The Olympic Games are just a couple of weeks away and as the world’s top athletes prepare to compete, the risk of injury is ever-present.

A recent study has revealed the most common injuries impacting Olympic athletes, and knee injuries are coming out on top. Here we’ll explore what the study found, and how you can prevent and treat knee injuries as an athlete if they do occur.

Common injuries for Olympic athletes

A recent study published in the British Journal of Sports Medicine, analysed the injuries sustained by 533 Norwegian athletes over the course of five Olympic Games. It revealed knee injuries were among the most common, significantly affecting athletes’ performance and participation.

The study found that ACL injuries, patellar tendinopathy, respiratory infections, and lumbar pain were the most common injuries sustained prior to the games. Interestingly, it also revealed that female athletes were more at risk of injury.

Another Swedish study looked at the incidence of knee injuries in Swedish Olympic athletes, using data from across 1999 to 2020. There was no difference in overall incidence between males and females, but females had higher incidence of ligament and meniscal injuries. With incidence of knee injuries varying by sports, it emphasises the need for targeted knee injury preventive measures.

What is an ACL injury?

An ACL, or Anterior Cruciate Ligament injury involves a tear or sprain of the ACL, one of the major ligaments in the knee. This injury is particularly common in sports that require sudden stops, jumps, or changes in direction, such as basketball, football, and skiing.

The symptoms of an ACL injury can vary in severity but often include:

  • A loud pop or a ‘popping’ sensation in the knee
  • Severe pain and inability to continue activity
  • Rapid swelling
  • Loss of range of motion
  • A feeling of instability or ‘giving way’ with weight-bearing activities

Recovery from an ACL injury typically involves a combination of surgical and non-surgical treatments. Non-surgical options include physical therapy to strengthen the muscles around the knee and improve stability. However, for athletes or those with severe injuries, surgery may be required to reconstruct the torn ligament using a graft.

Post-surgery, rehabilitation is crucial for regaining strength and mobility in the knee. The recovery period can range from six months to a year, depending on the severity of the injury and how well the patient follows their rehabilitation program.

Preventing and treating knee injuries

To reduce the risk of injury, Team GB will have its own Performance Services team at the Paris Olympics, including doctors, physiotherapists, psychologists, and other specialists dedicated to athlete health and performance.

Preventing knee injuries involves a combination of strength training, flexibility exercises, and proper technique – but also good health and nutrition. Exercises mainly focus on strengthening the muscles around the knee, including the quadriceps, hamstrings, and calves. This helps support the knee joint and absorb the stress placed on it during activity.

If you do suffer a knee injury, early intervention is key. Although low grade knee injuries are common and usually resolve with rest, anti-inflammatory medication and physical therapy guidance – in severe cases, such as a complete ACL tear, surgical intervention may be needed to repair or reconstruct the damaged ligament.

If you are suffering from a knee injury, book a consultation with Mr Shah Punwar. With his expertise, you can work towards a full recovery and return to sport with confidence.

A complex joint with many components, the knee is susceptible to a variety of injuries. Many of these injuries can be successfully treated with simple measures such as bracing and rehabilitation exercises, while others may require surgery.

Here, we cover the most common types of knee injuries and their typical treatments.

Fractures and Dislocations

Knee fractures and dislocations are also common injuries that require prompt medical attention. A fracture involves a break in one of the knee bones, such as the patella (kneecap), while a dislocation occurs when the bones in the knee are forced out of their normal alignment.

Treatment for fractures typically involves immobilising the knee with a cast or brace, and in severe cases, surgical intervention may be necessary to realign and stabilise the bones.

Anterior Cruciate Ligament injuries (ACL)

An anterior cruciate ligament (ACL) injury is one of the most well-known and serious knee injuries, often affecting athletes involved in high-intensity sports like football, basketball, and skiing. The ACL helps stabilise the knee by connecting the thigh bone (femur) to the shin bone (tibia).

ACL injuries typically occur when there is a sudden change in direction, rapid stops, or awkward landings from a jump. These movements can cause the ligament to stretch beyond its limit, resulting in a tear.

