What is an MCL injury?
The MCL is an important ligament which sits on the inside of the knee joint. The role of the MCL is to prevent the knee from bending inwards (valgus stress), alongside providing some restraint from rotation based forces. Most of the time, MCL injuries occur due to a contact directly to the outer aspect of the knee.
MCL injuries can present differently depending of the severity of the injury. Unfortunately
higher grade MCL injuries can also occur in combination with ACL and meniscus injury, so this needs to be taken into consideration in the assessment of this injury.
How do I know if I have an MCL injury?
Some of the signs and symptoms of an MCL injury include;
Pain located towards the inside of the knee.
Instability when loading the knee.
Pain when loading the knee.
One of the key signs the clinician will look for is joint is laxity, being how much sideways movement you knee has compared to the other side. More laxity can be an indication of a more severe injury.
Grades of this injury include;
Grade 1: On clinical testing some knee pain in the region of the MCL, but no increase in laxity in testing of the ligament.
Grade 2: Some laxity compared to the opposite side on clinical testing, however a clear end feel (demonstrating the ligament is still in tact)
Grade 3: Significant laxity and no end feel compared to the opposite side, demonstrating a higher grade injury to the MCL.
What are my management options?
Once a diagnosis has been established, a key component in management is addressing the laxity which is seen in grade 2 and above injuries. In these situations a brace is generally prescribed to assist in protection of this ligament to allow it to heal and the ligament to stiffen up. It's important higher grade MCL injuries are managed collaboratively, often with a Sports Physician or Orthopaedic Surgeon, as some of these injuries may be considered for reconstruction.
Typically bracing is completed for a period of 6 weeks, with generally a restriction in the permitted knee bend and straightening as these positions can stress the MCL in the earlier days. Following this, True Active Physiotherapy following the below framework in management of these injuries.
Protection: Within this phase the priority is to aim to settle down the knee. Typically higher grade injuries are managed with bracing during this period, whereas lower grade injuries may be managed with taping, icing and compression to allow the MCL to settle. The key outcomes from this stage is to rebuild stiffness back into the ligament, reintroduce a normal walking pattern, improve quadricep activation and gradually rebuild knee range of motion. During this phase it's generally possible to preserve foot and ankle, hamstring and glute strength.
Load Introduction: Generally during the later phases of wearing the brace, we are able to reintroduce some of the key movement patterns which will be loaded in later phases. As the brace is removed, we place a greater focus single leg based strength exercise, introducing hopping and landing progressions alongside running technique based drills to prepare for running.
Strength Development: Within this phase, we look to gradually increase the demand of our strength and jumping based exercise whilst we build running loads. Generally running progression will start with straight line based drills, gradually introducing change of direction drills. Graduation from this phase is based on quadricep, calf, glute and calf strength measures alongside a range of hopping, jumping and landing measures using our forceplates.
Speed & Power: Particularly following more severe MCL injuries, we often some impairment in the ability to cut and change direction in contested situations. Typical issues we encourage is reduced ability to cut and plant off with the injured leg (see this video for an example of this). Hence in this phase, we often work in integrating cutting and change of direction drills in contested envrioments whilst retraining good quality footwork and technique.
The physiotherapists at True Active Physiotherapy are experienced in the rehabilitation and management of MCL injuries. For more specific assistance for your injury, feel free to make an appointment online.