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Rehabilitation of MCL Injuries

Rehabilitation of a medial ligament injury to the knee. We outline some exercises and stretches.

The following examples are 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.

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.