Causes And Risk Factors Of Mcl Injuries
MCL injuries are typically caused by either a twisting motion on a bent knee, or contact with the outside of the knee, that causes the knee to collapse inward.
Many cases of this injury to the knee ligament are the consequence of a direct collision with another athlete while playing a sport. Contact sports and sports requiring a lot of pivoting, shifting, and quick directional changes have a greater risk for MCL injury.
Exercises To Support The Mcl And Acl Of The Knee
The medial collateral ligament and anterior collateral ligament are located in the knee joint. Both the MCL and ACL help connect the thigh and shin bones. Injuries to them are fairly common among adults, but strength training can do wonders for any knee ligament. Target muscles include the quadriceps, hip flexors, hamstrings and calves.
Can You Sprain Your Mcl
MCL tears are fairly common injuries. However, its also possible to injure your MCL without completely or even partially tearing it. You can easily sprain your MCL, resulting in many of the same symptoms as a complete tear. MCL sprains can occur as a result of anything which causes the ligament to be suddenly stretched, twisted, or pulled. While trauma can often cause a complete tear, a sprain may be more likely to result from smaller causes, such as sudden movements or from repeated stress. You may notice MCL pain with no swelling, which could mean you have a milder sprain rather than a severe or complete tear of the ligament. The good news is that if you have a MCL sprain without any tearing, youre likely to recover much quicker.
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Acl Vs Mcl Injury Symptoms
Other than the obvious difference of the site of the injury, both ACL and MCL injuries have similar symptoms, such as swelling and pain at the knee joint. However, an ACL tear has a popping sound at the time of the injury while a MCL injury does not. So if you heard a pop in your knee when you got hurt, it is likely an ACL tear.
Middle Phase Mcl Injury Rehabilitation
In the middle phase of MCL rehab, you will begin to re-expose the MCL to loads it will need to handle with everyday activities or sports you participate in. This includes progressive stability exercises focusing on joint proprioception, which is your bodys ability to understand where it is in space. The knee craves stability and joint proprioception, especially with single limb activity, so it is crucial to integrate interventions that target this as part of your recovery process! In addition, focusing on progressive strengthening is also an important part of this phase as well as when transitioning into the late phase of rehab.
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What Causes Mcl Pain
MCL pain is usually caused by direct trauma to the knee. When your knee receives a blow on its outer side, it gets pushed inwards. This can stretch your MCL, often leading to tears. Conversely, a blow that hits your inner knee can also cause a ligament tear, but to your ACL, though these injuries are less common, as its less likely for your inner knee to be hit.
Its also possible for your MCL to become injured from repeated stress. Your MCL can become weakened and stretched, just like an elastic band, from overuse. Repeated movements or stresses can end up leading to MCL injuries. In this case, any simple thing could push your MCL to its breaking point, causing an injury. For instance, you could get sudden MCL pain after running.
Approximate Tissue Healing Times Based On Tissue Type
This chart above provides an excellent breakdown of how tissue healing differs not only based on the type of tissue that is injured, but also the severity of the injury. For instance, a grade I ligament sprain may take up to 4 weeks to heal however, a grade II can take up to 4 months! It is important to know that these are averages of tissue healing times, and there are many more prognostic indicators that play a role in establishing healing times, which vary from person to person. Moreover, these timelines are based solely on the biological properties of the tissue. Understanding the basics of differences in healing times will help you gain perspective when recovering from an injury. You can read more on this topic below in our tissue healing article!
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Physical Therapist’s Guide To Medial Collateral Ligament Injury
The medial collateral ligament is the most commonly damaged ligament in the knee. The MCL can be sprained or torn as a result of a blow to the outer side of the knee, by twisting the knee, or by quickly changing directions while walking or running. MCL injury most often occurs in athletes, although nonathletes can also be affected. A physical therapist treats an MCL sprain or tear to reduce pain, swelling, stiffness, and any associated weakness in the knee or lower extremity.
What Tests Will Be Done To Diagnose An Mcl Tear
Your healthcare provider may use one or more of the following tests to diagnose an MCL tear:
- Physical exam: Your provider will examine your knee to see if you have pain with palpation on the inside of your knee. They’ll also apply pressure your MCL to see if its loose, which often means your MCL is torn.
- MRI: An MRI uses a large magnet, radio waves and a computer to make detailed images of your organs and bones. An MRI is the imaging test of choice for MCL tears. It can help your provider see if you have any other soft tissue injuries in your knee.
- Ultrasound: Ultrasound uses sound waves to take pictures inside your body. An ultrasound can help your provider see how severe your MCL tear is and if you have any other injuries in your knee.
- X-ray: Your provider may take an X-ray of your knee to make sure you dont have any broken bones or other injuries in your knee.
