What is it?
 
Osteoarthritis is a natural part of the aging process. Osteoarthritis is degeneration of the joint surfaces which will progress in severity. The cartilage coating the joint surfaces which reduces the amount of friction is gradually worn away. This will increase the friction within the joint, which will cause inflammation. In osteoarthritis of the knee, you will also get bony growths called osteophytes forming at the edge of the joints and cyst will form in the femur (thigh bone) and tibia (shin bone). This can be seen on an x-ray making the surface of the joint look oddly shaped.
 
What causes it?
 
There many factors that can influence the age of which osteoarthritis can begin, such as trauma, poor posture and dietary deficiencies. However, it is more commonly caused by repetitive stresses over a period of time, this can be occupational or sporting. Osteoarthritis onset can be brought about sooner by damage or removal of the menisci or parts of it previously. The menisci are fibrocartilage structures which act as shock absorbers and also aid in increasing the stability within the knee joint. Damage to the cartilage will also affect the amount of time taken before the onset of osteoarthritis.     
 
How does it feel?
 
In the initial stages, there will be some pain within the knee during activity. There will also be stiffness and possibly pain within knee joint after periods of rest e.g. waking up in the morning. The stiffness can last up to approximately 30 minutes. As the disease progresses the patient may feel pain at night which may disturb sleep and an increase in the pain intensity and duration.
 
What you should do
 
Ice should be applied to the inflamed joint as this will aid in reducing the inflammation and pain. It should be applied for 20 minutes every few hours. Rest will help reduce the symptoms in an acute phase/flare up.  Painkillers may help reduce the symptoms, however this will not help the cause of the pain. It is also important to stay mobile once the acute phase/flare up has passed, going on walks will also help. You should also increase your fluid intake. Swimming will also help in recovery as swimming is non-weight bearing and will help strengthen the muscles around the affected joint/s.
 
What you should not do
 
You should avoid aggravating the knee joint further. Once the acute phase has subsided exercises should be carried out such as going for short walks regularly. You should not stop exercising if possible as this will allow the disorder to progress further.
 
Long term effects
 
If left untreated, the disease may destroy the joint surfaces. This will then require knee replacement surgery. The pain in the knee may alter the way you walk and cause other parts of your body to compensate. This can cause problems such as early joint degeneration in the hip and in the low back.

Quadriceps strain
 
What is it?
 
A quadriceps muscle strain refers to a tear in the large muscle group, which covers the front of the thigh.
 
How does it happen?
 
A quadriceps muscle strain typically occurs when the muscle is contracted with excessive force. This can occur in activities such as sprinting, jumping or kicking. In these activities, the quadriceps muscle group is particularly vulnerable to tearing, especially when it is working in a stretched position or required to contract against a load (i.e. kicking a ball).
 
How does it feel?
 
When the quadriceps muscle is strained the first sensation you feel is sudden pain in the front of the thigh, due to damage to muscle fibres. At the same time, you may have a ‘tearing’ sensation. With minor strains you may be able to continue participating with minimal restriction. However, as the muscle cools down following activity, pain may gradually increase as bleeding and swelling around the injured muscle continues. This may be associated with progressive tightening and stiffening of the quadriceps muscle. In more severe strains. these sensations may be exaggerated such that you are unable to continue participating due to excessive pain in the thigh, muscle tightness, weakness and spasm. In these cases, the pain may be so intense that you may be unable to walk without a limp. There may also be obvious swelling and a visible defect in the muscle.
 
What should you do?
 
To limit the severity of this injury it is advised you stop your activity immediately and start initial treatment. The most important time in the treatment of any injury is the first 24–48 hours. Swelling is a necessary step in the healing process; however, too much swelling can delay healing and cause further tissue damage. To control the amount of swelling and limit the degree of damage to the quadriceps muscle, the RICE regime should be commenced (Rest, Ice, Compression, Elevation). This will help to reduce blood flow to the injured area, thereby reducing the extent of swelling and tissue damage. You should continue the RICE regime until you consult an osteopath, preferably within 2 days of the initial injury.

What shouldn’t you do?
 
Following a quadriceps muscle strain, you shouldn’t undertake activities which increase blood flow to the quadriceps muscle. These include hot showers, quadriceps stretching, heat rubs, massage, consumption of alcohol and excessive activity. These can increase muscle bleeding, resulting in further pain and an extended recovery period.
 
Could there be any long-term effects?
 
Although most quadriceps muscle strains heal without complication within a number of weeks, a proportion of injuries can result in longer-term effects, depending on the extent of damage and inappropriate early management. When the quadriceps is torn a number of structures contained within and around the muscle may be injured. Injury to these structures may delay return to sports participation. This may also result in a tight or weakened quadriceps muscle group that is prone to re-injury when returning to activity. Re-injury may also result if the cause of the initial quadriceps tear was not accurately diagnosed and addressed.
 
