Anatomy
The knee joint is made up of the femur (thigh bone), tibia (shin bone) and patella (knee cap). Ligaments connect bone to bone; the medial collateral ligament connects the femur to the tibia and the lateral collateral ligament connects the femur to the fibula. These ligaments are important in maintaining the stability of the knee.
Injury to the medical collateral ligament usually occurs due to a valgus (inwards stress) to the knee or twisting which is common in skiing.
Symptoms:
Pain
Swelling
Instability feeling
Grading of ligament injuries:
Slightly stretched- no laxity or swelling, some tenderness on medial side of knee
Partial tear- Some laxity, some local swelling, tenderness
Complete tear- instability, lots of laxity, may not have as much pain as a partial tear. Grade 3 tears are often accompanied with ACL tears
Treatment:
- Unless other structures (such as the ACL is ruptured) medial collateral ligament injuries are often treated conservatively (without surgery)
Rehab for MCL injuries
Phase 1 (0-1 weeks for mild injury) (0-4 weeks severe injury)
1. Control swelling- (PRICE: protect, rest, ice, elevate, compress), electrotherapy (which can be done by your PT)
2. Control pain- ice, crutches, rest, and painkillers
3. Regain/maintain range of movement of the knee: aim for 90+ degrees knee flexion; allow -20 degrees of full extension for mild and -30 for severe strains
- Exercise: bending and straightening of knee
4. Maintain quadriceps strength
- Exercise: -Lying on your back with your knee extended try to push your knee downwards to touch the bed- you should feel your quadriceps contracting
- Hold this position for 5 seconds. Repeat 15 times
5. Normalize gait/ walking pattern and as pain allows try to walk without support
6. Maintain/ improve strength of supporting muscles
Exercises:
Strengthening
Calf raises holding onto something (come up onto your tip toes and slowly lower yourself back down x15)
Resistance band hamstring curl- lying on your stomach tie a theraband around your ankle, slowly bend your knee upwards towards your buttocks and then slowly lower down (x15) - you should feel the muscle on the back of your thigh contracting
Straight side leg raise- increases strength of hip abductors (muscles around hip)-
-Lying on your side with your injured leg on top
-Tighten your quadriceps and lift your leg about 20cm of the bed
- Try to keep your knee and hip straight and in line with the rest of your body
- Hold for 5 seconds and then slowly lower your leg back down. Repeat 15 times
4. Bridging- helps strengthen your hip, core and hamstring muscles
-Lying on your back with your knees bent
-Slowly raise your bottom of the bed, squeezing your glutes together as you do this. Then slowly return to the starting position
-Repeat 15 times
stretches
. Gentle stretches as pain allows; try to hold for 30 seconds x 3
1. Hamstring (the muscle on the back of your thigh) stretch
- Standing up, place your leg to be stretched in front of the other foot, this leg should remain straight and whilst keeping your heel on the floor point your toes upwards. Bend the other knee slightly and bend over so both hands are on that bent knee. Keep bending over from your hips until you can feel the stretch
2. Calf stretch
- Standing with your hands touching a wall, place your foot with your heel touching the floor and your toes pointing upwards against the wall. Lean forwards until you feel the stretch. Your heel must not leave the floor.
3. Quadriceps stretch
Standing up, bend your knee and holding onto your ankle pull your foot towards your buttock until you can feel a gentle stretch
Phase 2 (week 1-2 mild) (4-6 severe)
Regain full flexion by continuing bending and straightening exercises, continue stretching exercises
- if you are struggling to regain full flexion try placing a dressing gown around your foot and use this to help bend your knee
Continue to ice your knee regularly, continue to rest from painful activities
You can begin light swimming (front crawl), jogging, road biking
Progress strengthening exercises:
Single leg calf rises
Mini squats and lunges
Step-ups
Single leg bridges
Add Theraband to hip abduction exercises
Start basic balance exercises such as standing on one leg, reaching to cones etc.
Phase 3 (2- 4 weeks mild) 6-10 weeks severe
Regain full ROM and strength, return to running and be able to do a full squat
Start agility drills- ladder drills, changing direction exercises, hopping, kicking, jumping etc.
Progress exercises- increase repetitions/weights
Increase difficulty of balance exercises e.g. wobble cushion exercises- standing on wobble cushion, one-legged stand on cushion, squats and lunges onto cushion
Phase 4: 3-6 weeks mild, 8-10 weeks severe tear
Return to sports
You may be advised to wear a knee brace but do not become reliant on this
Staged rerun to match play/ competition
Sport specific strengthening which your physiotherapist will be able to guide you through
Exercises should be completed under the guidance of a physiotherapist
