Practising knee anatomy

GAG chains, a pain in the hip, and a training blip.

I’m halfway through the first semester of my physiotherapy degree!

Last week, we had our final sessions on hip anatomy, assessment and pathologies. Apart from ironically developing a pain in the hip (more on that later) I’m feeling pretty good about everything! This week we moved on to the knee. In one sense, it’s scary knowing that we won’t be revisiting the hip again in lectures or practical sessions. It all seems so new and daunting at the moment. However, our group often meets to formalise and consolidate our learning, and I know we will have many opportunities to come in and practice our hip assessment on each other between now and our first examinations. It’s also exciting to move onto the knee, although we now have a fresh area of anatomy to become familiar with. The knee and the hip form part of a kinetic chain but so far – by necessity – we’ve been looking at the hip joint in isolation rather than as part of a series. I’m sure that even though we have moved ‘down the limb’ so to speak, we’ll deepen our understanding of the hip even as we look at something new.

Last week, some of us also had the chance to work with a group of second year physiotherapy students. We formed small groups and we – the first years – practiced explaining a topic we had learned both as if to another clinician and also as if to a lay-person. For some unknown reason, I decided to explain the rather complex role of GAG (glycosoaminoglycans) chains in the special properties of connective tissue and the importance of movement during tissue healing. This was a really useful exercise as while I found that I was pretty good at explaining in depth the process by which the overall negative charge of GAG chains and the proteoglycans that they are attached to repel each other, creating space (limited by the anchoring effect of collagen fibrils), into which is attracted the positive poles of water molecules. In the presence of a compressive force, the repulsion of the proteoglycans is overridden, forcing them closer together and counteracting their hydrophilia, therefore expelling the fluid that occupied the now compressed space.

GAG chains exist in connective tissue. As connective tissue is avascular – having no blood supply – this ‘reversible’ attraction to water allows for fluid in the extra-cellular matrix to be drawn in and out of connective tissue, nourishing and flushing out waste products. Movement then – by creating compressive forces on the connective tissue – aids tissue healing.

Diagram of Gag Chains

So far so good.

Next, I tried to explain this in lay-persons terms to my second year student. I completely bombed. Now this is worrying because it will be most of the job, trying to relay to patients the importance of movement and exercise when our tendency is to shy away from moving the parts of us that hurt.

I stuttered, I stammered, I backtracked. I probably went several shades of red. I think part of it was knowing that I was explaining to someone who knew more than me, and so I struggled with self-consciousness even though I was supposed to be keeping it simple. Obviously the feedback I received was to work on that part that I struggled with.

Off the back of that session, a group of my year have started meeting a couple of times a week where we will go over what we have learned and practice explaining them both ways –  to a clinician and to someone who would benefit from a simpler explanation. I think that it will be really useful. You can’t learn ‘patter’ from books. Interestingly, the next time I went into my part-time job, whilst convincing a colleague of the benefits of exercise on his current health, I managed to glibly explain exactly the concept of movement and tissue healing that I had struggled so hard with two days before. It made a difference that I wasn’t self-conscious about it, and at least I know that I can do it. Now it needs to become second nature.

Insult to injury.

So having moved away from the hip and onto the knee in class, I only ended up developing a hip injury! I can’t say exactly what caused it but I am going with overuse at the moment – I’m taking swimming classes as well as working out at the gym and continuing my marathon training. The injury occurred when running for a train. I was taking a diagonal line between two platforms with a heavy bag and my left leg gave way with a sharp pain. Now I am experiencing an intermittent, sharp, catching pain in my groin, over the hip joint, which causes my leg to occasionally give way. Hip flexion and extension seem normal but I can notice quite restricted range of motion in both adduction and abduction. The injury occurred 6 days ago and I’m still having frequent pains while walking so I’m going to continue to have complete rest. I’ve had to stop training in all areas and pull out of this weekends planned XC race with my club, the Manchester Frontrunners.

My main goal is the Manchester Marathon in April, for which I would hope to have started increased training for in December. The absolute worst thing I could do is push on regardless so I am hoping that by being sensible, I can start training again without risk of re-injury, even if that means pushing the December deadline back a bit. In the past, I haven’t been very good at following recovery guidelines but it makes a difference understanding what’s happening at a cellular level. You can’t argue with GAG chains, therefore, I’ll be incorporating some gentle mobilisation of my joint in order to properly rehabilitate my hip.

So there we go.  With GAG chains, a pain in the hip, and a training blip, my recent learning collides full force with my current fitness state. It makes it interesting for me to be able to consolidate recently acquired knowledge, but it still doesn’t make being injured suck any less. Wish me luck!


Category: Physio Student JourneyPhysiotherapyRunningTraining


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Article by: Vee Uye

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