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

The aims of lateral ligament injury rehabilitation are to reduce pain and swelling, restore full mobility, strength and stability and gradually return to full activity. Below are examples of lateral ligament rehab programs for grade 1, grade 2 and grade 3 ligament injuries.

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.