Symptoms of an ACL injury include a loud popping sound at the moment of injury, severe pain, swelling, and instability in the knee.

Treatment often involves ACL reconstruction surgery. During this procedure, Mr Woodward replaces the torn ligament with a graft, usually taken from the patient’s own hamstring. Usually a day case, surgery takes around 90 minutes to perform.

Post-surgery, patients undergo a rigorous rehabilitation programme to restore strength, stability, and mobility to the knee. This process can take several months, but with dedication and proper care, many patients can return to their previous level of activity.

Meniscal Tears

Meniscal tears are another common knee injury, frequently occurring in athletes but also affecting people of all ages. The meniscus is a C-shaped piece of cartilage that acts as a cushion between the femur and tibia, helping to distribute weight and reduce friction during movement.

Meniscal tears can result from a sudden twist or turn of the knee, often during activities that involve pivoting or squatting. Symptoms include pain, swelling, stiffness, and a feeling of the knee being locked or unable to move fully.

Treatment for meniscal tears depends on the severity and location of the tear. For minor tears, conservative treatments such as rest, ice, compression, and elevation (RICE), along with physical therapy, may be sufficient. However, in selected patients with suitable tears, the shock absorbers can be repaired with surgery.

Meniscal surgery can involve either repairing the torn meniscus or removing the damaged menisci (meniscectomy) to restore knee function. Rehabilitation post-surgery is crucial for regaining strength and mobility.

For more information about ACL surgery or meniscal tear surgery, schedule an appointment with Mr Shah Punwar. He will discuss with you a tailored treatment plan that will help you on your path to recovery.

Anterior cruciate ligament (ACL) injuries pose a significant challenge, especially for female athletes. Research shows that women are two to eight times more likely than men to experience these injuries.

Following the recent news that another young female footballer playing for the Hearts team in Scotland sustained a serious ACL rupture, we look at why women are more likely to develop these injuries.

Why are women more likely to develop ACL injuries?

Several factors could explain why ACL injuries are more common in women than in men. For example, anatomical differences may play a major role. Women typically have a wider pelvis, which affects the alignment of the thigh bone, tibia, and knee joint, increasing stress on the knee’s ligaments and soft tissues. This misalignment makes the knee more prone to both overuse and sudden injuries.

Women also tend to have less muscle mass around their knees compared to men, which can lead to joint instability. This reduced muscle density makes the ligaments, like the ACL, more likely to overstretch and tear during physical activities. Hormonal differences also matter; oestrogen levels fluctuate throughout the menstrual cycle, which may cause tendons and ligaments to become more flexible and prone to injury.

Lastly, external factors such as sports equipment designed mainly for men alongside lower-quality facilities and insufficient support from physios and sports therapists, may further contribute to women’s higher ACL injury rates.

Half of ACL injuries could be prevented

Experts believe that up to half of ACL injuries could be prevented with the right precautions. A well-structured warm-up routine that focuses on flexibility, strength, and stability around the knee is crucial.

Mr Shah Punwar recently attended the ‘Sports Knee Injury’ event which focused on the prevalence of ACL injuries in female athletes. During the talk, England Lionesses captain, Leah Williamson, also discussed the importance of a good warm up routine.

Dynamic stretches, plyometric exercises, and strength training help stabilise the knee by targeting the surrounding muscles. This type of warm-up not only prepares the body for the demands of sports, but also ensures proper alignment of muscles and joints, significantly lowering the risk of injury.

Preventing and treating ACL injuries

While it isn’t always possible to prevent ACL injuries, there are things you can do to reduce the risk. Proper training, wearing appropriate sports gear, and understanding your body’s limits can all help to prevent these injuries.

Building up the muscles around the knee is crucial for both preventing injuries and reducing their impact. Female athletes should use sports equipment designed for their specific body mechanics and play on high-quality surfaces to minimise the risk of injury.

