LCL Sprain Rehabilitation

Here we outline an LCL sprain rehabilitation program for grade 1, 2 and 3 lateral knee ligament sprains. This will vary from patient to patient depending on a number of factors including the grade or severity of the 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 to the knee.
• Improve strength and stability with a gradual return to normal training.

Below are examples of lateral ligament rehab programs for grade 1, grade 2 and grade 3 ligament injuries:

Grade 1 LCL sprain rehabilitation

Phase one: Immediately following injury

• Duration: 1-7 days.
• Aims: Reduce pain and swelling (if any), and ensure your knee can be fully straightened and bent to 90 degrees.
• Stop play or competition immediately.
• Apply ice or cold therapy, as soon as possible following injury to reduce pain and any swelling. a compression bandage can also be worn all the time 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.
• As soon as possible providing there is no pain, try to walk normally without a brace or support.
• Start gentle stretching for the hamstrings and quadriceps, providing there is no pain. Flexion and extension exercises are a good place to start.
• As soon as pain allows begin static/isometric strengthening exercises.
• Massage may be applied after the first 2 days.
• Maintain aerobic fitness with cycling.

Phase two: 7-14 days after injury

• Duration: 2 weeks.
• Aims to eliminate any swelling completely, regain full range of motion, progress strengthening exercises.
• 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.
• In addition include half squats, step-ups, hip raises and hip strengthening exercises and single-leg calf raises.
• Cross friction massage to the ligament can be applied on alternate days.
• Maintain aerobic fitness with cycling, stepping machine, and gentle jogging although no sudden changes of direction allowed.

Phase three: 2-4 weeks after injury

• Duration: 2 weeks.
• Aims to maintain a full range of motion, equal strength of both legs, return to running and some sports specific training.
• Continue with stretching exercises daily and sports massage techniques every 3 days. 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 a 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 after injury

• Duration: Ongoing.
• Aims to return to full sports specific training and competition.
• Sports massage for surrounding muscles on a weekly basis.
• Continue with strength training as above but start to include hopping and bounding exercises.
• You 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. Use initially for confidence building.

Grade 2 LCL sprain rehabilitation

For grade 2 are more severe and require a slower and longer rehabilitation program. The rehabilitation guidelines for a grade 2 lateral ligament sprain can be split into 4 phases:

Phase 1: Immediately following injury

• Duration: 3 weeks.
• Aims to reduce pain and swelling, ensure the knee can be fully straightened and bent to 90 degrees.
• Stop play or competition immediately. Apply cold therapy and compression.
• Apply ice or 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. Crutches may be needed.
• Wear a knee brace to support and protect the ligament.
• Pain-free stretches for the hamstrings, quads and calf muscles in particular.
• Gentle cross friction massage 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

• Duration: 3 weeks.
• Aims to eliminate swelling, full weight bearing on the injured knee, full range of motion, increase strength in the injured leg.
• Continue with cold therapy and compression to eliminate swelling, particularly following exercises.
• Strengthening exercises to include half squats, step-ups, hip raises, hamstring curls and single-leg calf raises.
• It may be possible to begin to swim although avoid not breaststroke! Or use a stepper for aerobic fitness.

Phase 3: 6 weeks following injury

• Duration: 4 weeks.
• Aims to regain full range of motion, strength, and return to light jogging and by week 8.
• Continue with cold therapy following training sessions and wear a brace or support as required.
• Cross friction massage can be applied to the ligament 2 to 3 times a week.
• Strengthening exercises should be continued from phase 2 but increasing intensity and moving double leg exercises to single-leg exercises.
• After week 8, no sooner, begin to run but no sudden changes of direction though.

Phase 4: 10 weeks following injury

• Duration: 2 to 4 weeks.
• Aims to return to full sports specific training and competition without a brace for support, full strength and mobility.
• Start to add in sideways and backward running drills followed by a change of direction and agility drills.
• 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 3 LCL sprain rehabilitation

• 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.
• Rehabilitation exercises will be the same as for a grade 2 injury once the ligament has healed.