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A skiing accident tore my left knee anterior cruciate ligament – I don’t have one – but I think I have the posterior (I think). Although I wore a brace last time I skied I fell and the brace worked but my knee has felt tight and unstable since it has never felt unstable before as I do knee exercises with a rubber band.

Can you advise what the best recovery exercise and complementary treatment is for this and also how can I tell if I have torn the posterior cruciate? I get a clicking noise when I do squat using the wall as a back support.

May sound daft but is there any way I can treat the anterior ligament to grow back if it is torn off altogether?

Firstly, I would recommend you visit your doctor to ascertain whether or not you have indeed torn your Posterior Cruciate Ligament (PCL). Most people are familiar with ACL (anterior cruciate ligament) injuries and the damage they do. But little attention is paid to the corresponding ligament in the knee, the PCL, or posterior cruciate ligament. The connective tissues called ligaments provide stability and help control movement. The PCL is located in the back of the knee and connects the thigh bone (femur) to the shin bone (tibia) to prevent the shin bone from moving too far backward. It’s great that you wore a knee brace when you last skied, however, I would seriously consider keeping all pressure off your knee – and doing low impact activities – until you get a professional opinion from your doctor or physiotherapist. Any further injury could seriously affect the stability and functionality of your knee. This could very likely create big problems for you in the future if left untreated.

The PCL is very strong, but a powerful force can rupture or tear it. For example, PCL tears can occur when a football or soccer player falls on a bent knee – this could very well have happened when you had your skiing accident. Motor vehicle accidents are another common cause of injury to the PCL. When the driver or passenger strikes the bent knee just below the kneecap (patella) against the dashboard, the force can tear the PCL and damage other ligaments, bones and muscles. Excessive tension, such as results from a dislocated knee, can also damage the PCL. The clicking noise you describe is undoubtedly a result of the damaged ligament/s and resultant instability of your knee.

Marked, immediate swelling (within three hours of the injury)
Difficulty walking after the injury
Painful to move the knee
Occasionally, a feeling of instability, or the knee "giving way"

To determine the extent of the injury, the physician relies on an account of the accident, a visual examination, and several diagnostic tests. The doctor will need to know if you have a history of knee injuries. During the examination, the doctor will compare the injured leg with the normal leg and see if there is any sag or movement in the shinbone. PCL injuries may be isolated or combined.

Isolated PCL injuries: Can usually be treated non-surgically, do not involve any other structures in the knee, and may be either partial or complete tears.
Combined PCL injuries: May involve injury to other ligaments, bone, nerves or blood vessels and usually require surgical repair.

An MRI (magnetic resonance image) can be used to confirm the diagnosis. X-rays do not show ligaments, but they can reveal any associated damage to the bones and cartilage. For example, if the PCL is torn completely from its attachment to the shin bone, it may take a piece of bone as well. This is called an avulsion fracture and can be seen on an X-ray.

The type of injury dictates the type of treatment you need. For minor PCL tears, the initial/immediate treatment is RICE: rest, ice, compression and elevation. You may have to use crutches for a short time, and your doctor may prescribe some anti-inflammatory drugs such as aspirin or ibuprofen. After the swelling subsides, you will need to follow a programme of physical therapy to strengthen your quadriceps muscle and regain range of motion.

Some patients require surgery to stabilise the knee. Arthroscopic surgery, which uses small incisions and pencil-sized instruments, is used to determine and repair damage to the cartilage in the knee. Avulsion fractures may need to be fixed with internal screws to ensure proper healing. If the PCL is completely torn, it may be reconstructed using a portion of the patella tendon or some other autograph… it is impossible for the torn ligament to “grow back” by itself.

The goals of rehabilitation are to restore range of motion and to strengthen the quadriceps (front of thigh) muscles, which help stabilise the knee. After surgery, you may have to use crutches and a knee brace. Exercises such as squats and leg presses are used because they put less stress on the knee. Full recovery takes several months.

I used to be very fit (running marathons and attempting the occasional triathlon), and whenever I had a prolonged break and got back into my training, I experienced extreme muscle soreness which has put me off exercise to a large degree. I no longer train and I have since piled on the pounds and want to begin an exercise programme but I really don't want to feel the stiffness and pain after training. Can you help me?

You are not alone. Delayed Onset of Muscle Soreness (DOMS) associated with exercise deter many people from working out or participating in physical activity. Hopefully by following a few tips to better understand, prevent and treat aches and pains, you'll enjoy exercising more and stay motivated in your fitness routine. Before I explain, I feel it important to say that I'm concerned that you mention an experience of extreme muscle soreness. Without chatting to you in more detail, I cannot ascertain just how extreme this pain was, but I'm guessing that you were over-training for your level of fitness and not allowing your body sufficient time to recover after each workout or training session. Marathons and triathlons place a lot of strain on the body - especially when you're cross-training for long periods of time (particularly during your triathlon competion phase). Rest is just as important as training in any programme, no matter what your goal.

