Medial collateral ligament (MCL) injury
A sprained medial collateral ligament or MCL injury is a ligament tear inside the knee. This is usually the result of twisting or direct impact.
An injury to the MCL is the cause of impact to the outside of the knee when the knee is bent. If there is enough force, this will result in the ligament stretching or fibres to tear on the inside of the knee. A twisted knee can also cause a medial ligament sprain.
Depending on the injury, symptoms are classified as grade 1, 2 or 3.
- Grade 1: Injury in this grade can be mild and tender in the inside of the knee on the ligament. In most cases, there is no inflammation. Test this area with the valgus stress test by bending the knee to 30 degrees and applying force to the outside of the lower leg to stress the medial ligament. You will feel there is no joint laxity, though you will feel pain. A grade one tear compromises less than 10% of the fibres torn.
- Grade 2: Injury in this grade will be tender in the inside of the knee and some swelling will be experienced along the medial ligament. Test this by using the valgus stress test and there should be mild to moderate laxity in the joint and pain. The knee will not be able completely be able to bend sideways.
- Grade 3: Injury in this grade will be a complete ligament rupture. Pain in this grade will vary, though grade two is often more painful. The stress test will reveal important joint valgus.
Immediate first aid
- Apply R.I.C.E (rest, ice, compression, elevation)
- Apply a cold pack for 10 – 15 minutes every hour after initial injury.
- Wear a knee support or compression bandage to reduce swelling. Wearing a support will be most effective for grade two and three injuries.
Wear a hinged knee brace
A hinged knee, from a knee support, prevents sideways movement of the joint to protect the knee while healing. Knee supports are recommended for grade two and three injuries to restrict movement or bending while the joint is healing.
A chiropractor or physiotherapist may use an ultrasound in the early stages to treat by controlling pain and swelling.
Taping will support and protect the injured area. Taping can be done when the injury occurs or at later stages when returning to physical activity and training.
Taping technique should be considered as certain ways of taping can provide more support than cheaper hinged knee braces. Maintaining and re-applying tape is important when tape effectiveness reduces over time and stretches.
In most instances isolated MCL tears will require immediate exercises to take place very soon after the injury for the best results to be achieved long term with rehabilitation. Exercises in the first phase of rehabilitation will be to recovery any lost mobility especially in the extension plane.
Massage is effective treatment during the rehabilitation program. In the early acute stages, direct massage to the injury tissue should be avoided. When the ligament begins to heal, light cross friction massage may be used.