Joint, Tendon and Ligament Injuries

shoulder pain treatment Lilliput Health Poole

The body is a complex machine and it can be very confusing understanding the differences between various structures, especially when injuries occur. Here we endeavour to explain these differences and how Physiotherapy can be of benefit at times of injury and pain.


A joint is where two or more bones meet to form an articulation. There are several types of articulation each with its own features, for example the shoulder and the hip joints are ball and sockets where as the knee and elbows are hinge joints.

Joint pain and injury can be caused by several factors, these include:

  • Osteoarthritis and degenerative changes.
  • Traumatic injury such as fractures.
  • Dislocation or subluxation. A subluxation is an incomplete or partial dislocation of a joint.
  • Infection.
  • Inflammation. This can be within the joint itself leading to swelling within the joint capsule or it can be of the cartilage surfaces within the joint.
  • Bursitis. This is inflammation of a fluid filled sac (bursa) which can be found in and around some joints.


Treatment and management depends on the cause of the problem. Commonly an icing protocol such as RICE (Rest, Ice, Compression and Elevation) is used within the first 48 hours to control any inflammation and swelling and to help with pain. Often pain relieving medications are used to help with comfort following appropriate advice from a Doctor or Pharmacist.

A Physiotherapist will be able to carry out a thorough assessment to determine the origin of the symptoms and provide appropriate advice regarding movement, rest from activity or whether any further investigations are required. Physiotherapy treatment can involve joint mobilisations, soft tissue massage therapy and exercises to help with range of movement and strengthening.


Tendons attach muscle to bones to aid in the production of movement. They are strong and elastic and are able to withstand high levels of force. Tendons have collagen fibres running in a parallel direction providing a flexible and durable structure to transmit the power generated by muscles to move body parts.

Tendon injuries can occur due to trauma, repetitive overload and degeneration. Types of tendon problems frequently encountered by our Physiotherapists include:

  • Acute inflammation known as tendinitis.
  • Tendinopathies where the tendon has failed to cope with chronic repetitive loads.
  • Tears.
  • Weakness and dysfunction, commonly seen in Medial Tibial Stress Syndrome (shin splints).
  • Compression. This is often seen where tendons wrap around a bony prominence such as in the ankle or foot.
  • Chronic degeneration and calcification.


Physiotherapists manage tendon injuries by identifying the type of problem it is, for example acute inflammation or a tear, and any other contributing factors such as weakness in other muscle groups or stiffness in joints.

Activity modification plays an important part and your Physiotherapist will advise whether any exercise needs to be stopped to allow for sufficient healing.

A Physiotherapist will then work with you to progressively stretch and strengthen the affected tendon to help it adapt and re-learn how to respond to force and load. In the case of a tear, your Physiotherapist may refer you for further investigation such as an ultrasound scan.


Ligaments attach bones to bones. They are strong and fairly rigid structures designed to specifically provide support and stability within a joint. The arrangement of a ligament’s collagen fibres differs to tendons with a criss-cross formation producing their stabilising property.

Ligament injuries arise when a sudden forces and strains occur which can lead to tears. A common example is the Anterior Cruciate Ligament (ACL) in the knee joint. A ligament tear can lead to a loss of stability and pain within a joint.
Physiotherapists and Consultants use a simple system to grade ligament tears and injuries. This is then used to determine the best management plan.

  • Grade 1: A few fibres are torn but the joint involved remains stable.
  • Grade 2: Partial rupture of the ligament with some increased laxity (flexibility) of the joint. Stability is largely maintained.
  • Grade 3: Complete ligament rupture leading to gross instability of the joint involved.


Conservative management with physiotherapy is used for Grades 1 and 2. Occasionally a Grade 2 may require further intervention if there is lack of progression or if re-injury occurs. Grade 3 ligament injuries are managed with surgery followed by intensive Physiotherapy to regain normal strength and function.

Examples of common ligament complaints seen by our physiotherapists at Lilliput Health include:

  • Ankle inversion injuries, also known as a turned over ankle.
  • Knee injuries involving the ACL, the Medial and Lateral Collateral Ligaments (MCL and LCL).
  • Wrist injuries following a fall onto the hand or from lifting heavy weights.

If you have recently suffered an injury or you have been progressively experiencing pain without any obvious cause it is important to seek appropriate advice.

Our experienced Chartered Physiotherapists at Lilliput Health are able to discuss individual needs and provide thorough assessments of all complaints. Call the clinic today on 01202 725090 or contact us via

Book an appointment