When prevention falls short, treatment often involves a combination of surgery and physical therapy, depending on the severity of the ACL injury and individual needs. Surgical treatment may involve reconstructing or repairing the ligament, while physical therapy helps restore strength, flexibility, and stability.

If you’re concerned about an ACL injury, book a consultation with Mr Shah Punwar.

Long-distance runners often hear warnings about how running could wear out their joints. This can cause concern that their regular running routines are harmful to their knees, or may lead to osteoarthritis.

Here we’ll explore whether running can lead to osteoarthritis, and also provide some practical tips to help protect the knees when running.

Can running lead to osteoarthritis?

Contrary to popular belief, running may not be a cause of osteoarthritis. In fact, research indicates that runners generally have fewer cases of knee osteoarthritis compared to those who lead a sedentary lifestyle. Studies also suggest that runners often experience less knee pain.

Running does cause temporary changes in the knee cartilage, but some experts believe this conditions the cartilage over time. So, rather than damage the knee, it can help to improve overall strength and mobility.

Another way running can reduce the risk of knee osteoarthritis, is it helps to lower your BMI (Body Mass Index). Runners typically have a low BMI due to the distances they cover.

However, while running may not necessarily lead to osteoarthritis, you can still suffer various injuries, especially if you don’t take proper precautions.

What factors increase the risk of arthritis?

Running itself isn’t detrimental to knee health, but there are several other factors that can increase the risk of developing osteoarthritis. These include:

  • Age
  • Genetics
  • Overweight/Obesity
  • Previous joint injuries
  • Repetitive stress on the joint

Age is a primary factor, as the wear and tear on joints tend to accumulate over time. However, genetics play a significant role too, as a family history of arthritis means you may have a higher risk of developing it yourself.

Excessive weight puts additional stress on the joints, exacerbating the risk of damage and arthritis. If you’ve had previous joint injuries, or you work in certain occupations that demand repetitive stress on the joints, these factors can also increase the risk of developing osteoarthritis.

Tips for running safely

To protect your knees and ensure that running remains a beneficial part of your routine, there’s a few tips you’ll want to follow.

Start with a proper warm-up routine to prepare your joints and muscles for the impact of running. Choosing the right running shoes is also invaluable. Make sure you look for shoes that offer good support and suit the arch of your foot and running style. Gradually increasing the distance and intensity of your runs can also help avoid overloading the knees.

Another way to protect yourself from knee injury is by incorporating some strength and conditioning around your running, using weights or bodyweight exercises e.g. Pilates. It’s best to seek the advice of a physio/PT/coach for a tailored exercise plan that fits around your running goals and your specific biomechanical needs.

Running should be a joy and a health boost, not a source of pain. By taking the right precautions, you can continue to enjoy the benefits of running without compromising your knee health.

If you experience any discomfort in your knee after running, book a consultation with Mr Shah Punwar.

Mr Shah Punwar, orthopaedic knee and hip surgeon, is pleased to announce a new Central London clinic location at King Edward VII’s hospital in Marylebone.

Consultations are available between 18:00 and 20:00, on alternate Tuesdays.

For enquiries, click on his profile below, or you can contact his team through the usual contact email/numbers.



A recent Australian study has revealed that online physiotherapy, conducted via video conferencing, is just as effective as traditional in-person sessions when treating chronic knee pain.

Carried out during the lockdowns of the COVID pandemic, online physio not only proved viable, but also more beneficial than traditional sessions in some cases. However, despite this evidence, both patients and healthcare providers are sceptical.

Here, we’ll explore the latest findings and the benefits of prehabilitation prior to undergoing knee surgery.

Online physio as effective as in-person sessions

The recent study included a total of 394 adults aged over 45 who were experiencing knee pain. They were being treated by one of 15 physiotherapists enrolled in the research, spread across 27 practices throughout Victoria and Queensland, Australia.

The participants were split into two groups, with one receiving online physio sessions, and the other attending in-person sessions. Both groups underwent five sessions over a three-month period, along with a home exercise plan.

Interestingly, over the three months, those who did their physio online experienced the same benefits as those who did it in person. They were also more likely to attend all their sessions and found it more convenient.

