Dr. Howard Liss treats disorders that cause pain and disability by providing consultative services and soft tissue and joint injections when needed. When medically appropriate, he makes specific referrals for diagnostic testing (lab work, imaging, electrodiagnosis), physical and occupational therapy, interventional procedures (epidurals and facet joint injections), and surgery.
As the femur (thighbone), tibia (shinbone) and patella (kneecap) meet to form the knee joint, the kneecap is positioned in front, providing protection for the joint. With four primary ligaments (one pair of collateral and one pair of cruciate ligaments) in the knee to secure the bones and hold them together, the anterior cruciate ligament, or ACL, extends diagonally in the middle of the knee. The majority of knee injuries occur at the ACL, which is classified as an ACL sprain or tear.
For individuals and athletes involved in intense, heavy training or sports, a sudden movement, change in direction or tackle collision can easily damage the anterior cruciate ligament (ACL) resulting in a sports injury. Other structures may also be damaged including the articular cartilage, meniscus and ligaments. While the majority of ACL injuries are complete or “near complete” tears of the ligament, there are instances where ligaments are “sprained.” To better understand, consider a Grade 1 sprain in which the ligament is still able to secure the knee joint. This is despite being stretched or mildly damaged. If the ligament becomes loose, it is classified as a Grade 2 sprain or partial tear. In effect, a Grade 3 sprain is a complete tear, resulting in the ligament splitting into two pieces.
Symptoms of ACL Injuries
In the event that an individual tears his/her ACL, they could hear a “popping” sound as the ligament is torn. In addition, the knee may give way and become unstable. Other symptoms associated with an ACL injury include:
- Pain, swelling and inflammation
- Loss of range of motion
- Tenderness and sensitivity along the joint
- Pain and discomfort while walking
Treatment and Rehabilitation of ACL Injuries
Treatment and rehabilitation for ACL injuries requires a consideration of the type of injury, as well as the age and lifestyle of the patient. For instance, a young patient with an acute, Grade 3 ACL injury may require surgery in order to return to an active lifestyle or sport. On the other hand, an older, less active individual experiencing an ACL injury may be able to settle into a lifestyle without the need for surgery. In either case, treatment is a major component in preventing further injury and maximizing function.
Physiatrists understand multiple body systems and how each affect the nerves, joints, bones, ligaments, muscles and tendons. They assume a multidisciplinary approach regarding therapy. While reducing pain and inflammation are a primary focus, returning the joint to movement is also a high priority. Specific exercises are designed to build strength, increase stamina, improve body mechanics and enhance function. Tried and true techniques using bracing and/or crutches may be used to support and keep weight off of the knee.
In some cases, physiatrists incorporate teaching and counseling in the rehabilitation of athletes, and this includes an awareness of body positioning and mechanics. Treatment is often different for males than for females. For instance, rehabilitation and performance training for females with an ACL injury may require retraining the neuromuscular pattern to include different muscle groups that will naturally provide stability to the knee. In turn, to train for proper landing, the use of plyometrics, balance and perturbation are applied. Other non-operative forms of rehabilitation include:
- Patella mobilization
- Weight shifts and gait training
- Hip, ankle and core strengthening
- Gastrocnemius stretching
- Aquatic therapy
- Cardiovascular conditioning (using a stationary bike or aquatics)
- Isotonic quad strengthening
- Lateral activities
At the Howard Liss, M.D. Rehabilitation Institute in Englewood, patients can rely on Dr. Liss to put together the right treatment, therapy and rehabilitation plan to ensure the most optimal outcome. Dr. Liss works closely with other specialists required to rehabilitate patients suffering from chronic pain or serious injuries, and Dr. Liss will refer patients as needed to ensure appropriate treatment. With extensive education and exposure to a variety of conditions that affect the cervical and lumbar spine, bones, nerves, joints, ligaments, tendons, muscles, brain, and spinal cord, Dr. Liss is uniquely positioned to help patients manage their pain and maximize their functioning.
To schedule an appointment with Dr. Liss, contact the Howard Liss, M.D. Rehabilitation Institute in Tenafly today.