Medial Collateral Knee Ligament Sprain

with Phase I Rehab

The medial collateral ligament (MCL) of the knee helps hold the knee joint in proper alignment and prevents the bones from shifting out of alignment (displacing) to the inside (medially). Injury to the knee may cause a tear in the MCL ligament (sprain). Sprains may heal without treatment, but this often results 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 possibly decreased. Grade 3 sprains involve a complete tear of the tendon or muscle, and function is usually impaired.

SYMPTOMS

  • Pain and tenderness on the inner 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 MCL sprain occurs when a force is placed on the ligament that is greater than it can handle. Common mechanisms of injury include:

  • Direct hit (trauma) to the outer 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

MCL tears usually heal without the need for surgery. Sometimes however, surgery is required.

RELATED COMPLICATIONS

  • Frequently recurring symptoms, such as the knee giving way, knee instability or knee 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.

  • Injury to nerves, resulting in numbness of the outer leg, foot or ankle and weakness or paralysis, with inability to raise the ankle or toes.

  • Knee stiffness.

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 MCL injuries or injuries that involve other ligaments of the knee, surgery is often advised.

MEDICATION

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

  • Only use over-the-counter pain medicine as directed by your caregiver.

  • Only use prescription pain relievers as directed and only in needed amounts.

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 any activity, that aggravates the 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 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.

EXERCISES

PHASE I EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES–Medial Collateral Knee Ligament Sprain Phase I

These are some of the initial exercises that your physician, physical therapist or athletic trainer may have you perform to begin your rehabilitation. When you demonstrate gains in your flexibility and strength, your caregiver may progress you to Phase II exercises. As you perform these exercises, remember:

  • These initial exercises are intended to be gentle. They will help you restore motion without increasing any swelling.

  • Completing these exercises allows less painful movement and prepares you for the more aggressive strengthening exercises in Phase II.

  • 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.

RANGE OF MOTION–Knee Flexion, Active

  • Lie on your back with both knees straight. (If this causes back discomfort, bend your healthy knee, placing your foot flat on the floor.)

  • Slowly slide your heel back toward your buttocks until you feel a gentle stretch in the front of your knee or thigh.

  • Hold for __________ seconds. Slowly slide your heel back to the starting position.

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

STRETCH–Knee Flexion, Supine

  • Lie on the floor with your right / left heel and foot lightly touching the wall. (Place both feet on the wall if you do not use a door frame.)

  • Without using any effort, allow gravity to slide your foot down the wall slowly until you feel a gentle stretch in the front of your right / left knee.

  • Hold this stretch for __________ seconds. Then return the leg to the starting position, using your health leg for help, if needed.

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

RANGE OF MOTION–Knee Flexion and Extension, Active-Assisted

  • Sit on the edge of a table or chair with your thighs firmly supported. It may be helpful to place a folded towel under the end of your right / left thigh.

  • Flexion (bending): Place the ankle of your healthy leg on top of the other ankle. Use your healthy leg to gently bend your right / left knee until you feel a mild tension across the top of your knee.

  • Hold for __________ seconds.

  • Extension (straightening): Switch your ankles so your right / left leg is on top. Use your healthy leg to straighten your right / left knee until you feel a mild tension on the backside of your knee.

  • Hold for __________ seconds.

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

STRETCH–Knee Extension Sitting

  • Sit with your right / left leg/heel propped on another chair, coffee table, or foot stool.

  • Allow your leg muscles to relax, letting gravity straighten out your knee.*

  • You should feel a stretch behind your right / left knee. Hold this position for __________ seconds.

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

*Your physician, physical therapist or athletic trainer may instruct you to place a __________ weight on your thigh, just above your kneecap, to deepen the stretch.

STRENGTHENING EXERCISES–Medial Collateral Knee Ligament Sprain Phase I

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • In order to return to more demanding activities, you will likely need to progress to more challenging exercises. Your physician, physical therapist or athletic trainer will advance your exercises when your tissues show adequate healing and your muscles demonstrate increased strength.

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided by your caregiver.

STRENGTH–Quadriceps, Isometrics

  • Lie on your back with your right / left leg extended and your opposite knee bent.

  • Gradually tense the muscles in the front of your right / left thigh. You should see either your kneecap slide up toward your hip or an increased dimpling just above the knee. This motion will push the back of the knee down toward the floor, mat or bed on which you are lying.

  • Hold the muscle as tight as you can without increasing your pain for __________ seconds.

  • Relax the muscles slowly and completely in between each repetition.

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

STRENGTH–Quadriceps, Short Arcs

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

  • 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.

STRENGTH-–Quadriceps, Straight Leg Raises

Quality counts! Watch for signs that the quadriceps muscle is working, to be sure you are strengthening the correct muscles and not "cheating" by substituting with healthier muscles.

  • Lay on your back with your right / left leg extended and your opposite knee bent.

  • Tense the muscles in the front of your right / left thigh. You should see either your knee cap slide up or increased dimpling just above the knee. Your thigh may even shake a bit.

  • Tighten these muscles even more and raise your leg 4 to 6 inches off the floor. Hold for __________ seconds.

  • Keeping these muscles tense, lower your leg.

  • Relax the muscles slowly and completely in between each repetition.

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

STRENGTH–Hamstring, Isometrics

  • Lie on your back on a firm surface.

  • Bend your right / left knee approximately __________ degrees.

  • Dig your heel into the surface as if you are trying to pull it toward your buttocks. Tighten the muscles in the back of your thighs to "dig" as hard as you can, without increasing any pain.

  • Hold this position for __________ seconds.

  • Release the tension gradually and allow your muscle to completely relax for __________ seconds in between each exercise.

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

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.