This is great news, especially for those who have trouble getting to a physiotherapist’s office. It shows that online physio can be a reliable option for those in need.

The importance of prehabilitation before surgery

Prehabilitation, or ‘prehab’ involves a structured program of exercises and physiotherapy. It is designed to strengthen the knee and improve its function before the patient undergoes their operation.

Engaging in prehab can significantly minimise knee pain while you wait to have the surgery, as well as speed up recovery. It helps to strengthen the muscles around the knee, improving mobility and leading to improved results after the procedure.

While it is known to have many benefits, physical therapy for knee osteoarthritis isn’t used often enough. This recent research may help to encourage more practitioners to encourage physiotherapy prior to knee surgery.

Other ways to prepare for knee surgery to improve results

Alongside physiotherapy, there are other things you can do to increase the likelihood of a smooth, fast recovery, and achieve optimal results after knee surgery. Lifestyle changes such as stopping smoking, eating healthily, and managing your weight can make a big difference to the results.

Another thing to focus on is making sure you choose the right surgeon. You can follow the best prehabilitation plan in the world, but if you choose an inexperienced surgeon you aren’t going to achieve the best results. Always make sure you are choosing a skilled, experienced orthopaedic surgeon like Mr Shah Punwar.

Schedule an appointment with Mr Punwar today to determine the best way to prepare for your upcoming knee surgery.

Mr. Shah Punwar recently attended the ‘Sports Knee Surgery’ event in Edgbaston, focusing on ACL prevention and rehab. There, an insightful interview unfolded between Leah Williamson, the England Lionesses captain, and Austin Healey, an ex-England Rugby player who has undergone total knee replacement surgery.

Williamson’s experience with an ACL injury, a common injury among women in football, was a focal point of discussion. Coincidentally, Healey also experienced an ACL injury ahead of a World Cup game. She highlighted the challenges and the importance of proper rehabilitation and injury prevention in sports.

Here, we explore some key takeaways from the event, and why women are more susceptible to ACL injuries in high impact sports.

Female football players suffering ACL injuries

Williamson ACL InjurySharing her own experience with an ACL injury, Leah shed light on the critical issue of this being so prevalent in women’s football. Women can suddenly find themselves playing football at elite level from the age of 18. This differs to men, who can begin a structured athletic development programme from the age of 9.

Another aspect is the importance of a proper warm-up before activity. Healy and Williamson discussed how crucial it was to adopt proper warming up protocols from a young age. Now, after the success of the lionesses and with more girls encouraged to take up football, this is more important than ever.

“At school we all do PE, so introduce it there, and make it second nature,” said Williamson.

Her ACL injury, like many others in high-level sports, was exacerbated by the demanding schedule of games, which often does not allow adequate time for rest and recovery. This rigorous scheduling can increase the risk of injuries, making prevention and proper rest periods crucial for athletes.

What is an ACL Injury?

The Anterior Cruciate Ligament (ACL) is one of the key ligaments that help stabilise the knee joint. An ACL injury is a tear or sprain of this ligament, often occurring in sports that involve sudden stops, jumps, or changes in direction.

These injuries can be debilitating, requiring extensive rehabilitation and, in some cases, surgical intervention. The recovery process can be lengthy and challenging, which makes effective treatment and rehabilitation strategies crucial.

ACL injuries typically occur when the knee is forced into an unnatural position, often during high-impact or rapid-movement sports. This excessive stress can cause the ACL, which is crucial for knee stability and smooth joint movement, to stretch or tear.

The severity of an ACL injury can range from a mild strain (where the ligament is slightly stretched) to a complete tear, where the ligament is split into two parts. Recovery and treatment plans vary based on the severity of the injury and the person’s overall health and activity level.

Why ACL Injuries Affect So Many Women in Sports

ACL injuries are particularly prevalent in women’s sports, with athletes in football, skiing, bouldering, and netball often affected.

