Rehabilitation of a medial ligament injury to the knee. We explain the rehab process at various stages of mcl sprain treatment for grade 1, grade 2 and more severe grade 3 medial ligament injuries.
The following examples are for information purposes only. We recommend seeking professional advice before attempting any rehabilitation.
Grade 1 Sprain:
The rehabilitation guidelines for a grade 1 and 2- or mild medial ligament sprain can be split into 4 phases:
Phase 1: Immediately following injury
Aims - to reduce swelling (if any), ensure the knee can be straightened fully and bent to more than 90 degrees, begin pain free strengthening exercises.
Duration - 1 week
- Rest from activities that cause pain. As pain allows, aim to walk normally without support or pain.
- Apply cold therapy and a compression support to limit any swelling. Apply ice for 15 minutes every 2 hours for the first day. The frequency can be gradually reduced to 3 times a day over the next few days. Do not apply ice directly to the skin (ice burns!)
- Pain free stretching exercises for quadriceps and hamstring muscles as well as flexion / extension mobility exercises.
- Static strengthening exercises as soon as pain allows.
- Sports massage techniques can usually be applied from day 2, specifically to the ligament.
- Maintain aerobic fitness with cycling.
- Apply cold therapy after each strengthening / stretching session.
Phase 2: After 1 week
Aims - Eliminate any swelling completely, regain full range of movement, continue with strengthening exercises and return to slow jogging.
Duration - 1 week.
- Rest from painful activities, however the athlete may be able to jog slowly as long as it is not painful.
- Apply cold therapy following exercise or rehabilitation exercises.
- Continue with stretching and strengthening exercises from phase 1.
- Introduce dynamic strengthening exercises such as knee extension, knee flexion, 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).
Phase 3: After 2 weeks
Aims - Maintain full range of motion, equal strength of both legs, return to running and some sports specific training.
Duration - 2 weeks.
- Continue to apply cold therapy after training sessions.
- 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. Increase until your strength equals the other leg.
- 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 - 3 to 6 weeks.
- Sports massage for surrounding muscles on as 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 or 3 Sprain:
For a grade 2+ and particularly 3 sprain it is important that the ends of the ligament are protected and left to heal without continually being disrupted. The rehabilitation guidelines for a grade 2+ or 3 medial ligament sprain (more severe) can be split into 4 phases:
Phase 1: Immediately following injury
Aims - Control swelling, maintain ability to straighten the leg bend the knee to more than 90 degrees, begin strengthening exercises.
Duration - 4 weeks.
- Rest from all painful activities. Use crutches if necessary - non weight bearing to start with, then partial weight bearing (week 2) and by end of week 4 aim to be walking normally.
- Wear a hinged or stabilised knee brace to protect the medial ligament.
- 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.
- Pain free stretches for the hamstrings, quads, groin and calf muscles in particular.
- Sports massage (gentle cross frictions) may be possible from day 2 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: Following week 4
Aims - Eliminate swelling, full weight bearing on the injured knee, full range of motion, injured leg almost as strong as the good one.
Duration - 2 weeks.
- Continue with cold therapy and compression to eliminate swelling following exercises.
- Introduce dynamic strengthening exercises - knee flexion, knee extensions, half squats (both legs), step ups, hip raises, hamstring curls and single leg calf raises.
- It may be possible to begin to swim (not breaststroke!) or use stepper for aerobic fitness.
Phase 3: Following week 6
Aims - Full range of motion, strength, return to light jogging and by week 10 from injury, return to sports specific exercises.
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 weeks.
- Strengthening exercises as above increasing intensity and moving double leg exercises to single.
- After week 6, no sooner, begin to run if comfortable- no sudden changes of direction though.
- After week 8 begin to run sideways and backwards so by week 10 the athlete is able to begin to change direction at speed.
- For footballers, kicking may now be possible.
Phase 4: Following week 10
Aims - Return to full sports specific training and competition without a brace for support, full strength and mobility.
Duration - 2 to 4 weeks.
Gradually bring into training more and more sports specific drills, changing direction and plyometric (hopping and bounding) exercises.