MCL Sprain Physical Therapy
MCL Injury 101
Knee injuries are hard to ignore. Even mild knee pain can interfere with your day to day activities. While a mild knee injury may heal and resolve on its own with a little rest, injuries to the ligaments of the knee can be more serious and physical therapists are often involved from the early protection phase to the return-to-activity phase to ensure the injury heals fully and that you are as protected as much as possible from future reinjury. In this article we will discuss how these injuries occur and what factors affect their recovery.
MEDIAL COLLATERAL LIGAMENT (MCL) ANATOMY
The knee joint is considered a hinge joint whose main function is to flex and extend in a single plane. This joint is made up of the articulating surfaces of the rounded femoral condyles at the end of the long thigh bone and the flattened end of the tibia or lower leg bone. Within and around the knee joint, four main ligaments exist to limit the movement of the knee to primarily flexing and extending. When these ligaments are torn or stretched, the stability of the knee can become compromised.
The medial collateral ligament is, as it implies, on the medial or inner side of the knee joint. Unlike some of the other ligaments, the MCL is located outside of the joint capsule itself. It runs from the end of the femur to the top of the tibia. Because of its location, the MCL resists what is called a valgus moment at the knee, meaning it prevents the knee from bending inward toward the opposite knee. It also provides some rotational stability to the knee. An excessive valgus force or sudden rotation outward of the lower leg will stress the MCL. If this stress exceeds the tolerance of the ligament an injury can occur.
HOW COMMON ARE MCL INJURIES?
While there are a variety of injuries and conditions affecting the knee, MCL injuries are not uncommon. In fact, according to the American Academy of Physical Medicine and Rehab Physicians (AAPMR), around 74,000 MCL injuries occur annually. This type of injury can occur in anyone under the right circumstances, however, we most often see this type of injury in athletes.
MCL injuries are the most common knee injury experienced by high school athletes. Athletes involved in contact sports like football, rugby, hockey and soccer are at higher risk for experiencing MCL injuries but skiers may be at the highest risk. In fact 60% of skiing-related injuries are either MCL or LCL (lateral collateral ligament) injuries likely due to the forces applied to the knee while the foot is held in place by the ski.
An injury to this ligament often occurs during sudden bending, twisting or direction changes or when the outside of the knee is hit such as during a football or slide tackle. As you can see, any sport that requires a lot of pivoting, cutting or contact with other players can put the knee at risk for an MCL injury. That being said, this type of injury can also occur outside of sport. A misstep off a curb or a fall that occurs while your foot is stuck in one position can easily lead to an injury to the MCL.
WHAT ARE THE SIGNS AND SYMPTOMS OF AN MCL INJURY?
Following a knee injury, there are several signs and symptoms that point to involvement of the MCL:
Hearing a popping sound at the time of injury
Pain or tenderness along the inside of the knee joint
Swelling along the inside of the knee joint (note, because the MCL is located outside of the joint capsule localized swelling can occur outside the joint but effusion inside of the joint would suggest that other knee structures may also be injured)
Sensation of locking or catching in the knee joint
Feeling like the knee may give out when you put weight on it
Your physical therapist can help determine if your MCL has been injured based on physical exam techniques like palpation of the tissues over the MCL for pain or swelling and also with special tests that assess the integrity of the ligament. These special tests can help determine the severity of the injury based on how much laxity is felt in the knee when the MCL is stressed. Because the mechanism of injury for an MCL tear may cause injury to other areas of the knee, imaging may be recommended. X-rays are frequently utilized to ensure there are no fractures in the bones around the knee and an MRI may be recommended to confirm the diagnosis of MCL injury, assess the severity and determine if any other soft tissue structures like the ACL, PCL or menisci are involved.
WHAT’S THE PROGNOSIS?
The prognosis of an isolated MCL injury is typically good. Return to play or unrestricted activity in an isolated MCL injury depends largely on the severity of the injury.
Grade I (mild): microscopic damage has occurred to the ligament but only mild local tenderness and minimal bruising/swelling is noted without compromising joint stability. Typically takes 2-3 weeks to heal.
Grade II (moderate): partial tear/rupture of the ligament. Obvious swelling and tenderness noted over the injured ligament but joint instability is either minimal or absent. Typically requires 3-6 weeks to heal.
Grade III (severe): complete rupture of the ligament with severe swelling and tenderness. This injury may be difficult to distinguish from a fracture initially. If joint instability is minimal, it may take 2-3 months to heal. If valgus instability is present, surgical repair is likely to be recommended to re-establish joint stability.
When other joint structures like the PCL (posterior cruciate ligament), ACL (anterior cruciate ligament), menisci or bones are also injured, the timeline for healing will vary. While it is necessary to modify or take a break from certain activities to allow the ligament to heal, there is still a lot that can be done under the watchful guidance of a physical therapist to minimize loss of strength and endurance and facilitate the quickest and most complete recovery possible. If you have suffered an MCL injury or think you may have, don’t wait to schedule an appointment with one of our physical therapists, we can help you start your recovery right away.
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