Rehabilitation - LCL Sprains

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

Grade Three Injuries

• These are generally full ruptures. An injury this severe should require professional treatment, including an X-ray or MRI to rule out associated fractures or damage to other soft tissues such as cartilage.
• A full tear may require casting or even surgery.