Management
 
The assistance of an osteopath is important in the treatment of a quadriceps muscle strain. Initially, they can assist in determining the exact tissue/s damaged and the extent of this damage. From this information an indication of how long the injury is expected to take to heal can be determined. Osteopaths can also use a number of other treatment techniques to assist in reducing pain and swelling and enhance the healing of the injured structures. This should also include an appropriate progression of exercises aimed at increasing your range of motion, strength and function. These exercises will facilitate your return to sport participation and, by identifying the reason why you tore your quadriceps, help prevent rein-jury. This can be performed whilst minimising the risk of a re-bleed and will accelerate your return to sports participation.

What are anterior cruciate ligaments?
The knee joint has four very strong ligaments. These are the medial collateral ligament, lateral collateral ligament, anterior cruciate ligament and posterior cruciate ligament. The anterior cruciate ligament is a deep ligament inside the knee. The anterior cruciate ligament and the posterior cruciate ligament cross over each other and look like a crucifix hence the name cruciate ligaments. Its function is to stop forward movement of the shin bone (tibia), on the thigh bone (femur). It acts as a stabilising structure, to prevent excessive movement of the knee and to prevent rotation the knee.

How does injury to the anterior cruciate ligament occurs?
Injury to the anterior cruciate ligament occurs when a shearing or twisting movement occurs through the joint. Anterior cruciate ligament damage occurs usually in sport, although any movement that puts a strain on the ligament can cause damage. An example of injury in sport would be to have the foot fixed on the ground fully weight-bearing, with sportsperson attempting to turn. As the foot planted to the ground, the rotational force can go through the knee causing damage to the anterior cruciate ligament. It can also happen in scenarios such as a car crash, where the driver is in a fixed position on the seat, and has a force through the pedals, which then goes through the knee causing a shearing force damaging the anterior cruciate ligament. Many footballers have suffered cruciate ligament damage. The most recent and most memorable individuals are Michael Owen, Alan Shearer, Joe Cole, Michael Essien, Ruud Van Nistelrooy and Paul Gascoigne.

What are the symptoms?
When the injury first occurs, there may be an audible pop or crack, all the feeling of something moving out of place and then back into place again. There may be severe pain following injury, this however does subside fairly quickly. When you try to weight bear, there will be a feeling of instability, or it may feel like the knee will give way when you put weight on it. Thigh injury to the cruciate, there will be swelling around the whole knee so that it resembles a knuckle. There will be swelling of the knee due to bleeding inside of the joint (this is known haemarthrosis) from. The knee will be unable to fully straighten, or fully bend, and this will be due to the amount of swelling that is present. The swelling is there to protect the knee from further damage and help stabilise the knee, however if the swelling persists, it may interfere with the rehabilitation

What should you do?
If you are participating in sport, you need to cease immediately. There will be a lot of swelling around the joint. This is because of bleeding in the joint because of the torn ligament, but also a protective mechanism to prevent further damage. However, too much swelling can cause a delay in dealing and possibly damage tissue. You should perform R.I.C.E to help keep the swelling under control.

Rest — you should limit weight-bearing movements on the knee and cease activity. Crutches may be helpful if you have access to them.

Ice -- Ice packs should be applied to the site of injury to help limit the amount of swelling, but also take away any inflammation that may be occurring.

Compression -- keeping the knee wrapped in a tubular elastic bandage for compression will limit the amount of swelling that may occur and also give you vital support around the knee.

Elevation -- elevating your legs at roughly the same height as your heart will allow fluid to move easier through your leg.

We should try and see your osteopath as soon as possible, who will diagnose accurately, what injury you have done. They will then discuss with you how bad the injury is and what your next step is in terms of your rehabilitation

What shouldn't you do?
We should not continue to participate in any activity or sport. You should rest and avoid any activity that involves applying heat to the knee or causing your body temperature to rise, for example, a hot water bottle. This will increase blood flow through the area, decreasing your body's ability to heal.

Could there be long-term effects?
Unfortunately, injury to the anterior cruciate ligament can take a long time to recover. The ligament cannot heal itself and it was required for effective knee function. Surgery is required to reconstruct the ligament. Tissue from another part of the body may be used to reconstruct the anterior cruciate ligament. The mechanism of injury to the anterior cruciate ligament, other structures may also be injured such as the cartilage between the tibia and femur and/or other ligaments. Due to injury to the structure, this may lead to a greater possibility of getting osteoarthritis of the knee later on in life.

Management
Usually, management of the injury requires corrective surgery to reconstruct the damage ligament. This may be in the form of either a hamstring tendon graft or patellar tendon graft. Following surgery, the knee has to be stabilised and strengthened to help rehabilitate it. Rehabilitation can take up to 6 months to a year.