Factors that increase the risk include:

  • Anatomical differences
  • Hormonal influences
  • The biomechanics of movement in women

Leah’s experience and Healey’s insights at the Sports Knee Surgery talk, highlight the importance of understanding proper warming-up exercises for ACL prevention, and total adherence to prehab should surgical treatment be needed, as well as the rehab which follows.

If you have experienced an ACL injury, schedule an appointment with Mr. Shah Punwar today. With his extensive experience, he can assess the injury and recommend the best treatment plan to help ensure the best recovery. Early intervention is crucial to help you get back to the sport you love.

Each year, thousands of people manage to regain mobility and lead a pain-free life thanks to knee replacement surgery. According to the National Institute for Health and Care Excellence, more than 100,000 knee replacement surgeries are carried out in the UK annually.

While most of these surgeries run smoothly, for various reasons, some patients may experience issues with their new knee. That’s where knee replacement revision surgery comes in.

Here we’ll explore why you may need a revision surgery, and what happens before and after the procedure.

Why you may need a knee replacement revision surgery

The most common reasons you may need a knee replacement revision include:

  • Natural wear and tear
  • Loosening of the replacement
  • Infection
  • Falls

Knee replacements aren’t designed to last forever. They typically last between 10 and 20 years, eventually giving way to wear and tear. As people live longer now, there’s been an increased demand for knee replacement revision procedures.

As well as general wear and tear, occasionally the replacement can loosen. This is easily identified through an X-ray. The plastic component may also wear down, leading to discomfort and reduced functionality.

Whatever the reason, a revision surgery can help patients to get back to living a pain-free life. It benefits from a high success rate, but it can be quite a complex procedure compared to the original replacement.

What happens before a knee replacement revision surgery?

Before having a knee replacement revision surgery, you’ll need to undergo an assessment. It starts with a physical examination, assessing how well the knee bends and its overall functionality. Imaging tests, such as X-rays, help pinpoint the specific issues with the replacement. Blood tests may also be conducted to rule out any underlying health concerns.

After the surgery, a rehabilitation and recovery plan will be provided. Following the surgeon’s aftercare instructions is crucial to ensure best results. This typically includes instructions for keeping the wound clean, partaking in physical therapy, and when you can get back to physical activities.

Other than revision surgery, are there other treatment options?

Depending on the specific issues identified, various approaches can be explored to address the challenges faced by knee replacement. This could range from non-invasive interventions to surgical procedures aimed at rectifying the underlying problems.

In some cases, revision surgery becomes the most viable option to restore optimal function and eliminate any pain the patient is experiencing. This involves removing all or part of the components of the replacement that have failed or are damaged.

If you have had a total knee replacement and are worried about pain, swelling, clunking or feeling unstable then do come and see Mr Punwar for a detailed review.

Undergoing knee surgery can be a daunting process, especially when you’re faced with multiple options. A total knee replacement is usually recommended for treating widespread tissue damage in the knee. But sometimes a partial knee replacement is more suitable.

Designed to treat specific areas of arthritis damage in the knee, a partial knee replacement is a less invasive approach than a total replacement. So, what does this procedure involve, and could it be a better option for you? Read on to discover more.

What is a partial knee replacement?

A partial knee replacement focuses on replacing only one damaged compartment of the knee. It is often referred to as a unicondylar replacement or unicompartmental knee replacement surgery.

There are two main types of replacement you can undergo, including fixed-bearing and mobile-bearing procedures.

In a fixed-bearing partial knee replacement, there’s a rounded component on the femur that sits on top of a flat component on the tibia.

The mobile-bearing procedure features a movable plastic spacer nestled between these components, allowing for slight rotation in the medial compartment. This rotation capability gives it the ‘mobile’ descriptor.

Research has proved that both types of partial knee replacement give favourable outcomes. However, Mr Punwar uses the fixed-bearing partial knee replacement because it has excellent results on the National Joint Registry.

When might it be recommended?

A partial knee replacement may be suggested when only one compartment of your knee is affected by arthritis or damage, and the other parts remain healthy. This could be due to specific injuries, isolated arthritis, or wear and tear localised to one area.

