Lateral Collateral Knee Ligament Sprain

with Phase II Rehab

ExitCare ImageThe lateral collateral ligament (LCL) of the knee helps hold the knee joint in proper alignment and prevents the bones from shifting out of alignment (displacing) toward the outside (laterally). Injury to the knee may cause a tear in the LCL ligament (sprain). The LCL is the least common ligament of the knee to be injured. Sprains may heal on their own, but they often result in a loose joint. Sprains are classified into three categories. Grade 1 sprains cause pain, but the tendon is not lengthened. Grade 2 sprains include a lengthened ligament, due to the ligament being stretched or partially ruptured. With grade 2 sprains there is still function, although the function may be decreased. Grade 3 sprains involve a complete tear of the tendon or muscle, and function is usually impaired.

SYMPTOMS

  • Pain and tenderness on the outer side of the knee.

  • A "pop", tearing, or pulling sensation at the time of injury.

  • Bruising (contusion) at the site of injury within 48 hours of injury.

  • Knee stiffness.

  • Limping, often walking with the knee bent.

CAUSES

An LCL sprain occurs when a force is placed on the ligament that is greater than it can handle. Common causes of injury include:

  • Direct hit (trauma) to the inner side of the knee, especially if the foot is planted on the ground.

  • Forceful pivoting of the body and leg, while the foot is planted on the ground.

RISK INCREASES WITH:

  • Contact sports (football, rugby).

  • Sports that require pivoting or cutting (soccer).

  • Poor knee strength and flexibility.

  • Improper equipment use.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Wear properly fitted protective equipment (correct length of cleats for surface).

  • Functional braces may be effective in preventing injury.

PROGNOSIS

If treated properly, LCL tears usually heal on their own. Sometimes, surgery is required.

RELATED COMPLICATIONS

  • Frequently recurring symptoms, such as knee giving way, instability, and swelling.

  • Injury to other structures in the knee joint.

  • Meniscal cartilage, resulting in locking and swelling of the knee.

  • Articular cartilage, resulting in knee arthritis.

  • Other ligaments of the knee (commonly).

  • Injury to nerves, causing numbness of the outer leg, foot, and ankle and weakness or paralysis, with inability to raise the ankle, big toe, or lesser toes.

  • Knee stiffness (loss of knee motion).

TREATMENT

Treatment first involves the use of ice and medicine, to reduce pain and inflammation. The use of strengthening and stretching exercises may help reduce pain with activity. These exercises may be performed at home, but referral to a therapist is often advised. You may be advised to walk with crutches, until you are able to walk without a limp. Your caregiver may provide you with a hinged knee brace to help regain a full range of motion, while also protecting the injured knee. For severe LCL injuries, or injuries that involve other ligaments of the knee, surgery is often advised.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given, if your caregiver thinks they are needed. Use only as directed and only as much as you need.

HEAT AND COLD

  • Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 4 to 6 weeks, despite treatment.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

PHASE II EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Lateral Collateral Knee Ligament Sprain Phase II

After your physician, physical therapist or athletic trainer feels your knee has made progress significant enough to begin more advanced exercises, he or she may recommend some of the exercises that follow. He or she may also advise you to continue with the exercises which you completed in Phase I of your rehabilitation. While completing these exercises, remember:

  • These exercises are intended to help you restore motion without increasing any swelling.

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image STRETCH - Quadriceps, Prone

  • Lie on your stomach on a firm surface, such as a bed or padded floor.

  • Bend your right / left knee and grasp your ankle. If you are unable to reach your ankle or pant leg, use a belt around your foot to lengthen your reach.

  • Gently pull your heel toward your buttocks. Your knee should not slide out to the side. You should feel a stretch in the front of your thigh and knee.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH - Knee Extension, Prone

  • Lie on your stomach on a firm surface, such as a bed or countertop. Place your right / left knee and leg just beyond the edge of the surface. You may wish to place a towel under the far end of your right / left thigh for comfort.

  • Relax your leg muscles and allow gravity to straighten your knee. Your caregiver may advise you to add an ankle weight, if more resistance is helpful for you.

  • You should feel a stretch in the back of your right / left knee. Hold this position for __________ seconds.

Repeat __________ times. Complete this __________ times per day.

* Your physician, physical therapist or athletic trainer may ask you to use a __________ ankle weight to enhance your stretch.

STRENGTHENING EXERCISES - Lateral Collateral Knee Ligament Sprain Phase II

These are some of the exercises you may progress to in your rehabilitation program. Do not begin these until you have your caregiver's permission. Although your condition has improved, the Phase I exercises will continue to be helpful and you may continue to complete them. As you complete strengthening exercises, remember:

  • Strong muscles with good endurance tolerate stress better.

  • Do the exercises as initially prescribed by your caregiver. Progress slowly with each exercise, gradually increasing the number of repetitions and weight used under his or her guidance.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does get worse, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your caregiver.

ExitCare Image STRENGTH - Hamstring, Curls

  • Lay on your stomach with your legs extended. (If you lay on a bed, your feet may hang over the edge.)

  • Tighten the muscles in the back of your thigh to bend your right / left knee up to 90 degrees. Keep your hips flat on the bed.

  • Hold this position for __________ seconds.

  • Slowly lower your leg back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

OPTIONAL ANKLE WEIGHTS: Begin with ____________________, but DO NOT exceed ____________________. Increase in 1 pound/0.5 kilogram increments.

ExitCare Image STRENGTH - Quadriceps, Short Arcs

  • Lie on your back. Place a __________ inch towel roll under your right / left knee, so that the knee bends slightly.

  • Raise only your lower leg by tightening the muscles in the front of your thigh. Do not allow your thigh to rise.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

OPTIONAL ANKLE WEIGHTS: Begin with ____________________, but DO NOT exceed ____________________. Increase in 1 pound/0.5 kilogram increments.

ExitCare Image STRENGTH - Quadriceps, Step-Ups

  • Use a thick book, step or step stool that is __________ inches tall.

  • Hold a wall or counter for balance only, not support.

  • Slowly step up with your right / left foot, keeping your knee in line with your hip and foot. Do not allow your knee to bend so far that you cannot see your toes.

  • Slowly unlock your knee and lower yourself to the starting position. Your muscles, not gravity, should lower you.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Quadriceps, Wall Slides

Follow guidelines for form closely. Increased knee pain often results from poorly placed feet or knees.

  • Lean against a smooth wall or door and walk your feet out 18-24 inches. Place your feet hip width apart.

  • Slowly slide down the wall or door until your knees bend __________ degrees.* Keep your knees over your heels, not your toes, and in line with your hips, not falling to either side.

  • Hold for __________ seconds. Stand up to rest for __________ seconds in between each repetition.

Repeat __________ times. Complete this exercise __________ times per day.

* Your physician, physical therapist or athletic trainer will alter this angle based on your symptoms and progress.