunction in the symphysis pubis they can feel discomfort to pain when going to the toilet. It can be because of its attachment to the pubic bone and the stresses placed upon this muscle.

Diastasis Abdominis Recti

Approximately 1/3 of pregnant women will experience this condition. A diastasis occurs when the right and left sides of the rectus abdominis are stretched, separated or partially separated along the vertical midline; this can happen during the pregnancy or birth. The abdominal muscles separate because of the increasing pressure of the growing fetus. Diastasis abdominis recti is primary genetic, but it may also be caused by weak abdominal muscles or rapid abdominal growth. If you think you might have a diastasis you will notice a bulging along the midline of your abdomen and a space wider than 2 finger widths between the left and right sides of your abdominal muscles.

Length of Step & Pelvic Instability back

The pregnant woman has a different pattern of gait. The step lengthens as the pregnancy progresses. This is due weight gain and changes in posture. Both the length and height of the footstep shortens with pelvic girdle pain. Sometimes the foot can turn inwards due to the rotation of the hips when the pelvic joints are unstable. On average, a woman's foot can grow by a half size or more during pregnancy. Pregnancy hormones that are released to adapt the bodily changes also affect the ligaments in the foot. In addition, the increased body weight of pregnancy, fluid retention and weight gain lowers the arches, further adding to the foot's length and width. There is an increase of load on the lateral side of the foot and the hind foot. These changes may be responsible for the musculoskeletal complaints of lower limb pain in pregnant women.

Nerves back

There are also numerous nerves that pass in and around the pelvis. All branch out from the spinal column. The spinal column is made up of the Cervical, Thoracic, Lumbar, Sacral and Coccyx. Each region has its own specialty.

The Cervical Spine back

The neck supports the weight of the head and protects the nerves that come from the brain to the rest of the body. This section of the spine has seven vertebral bodies (bones) that get smaller as they get closer to the base of the skull.

The 12 vertebral bodies in the upper back make up the thoracic spine. The firm attachment of the rib cage at each level of the thoracic spine provides stability and structural support to the upper back and allows very little motion. The thoracic spine is basically a strong cage and it is designed to protect the vital organs of the heart and lungs.

The Lumbar Spine back

The lower back has a lot more motion than the thoracic spine and also carries all the weight of the torso.

The Sacrum back

Contains a series of five openings on each side through which the sacral nerves and blood vessels run.

The Coccyx back

Is located at the base of the spine (also called the tailbone) and is composed of three to five fused vertebrae. Ligaments attach the coccyx to the sacral hiatus at the synovial sacrococcygeal joint.

Sciatica back

The nerve roots that exit the spinal cord and form the sciatic nerve exit through little holes in the spine called intervertebral foramen (literally, holes between the vertebrae. Normally, the holes formed by the bony spine are big enough for roots to exit through without difficulty. Sometimes, however, disease, trauma or arthritis causes the diameter of these holes diminish. This decrease in space may cause a tightening around the nerve root, which can aggravate or irritate the nerve and cause sciatica. In some cases the bony hole may have a spur or sharp bony structure that actually touches the nerve root, further aggravating the condition. There are other space-occupying lesions that can cause sciatica, including tumor growth, organ enlargement (from an underlying disease) or even severe scar tissue formation from previous surgeries. In addition, some women complain of sciatica after they receive an epidural during labour.

Symptoms Caused By Nerve Pain back

Part of the leg feeling warm.

Numbness and tingling.

Dull aching pain.

Trouble weight bearing.

Part of the leg feeling warm.

Some reasons for nerve pain back

The way the baby lies in your uterus.

The pressure during a vaginal delivery.

Pelvic instability.

Pelvic surgery.

A heavy fall.