Patients experiencing consistent pain, swelling, or stiffness in one part of the knee, which isn’t relieved by non-surgical treatments could be ideal candidates for the procedure.

Your orthopaedic surgeon will evaluate the extent of the damage through physical exams and imaging tests. This will help to determine if it is the right solution for you.

The benefits of a partial knee replacement

Choosing a partial knee replacement offers several advantages. Firstly, because it’s a less invasive procedure, the surgery typically involves a smaller incision. This can mean less pain postoperatively and a quicker healing process. Also, with the ‘mid-vastus’ technique, the quadriceps tendon is not split, so the recovery is quicker with a faster ability to do a straight leg-raise.

The procedure is usually carried out under a regional anaesthesia, which avoids potential complications of general anaesthesia. Also, it often leads to a shorter hospital stay and a faster return to daily activities. Since only the damaged part of the knee is replaced, preserving more natural bone and tissue, patients also tend to feel that their knee moves more naturally compared to a total knee replacement.

Of course, knee arthritis can continue to spread into other areas of the knee, but a partial knee replacement can help with knee stability, giving additional protection against wear and tear.

Certainly, all these benefits make partial knee replacements an attractive option for those who qualify.

To determine your eligibility for a partial knee replacement, or to find out more, schedule a consultation with Mr Shah Punwar.

Since the Lionesses have been on centre stage, there has been a spotlight on Anterior Cruciate Ligament (ACL) injuries. England Captain Leah Williamson suffered an ACL injury in April, preventing her from competing in the Women’s World Cup. This followed a bout of ACL injuries among other elite female football players.

Here, teaching assistant Lia, talks about her own football ACL injury, and her gruelling rehabilitation after surgery to get back to the pitch.

Lia’s footballing ACL injury – not that uncommon

Lia had been playing football for twenty-four years, and had suffered some serious ankle injuries – but no knee issues.

“As a defender, I slide in to make tackles all the time.” However, when playing a semi-final game with her Sunday league team in Sidcup, she went to make a tackle, but her leg had other ideas. “My knee went one way, and my foot the other,” she says. “I just remember my knee burning.”

After three weeks resting, Lia was keen to return for some light training, but when her leg instantly gave way she realised her injury was more serious than first suspected. Some weeks later, a scan revealed a torn ACL.

Lia is certainly not alone though. Research shows that female footballers are up to six times more likely to suffer a non-contact ACL injury than male players. In fact, both Lia’s sisters had experienced ACL ruptures through football, and both received surgeries. Also, similar to many other cases, Lia’s injury did not involve contact, and seemed to be caused by a sudden change in speed…in her case a sudden stop.

Lia’s ACL surgery recovery

With her mind set on returning to football, surgery was the best way to get her back to her sport. A year later, Lia was set for an ACL repair with Mr Punwar at The Blackheath Hospital. From the moment she arrived, Lia recalls being fully informed on the procedure. “It was all explained. I knew exactly what was going to happen. It was very reassuring.”

Mr Punwar ACL repair surgery uses the UltraSTAR surgical technique with a single, quadrupled semitendinosus graft. After surgery, Lia said she was very naive about how long the recovery process would take. “My sisters said it’s going to hurt, you’ll get to a point where you don’t think you can do another set of exercises. But do them!”

Lia received her physio exercises the morning after her surgery, but found it exhausting. But she pushed through, setting herself small goals and with a strong support network of friends, family and club-mates. “I remember when I was able to walk to the kitchen without my crutches and make a cup of tea. I sent my friends a photo because I was so proud of myself!”

More research into footballer’s ACL injuries needed

Now, almost five months since her surgery, Lia’s physio is going well, and she is looking forward to running again soon. She is hoping to return to football next Spring. That will be 12 months after her surgery, and two years since her ACL injury occurred.

When considering the plight of so many other football players experiencing ACL injuries, Lia says: “It needs to be looked at. More research is needed. And not just in female football. They’re not nice injuries to have – career-ending injuries for some people. Anything that can help prolong people’s footballing careers.”

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