Physical Therapy for Medial Collateral Ligament Injury

Medial collateral ligament (MCL) knee sprains can be a painful and debilitating injury to deal with.  After an MCL sprain, depending on severity, the knee loses some of its’ side-to-side stability and the knee feels like it “buckles” or is unstable.  Furthermore, range of motion can be painful and stiff.  The sports physical therapists at SSOR are knee rehab specialists and have the knowledge and clinical acumen to get you back to doing what you need and want to do.

What is the MCL?

The medial collateral ligament is a ligament on the medial or “inner” part of the knee that provides stability in the frontal or “side-to-side” plane.  Think of a building collapsing on itself.  The MCL helps prevent this from happening on the inner/medial aspect.  Unlike the ACL which is more band/rope –like , the MCL is more of a thickening of the joint capsule and is flat.  The MCL has both a superficial and a deep band that collectively provide stability in different parts of the range of motion.

How is it injured?

Medial collateral ligament injuries occur most commonly in sports when someone cuts or lands awkwardly from a jump and the knee buckles inward.  When this happens, there should also be a concern about an anterior cruciate ligament (ACL) rupture as well.  In the contact athlete like offensive/defensive linemen, soccer players, and wrestlers, a blow to the lateral or “outside” aspect of the knee can cause the MCL to be injured.  The MCL can also be damaged in the non-athlete by slipping on wet floors or icy surfaces, causing the “buckling” that occurs in the athletic population.

How long does it take to recover?

If you are an athlete, the general rule for return to sport following an MCL sprain (IN GENERAL!) is 2 weeks for every grade of tear.  So, for a Grade II MCL sprain, figure about a month before you are back to sports with no restrictions and no stability issues.  However, this is largely dependent on the severity of the sprain, the sport you play, and how your rehab goes after the injury.

Do I need surgery?

Most MCL sprains resolve without surgery.  The only time surgery is indicated is if for one, it is in combination with other injuries (ACL, meniscus, etc).  Even then however, the surgeon may not fix it because surgically fixing MCL’s commonly causes significant range of motion issues.  The other time they may fix it surgically is if physical therapy fails and the person is still unstable.
Physical Therapy for an Medial Collateral Ligament Sprain
Physical therapy depends somewhat on the severity of the sprain. For more severe sprains, you most definitely should use crutches to help with the stability of the knee.  Furthermore, you should use a brace that allows a graded progression of range of motion.  In general for more severe sprains, you should start with 30-90° in the brace and increase by 10° in each direction every few days.  What this graded progression does is allow the ligament to heal properly.  If you stress it too much too soon, it will heal in a lengthened, disorganized state and won’t be stable.  An evaluation by a physician, athletic trainer, or sports physical therapist will help you determine what you should do.  After these general rules are followed, rehab for an MCL sprain should consist of the following:

1. Biking or range of motion activities to get full range back.  DO NOT force this however – if it’s painful, don’t push through it.  You can damage the healing tissue.
2. Lower extremity strengthening.  First goal should be to complete a straight leg raise without a quadriceps lag.  After that is achieved, weight-bearing activities like squats, step ups, and lunges can take place in a pain free range.
3. Balance training.  Due to the stability issues, this is a necessity.
4. Begin lateral activities once full range of motion is restored and front/back activities are painless and stable.
5. Jogging and impact activities should occur only after appropriate strength and functional testing by an athletic trainer or sports physical therapist.
6. Ice massagefor pain.
7. Pulsed ultrasoundover the ligament to help heal.  Ultrasound gets a bad rap in rehab, but this is actually a good time to use it. There are two studies in the American Journal of Sports Medicine that show this, here is one, here is the other.
8. In some cases after chronic injury with lack of range of motion,instrument-assisted soft tissue mobilization (IASTM) or cross-friction massage can be used to break up old scar tissue to stimulate the healing process.  This research is still in it’s infancy, but one study has shown it was effective.

If you suffer an medial collateral ligament injury, the physical therapists at SSOR are sound clinicians that understand the healing process and the most effective interventions for you to achieve your goals.  Give us a call, it would be a privilege to serve you.