Let me answer your question now... Yes, I can help you. Muscle soreness, which typically occurs a day or two after an activity, results from micro-scopic muscle or connective tissue damage. These aches and pains should be minor (hence my comment before about your experience of extreme pain), and are simply indications that your muscles are adapting to your fitness regime. In an address to health and fitness professionals at the seventh-annual ACSM Health and Fitness Summit & Exposition, Carol Torgan, Ph.D., FACSM recommended these tips to address muscle soreness:

1. Don't interpret soreness as sorely out-of-shape. Some people think they have no business exercising because exercise is 'painful'. That's not the case. The soreness is there simply because your muscle is learning something new, and the benefits of exercise far outweigh any discomfort.

4. Application of balms, creams and/or ice, as well as submersion in warm water, may provide temporary relief.

5. There is no scientific evidence that herbal remedies are effective, but products containing ibuprofen may help lessen the discomfort. The best treatment is to take it easy for a few days while your body adapts. This does not necessarily mean you shouldn't workout or train in your particular sport; just train at a lower intensity.

6. Don't avoid activity because of muscle soreness. In fact, keeping the muscle in motion with light exercise can be beneficial.

7. Talk to your health and fitness instructor about muscle pain or soreness. It's normal to feel soreness, particularly after new moves, but if you're concerned, talk to your healthcare provider or instructor for more information.

A couple of years ago, I had separation of the symphysis pubis. I would like to strengthen this area in order to have another baby. I have been told that the abdominals, lower back and inner thigh group of muscles need to be strengthened. Is this true, and can you give me some exercises to do?

The symphysis pubis joins the pubic rami (part of the pubic bones) together at the front and has a thick pad of cartilage acting as a buffer between the two bone surfaces. This pad of cartilage between the two joint surfaces plays an important role in the stability of the pelvis. Stability is also dependent on ligaments, which are affected by the relaxin hormone during pregnancy, and on the correct alignment of the sacroiliac joints (where the sacrum meets the hip bones). The symphysis pubis has a normal seperation of 3-4mm, which can increase up to as much as 9mm in pregnancy. The effect of relaxin on the sacroilliac joints and symphysis pubis often leads them to become a source of discomfort. What you have experienced is extreme diastasis symphysis pubis (distinct seperation of the symphysis pubis). This is a very painful and immobilising condition of pregnancy.

You should benefit from a balance of all muscles around the pelvis: The short adductors (inner thigh muscles) tend toward tightness, not weakness so they should be stretched, not strengthened.

Try this stretch: Sit with the soles of your feet together at your midline. With elbows on the inside of your knees, press gently downward with your elbows. Hold for 30 seconds and repeat. Do this daily for a week, and 2-3 times per week thereafter to maintain. Your lumbar erector spinae (lower spine muscles) are also likely to be tight. They are hard to target properly in a stretch, and it is difficult to explain an appropriate stretch, but I would suggest trying two alternatives. The first I would recommend is commonly known as the "mad cat" stretch (popular in yoga). On all fours, begin in a neutral position (straight/flat back), contract your abdominals and arch your back whilst tucking your coccyx (tailbone) under your hips, also tuck your chin under and as close to your chest as possible. Keep breathing normally throughout. Hold this stretch for 6-8 seconds then go back to neutral position. Do this daily for a week and 2-3 times per week to maintain.

The alternative is a basic sit and reach stretch. Sit with both your legs outstretched in front of you. Pivot forward slowly from the hip. You will feel your hamstrings (back of your thighs) stretch first. Gradually edge your way forward. The entire stretch should last about one minute. After 60 seconds, return to the starting position and repeat. Do this daily for a week, and 2-3 times per week to maintain. Only when you have stretched these two muscle groups, use an abdominal curl to strengthen your anterior torso (abdominal) muscles. A reverse curl done supine (lying on your back) with your hips flexed (bent) to 90 degrees would also be useful. Ensure that the movement of the reverse curl is initiated at your tailbone, not by reaching your feet toward the ceiling. It should be a very slight movement of the hips, and you should not attempt to lift your buttocks (bottom) completely off the ground. Small lifts of the tailbone will strengthen the lower fibres of your rectus abdominus (abdominal muscles). Your hip abductors (outer thighs) should also be checked for function by a professional as they are primary supporters of the pelvis in standing and walking.

No. Per kilogram (kg) of body weight, bodybuilders actually need less protein than endurance athletes such as runners. This is because protein - or more precisely, amino acids (the building blocks of protein) - is actually used for fuel during intense exercise, particularly when carbohydrates are not available. Protein can provide up to 10 per cent of energy during exercise when a person is carbohydrate depleted.

There is a catch though: Even though endurance athletes may need more protein per kilogram of body weight, they tend to need a smaller total intake of protein because they often weigh less than bodybuilders.

The female athlete triad was first defined in 1993 to include disordered eating, amenorrhoea, and osteoporosis.

The female athlete triad was defined in a commentary article found in the American College of Sports Medicine's (ACSM) journal Medicine and Science in Sports and Exercise. This commentary was based on the discussions of a panel of experts convened in 1992 to discuss this disturbing triad of disorders often found in young female athletes.

These female athletes appear to be most at risk as they are driven to excel in their chosen sport and often pressured to fit a specific athletic image in order to achieve their goals. This puts them at risk of developing disordered eating patterns, which could lead to menstrual dysfunction and subsequent premature osteoporosis. It is the opinion of those in the know that the underlying cause of this disorder is not exercising or participating in any specific sport, but rather the continuous drive of girls and young women to be unrealistically thin by restricting their calorie intake in a misguided attempt to improve performance.