Rehabilitation - LCL Sprains
A basic rehab program for a lateral knee ligament sprain. This will vary from patient to patient depending on a number of factors including the grade or severity of injury.
The following example is for information purposes only. We recommend seeking professional advice before attempting any rehabilitation.
Aims of Rehabilitation
- Reduce pain and swelling.
- Restore full mobility.
- Improve strength and stability of the joint.
- Return to full activity.
Reducing pain and swelling
- Rest. Use crutches if necessary to take the weight off the injured knee.
- Apply ice or cold therapy for 15 minutes every couple of hours. Never apply ice directly to the skin.
- Use a compression bandage to help limit or reduce swelling.
Grade 1 LCL Sprain
Phase one: Immediately following injury
- Aims: Reduce pain and swelling (if any), ensure the knee can be fully straightened and bent to 90°
- Duration: 1-7 days
- Stop play or competition immediately
- Apply ice or cold therapy, as soon as possible following injury to reduce pain and any swelling
- Apply a compression bandage to reduce swelling
- A doctor may prescribe NSAID's (Non-Steroidal Anti-Inflammatory Drugs) e.g. Ibuprofen. Do not take Ibuprofen if you have asthma.
- Rest from aggravating activities.
- Providing there is no pain, try to walk normally without a brace/support
- Start gentle stretching for the hamstrings and quadriceps, providing there is no pain
- Try the flexion/extension exercises on the mobility page
- As soon as pain allows begin static strengthening exercises (see strengthening page)
- Sports massage can be performed after the first 2 days
- Maintain aerobic fitness with cycling
Phase two: 7-14 days
- Aims: Eliminate any swelling completely, regain full range of motion, progress strengthening exercises
- Duration: 2 weeks
- Rest from painful activities, however the athlete should be able to walk normally now.
- Apply cold therapy and compression 3 times a day for 15 minutes, particularly following exercise or rehabilitation exercises.
- Continue with stretching and strengthening exercises from phase 1.
- In addition include half squats, step-ups, hip raises and hip strengthening exercises and single leg calf raises.
- Cross friction massage on alternate days.
- Maintain aerobic fitness with cycling, stepping machine and gentle jogging (no sudden changes of direction though)
- Start to introduce jogging towards the end of this period, provided it is comfortable.
Phase three: 2-4 weeks
- Aims: Maintain full range of motion, equal strength of both legs, return to running and some sports specific training
- Duration: 2 weeks
- Continue with sports massage techniques every 3 days
- Continue with stretching exercises
- Build on dynamic strengthening exercises such as leg extension and leg curls exercises as well as squats to horizontal
- Increase the intensity / weight lifted and number of repetitions. Aim for between 10 and 20 to failure.
- In addition to straight running, start to include sideways and backwards running, increasing speed to sprinting and changing direction drills
Phase 4: After 4 weeks
- Aims: To return to full sports specific training and competition
- Duration: Ongoing
- Sports massage for surrounding muscles on a weekly basis
- Continue with strength training as above but start to include hopping and bounding exercises
- The athlete should now be ready to gradually return to full sports specific training and then competition
- A knee support or a strapping / taping techniques may provide extra support on return to full training, however do not become reliant on this. It will weaken the joint. Use initially for confidence building
Grade 2 Injury
For a grade 2 are more severe and require a slower and longer rehabilitation programme. The rehabilitation guidelines for a grade 2 lateral ligament sprain can be split into 4 phases:
Phase 1: Immediately following injury
- Aims: Reduce pain and swelling, ensure the knee can be fully straightened and bent to 90°
- Duration: 3 weeks
- Stop play or competition immediately
- Apply cold therapy and compression. Apply ice / cold therapy for 15 minutes every 2 hours for the first 2 days and gradually reduce the frequency to 3 times a day over the next week
- You may need to use crutches
- Rest from all aggravating activities
- Wear a knee brace to support the ligament
- Pain free stretches for the hamstrings, quads and calf muscles in particular
- Sports massage (gentle cross frictions) may be possible from day 3 but allow a week for more severe injuries
- As pain allows, static quads and hamstring exercises, double leg calf raises.
- Maintain aerobic fitness on stationary cycle as soon as pain allows
Phase 2: 3 weeks following injury
- Aims: Eliminate swelling, full weight bearing on the injured knee, full range of motion, increase strength in the injured leg.
- Duration: 3 weeks
- Continue with cold therapy and compression to eliminate swelling, particularly following exercises.
- Strengthening exercises - Half squats, step-ups, hip raises, hamstring curls and single leg calf raises.
- It may be possible to begin to swim (not breaststroke!) or use a stepper for aerobic fitness.
Phase 3: 6 weeks following injury
- Aims: Full range of motion, strength, and return to light jogging and by week 8
- Duration: 4 weeks
- Continue with cold therapy following training sessions
- Wear a brace or support as required
- Sports massage techniques to the ligament 2 to 3 times a week
- Strengthening exercises as above increasing intensity and moving double leg exercises to single
- After week 8, no sooner, begin to run - no sudden changes of direction though
Phase 4: 10 weeks following injury
- Aims: Return to full sports specific training and competition without a brace for support, full strength and mobility.
- Duration: 2 to 4 weeks.
- Start to add in sideways and backwards running drills
- Then introduce changes of direction.
- Kicking a ball should now be possible for football (soccer) players.
- Start to return to training, provided all exercises so far are pain free.
- Gradually bring into training more and more sports specific drills, changing direction and plyometric (hopping and bounding) exercises