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Exercises To Strengthen A Strained Mcl In The Knee
Your medial collateral ligament, or MCL, is one of four strong bands that stabilize your knee joint. Located on the interior side of your knee, injuries to this area are usually a result of a blow to the outside of the knee. Symptoms of an injured MCL include pain, possible swelling, and a feeling of instability when trying to stand. Depending on the severity of the injury, after addressing the initial trauma, therapeutic exercises may be recommended to rehabilitate and strengthen the knee.
How Is Mcl Pain Diagnosed
Doctors will diagnose your MCL injury based on a physical examination and your medical history. They will ask about what caused your injury, as well as the symptoms you are experiencing. Your doctor will also examine your knee, looking for signs of swelling and checking your mobility and range of motion. Your doctor may use X-rays or MRI scans to diagnose your injury, but in many cases they will be able to diagnose your injury based on only a physical examination.
Sometimes, what you believe to be MCL pain could be another condition or ligament injury, so its important to see your doctor and receive a proper diagnosis. Your doctor may ask for specific details about your injury, such as whether you have MCL pain after sitting, to help rule out other conditions.
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Exercises For Mcl Pain
There are also rehabilitative exercises that can help heal your MCL. In fact, a good exercise routine is essential not only to avoid muscle wasting while you rest your injured leg, but to help you regain full mobility and strength.
Once pain allows, you should begin doing mobility exercises, which involve stretches and movements to increase flexibility, maintain joint mobility, and loosen tension. Both heel slides and flexion extension exercises are helpful.
As your pain begins to subside, you can begin adding muscle-strengthening leg exercises into your routine. These can include calf raises, lunges, half squats, leg curls, leg presses, and step-ups. However, its important to avoid exercises which involve sudden changes in direction, as thats the kind of movement that may have caused the MCL injury in the first place. Stick with stationary muscular exercises.
Many of these exercises can be done using a hinged leg brace, ensuring that your knee remains immobilized. As you continue to recover from your MCL injury, you can add in more exerciseseventually you will return to your regular level of activity.
What Can I Do To Prevent An Mcl Tear
While not all MCL tears are preventable, there are steps you can take to lower your risk of tearing your MCL. Balance, strength and power exercises that focus on your thigh and hip muscles can help lower your risk of getting an MCL tear. In football linemen, braces have been shown to prevent MCL injuries.
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The Basics Of Ligaments
Ligaments are connective tissues that connect bones to other bones. Their primary function is to prevent excessive movement of one bone relative to another. In this way, ligaments provide support and strength to a joint, preventing injuries such as dislocations or instances of instability. As such, ligaments are present at almost every joint in our body. Some joints, like our hip joint, have what is called a good bony fit. This means that the actual shape and anatomy of the two bones that make up the hip joint fit together much like a lock and key and are inherently very stable. On the other hand, the knee joint has what is called a poor bony fit. Thus, the knee joint relies on a plethora of ligaments for support and stability, similar to our shoulder!
Special Population Cheat Sheets
I have been looking at the last few Strength and Conditioning Journals.
In the last few issues, they have included a cheat sheet covering what to do for specific special populations when it comes to designing an exercise program.
The one I am reading now is multiple sclerosis.
I have been saving them on my computer and putting them into my Special Populations folder.
I am going to refer back to this one, and to others I find.
If you get the journal or have access to the journal, I would recommend doing the same.
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Can You Still Walk With A Torn Mcl
If you have a grade 1 MCL tear, you’ll likely still be able to walk at the time of the injury, though it might be painful. A grade 2 MCL tear could make it difficult to walk at the time of the injury since your knee wont be as stable as it normally is. If you have a grade 3 MCL tear, itll be difficult to walk since your knee will be unstable, and you probably wont want to walk since itll be very painful. In most cases, treatment for MCL tears involves using crutches to limit the amount of weight you put on your affected knee.
If you injure your knee, its important to contact your healthcare provider immediately or go to the nearest hospital, even if you can still walk on it.
Can I Walk With An Mcl Injury
An MCL injury of the knee is one of the most common injuries athletes suffer. While you might not need surgery for an MCL tear, it can take a long time to heal and return to sports. In this Ask Dr. Geier video, I discuss the initial treatment and rehab of this common knee injury, including when you can walk with an MCL injury.
Earl asks: Can you walk on grade 3 MCL injury?
How Long Does It Take To Heal From An Mcl Injury
The recovery time for MCL pain varies depending on the severity of the injury. There are three grades of MCL injury:
- Grade 1: This grade typically includes mild sprains and pain, and recovery is in as little as a few days to a couple of weeks.
- Grade 2: MCL injuries in this grade typically involve more severe tearing of the ligament and swelling of the knee, can take up to a month to recover.
- Grade 3: A completely torn MCL is considered a grade 3 injury. These can take six weeks or longer to heal with treatment.
These recovery times are based on the assumption that you are doing the proper treatment for your injury. If you are not, MCL injuries can persist or even worsen. Some MCL injuries may require surgery, although this is rare.
Phase I: Program Objectives
The key is to identify the rehabilitation components that the therapist must address in order to restore normal function, and then progressing the exercise program to higher levels of function until the patient achieves an optimal level of function. The therapist considers a staged approach, and must assess the interaction of how one component is influenced by another. The components of the program include:
- Regulate post-surgical pain to avoid influence on ROM and muscle contraction.
- Reduce post-surgical hemarthrosis to avoid muscle shutdown and arthrofibrosis.
- Re-establish joint ROM as the primary objective in order to avoid deleterious motion loss.
- Advance weight bearing and development of normal gait mechanics without affecting the biological graft.
- Establish early exercise sequences to recondition the muscular system while minimizing risk to biological graft.
- Re-train the mechanoreceptor system through proprioception program.
- Establish subjective and objective data to identify deviations from norm to minimize influence on the outcome.
- Establish a functional algorithm to verify functional progression.
- Progressive functional return to activity and sport.
Re-establishing Range of Motion
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How Long Does It Take To Recover From A Sprained Mcl
The time it takes to recover from a MCL injury can vary. More severe injuries will take longer to heal, while mild injuries can clear up very quickly. Of course, this assumes that you are taking steps to heal your injury. For MCL pain relief and recovery, its important to reduce inflammation in the knee and ligament, as well as immobilize your knee so that it can stabilize and heal.
If you have a mild MCL injury, which could be a sprain or minor tearing, its possible for your pain to clear up in anywhere from a few days to a couple weeks with treatment. Usually, treatment will involve icing and resting your knee, and keeping it elevated.
For more severe injuries, MCL pain treatment usually lasts for six weeks, and can take even longer depending on how serious the injury is. Treatment for these injuries can involve wearing a hinged brace or cast, regularly icing the knee, taking pain relievers, performing rehabilitative exercises, andin rare casesundergoing surgery.
Treatment Of Grade I Mcl Tears
Grade I tears of the MCL often resolve within a few weeks.
Treatment consists of:
- Resting From Activity: This means you won’t be playing the sport where you sustained the injury while you recover.
Patients with a grade I MCL tear may be able to return to sports within one or two weeks following their injury.
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Review Of Injury Mechanism And Ligament Evaluation
Injuries to the knee follow a specific and well-defined pattern, resulting in high force production until tissue failure occurs. Multiple studies describe the key mechanism as an externally applied valgus force with the foot fixed at the distal segment.5,6,7 The application of a valgus force at the knee results in ACL/MCL tears, lateral compartment bone bruise, and lateral meniscus tear. Grood et al8 described the primary restraint ligaments and secondary structures to function like cables on a bridge, with progressive force application causing an increase in the strain that is applied to the primary ligament, as well as the secondary stabilizers. At 20 degrees of knee flexion, the MCL is the primary stabilizer to the medial compartment, with the posterior medial capsule providing a critical secondary role.
With a medial injury, three potential findings exist
- Medial pain with no increase in translation = grade 1
- Medial pain with increased translation up to 5 mm = grade 2
- Medial pain with increased translation in excess of 10 mm= grade 3
If ACL or PCL pathology concurrently exists with the MCL pathology, valgus translation will be increased in the 0 degree position and in hyperextension. The related cruciate injury will be corroborated by a positive result with either the Lachman’s test or appropriate PCL laxity test maneuver.
Preventing Injuries To The Mcl
While not all MCL injuries are preventable, you can take proactive steps to reduce the risks of ligament stretches, sprains and tears.
Balance, strength and power exercises may decrease the risk of MCL sprains. Focus on the thigh and hip muscles. Bracing as a preventative approach is controversial.
If you have an injury or currently suffer from any type of knee pain, contact one of our Steward Health Care: Center of Orthopedics & Sports Medicine to schedule an appointment. Our experienced physicians and surgeons can evaluate your orthopedic health and recommend the right strategies to treat and prevent MCL injuries.
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Private Knee Injury Course
I have been asked to do more private fitness education classes for fitness professionals in the Vancouver area. Companies and fitness professionals have been asking me to come to their facility and teach a group of 5 or 10 people about an injury topic they are interested in.
It has been fun getting these personal requests and setting up private fitness education courses for them.
In March, I have another one for a group of fitness professionals who want me to talk about knee injuries and exercises.
They have some specific questions about what to do with collateral ligament and meniscus injuries.
I know what I would do, but I always like to head to the research to see whats new.
I am reading this article right now:
Edson CJ. . Conservative and postoperative rehabilitation of isolated and combined injuries of the medial collateral ligament. Sports Med Arthrosc. 2006 Jun 14:105-10.
The article is okay theres a strong focus on diagnosis and what to do right after the injury.
Not much about what you should do when it has been multiple months since your medial collateral ligament other than wear a brace.
I will have to keep searching.
The main thing that I do is look at the hip and the core stability of the hip.
When it comes to the medial and lateral collateral ligaments, they provide stability in the frontal plane and so does the core stability of the hip.
When the core stability of the hip is poor, it puts greater stress on the collateral ligaments.