MCL Injury Rehab & Exercises (Medial Collateral Ligament Sprain)

Intro in this video I'm going to walk you through a comprehensive rehab program for the most commonly injured knee ligament the MCL your medial collateral Anatomy & Function ligament or MCL is located on the inner part of your knee and consists of a superficial and deep layer The Superficial portion is a long flat band while the Deep portion is a continuation of your joint capsule with connections to your medial meniscus both have attachments on your femur and tibia in this region you also have the posterior oblique ligament along with your MCL these structures primarily act to stabilize your knee against valgus and rotational forces the most common mechanism of injury is a direct blow to the outside of the thigh or leg while the foot is planted producing a valgus movement an injury can also occur when a valgus stress is coupled with tibial external rotation such as during skiing or sports involving cutting and pivoting in severe cases other knee structures can be injured as well including the medial meniscus lateral meniscus PCL and most commonly the ACL the majority of MCL sprains occur in Classification isolation and are generally graded on a scale from one to three based on findings during clinical examination or Imaging typically grade 1 presents with tenderness minimal to no joint laxity and a fully intact ligament grade 2 has a minor joint laxity and partial ligament disruption and grade 3 has gross joint laxity with complete ligament disruption it has been found that in grade 3 MCL injuries almost 80 percent of cases will have damage to other knee structures with a majority of these involving the ACL regardless of the severity of your Treatment Options injury an isolated MCL injury can often be treated non-operatively due to its high intrinsic healing potential here's an algorithm for the management of acute MCL injuries for isolated MCL sprains conservative treatment is the consensus across the literature for grades one and two for a grade 3 injury surgery may be considered if there's an avulsion fracture severe knee valgus alignment or MCL entrapment otherwise non-operative management is typically recommended if you continue to experience symptoms and instability after completing conservative treatment for an isolated grade 3 injury surgery might be indicated ultimately this decision is based on a combination of factors including signs of clinical instability Imaging duration and severity of symptoms and your long-term functional goals when a grade 3 injury is combined with an ACL tear surgery is usually indicated there are multiple options to consider and this decision will vary based on individual needs and surgeon preferences however it seems the general protocol is to rehabilitate the medial knee injury first allowing it to heal and then to reconstruct the ACL once there is good clinical and or objective evidence of MCL healing since most isolated MCL injuries do not require surgery the rehab principles in this video are geared towards non-operative cases if you had surgery you will likely have range of motion restrictions and weight-bearing precautions to consider so it's important you talk to your surgeon or physical therapist before beginning any new exercises Bracing the use of a hinge brace is commonly used during MCL rehab this brace may increase your confidence and protect the ligament against minor stresses that might irritate it furthermore it can help stabilize the knee when allowing early range of motion exercises and quadriceps strengthening as well as provide mechanical support however it should be noted that a hinge brace is not supported by high quality evidence and there's no consensus on whether or not it is even necessary for more severe injuries regardless most protocols for grades two and three include the use of a brace during the early phases of rehab and then either continuing to use the brace when returning to sport or discontinuing 8 to 12 weeks after injury in short you can use a hinge brace for more severe MCL injuries if it makes you feel more stable and confident but you do not want to rely on it indefinitely Rehab Overview as I mentioned earlier the MCL stabilizes your knee against rotational and valgus forces therefore the main goal of rehab is to gradually increase your tolerance to these stressors in general rehab will consist of three overlapping stages early middle and late in the early stage you will want to minimize and protect against these forces as tissues heal then in the later stages you will slowly increase your exposure to lateral and rotational movements in order to build your capacity and prepare you for the demands of your sport when you start each stage and how fast you progress and your timeline for Recovery will vary based on the severity of your injury symptoms goals Etc for example if you have a grade 3 MCL sprain you should expect the early stages of rehab and your timeline from injury to return to sport to last longer than if you have a grade 1 injury Early Stage the early stage for an acute isolated MCL sprain has four main goals control swelling regain knee range of motion restore quadriceps function and normalize walking first and foremost within the initial hours to days after an injury you will want to protect the injured tissues and allow for acute symptoms to subside then you will gradually integrate exercises for the other goals mentioned while trying to minimize increases in the pain or swelling if the exercises or other activity leads to a notable spike in symptoms you likely did too much too soon all this means is that you probably need to scale back the difficulty or the amount of exercises you do in subsequent sessions the second goal is to restore your knee extension and flexion range of motion here are two options for improving knee extension the first is quad sets straighten your leg and squeeze your quad for 10 seconds do this multiple times a day every day to intensify the stretch pull up on your foot using a towel or strap the second option is propping your heel on an elevated surface if you want to increase the stretch you can add a weight just above your knee hold this position for a tolerable 10 to 15 minutes every day for any flexion here are two options first you can ride a stationary bike start with the seat at a higher level and begin with half revolutions as your range of motion improves you can expose the knee to more flexion by lowering the seat and completing full revolutions another option is a heel slide using a towel or strap performed for 15 to 20 repetitions multiple times a day only bending your knee as far as comfortable to improve quadriceps function common exercises include squats split squats and step UPS early on these weight-bearing exercises might not be tolerable therefore you can try one of these three options one supine straight leg raise squeeze your quad and lift your leg keeping your knees straight work up to three sets of 10 to 20 repetitions two isometric knee extension you can perform these on a machine with a band or using a ball against the wall build up to the highest intensity possible with minimal to no pain if using the single leg variation is too challenging start with two legs three quad sets the quad set mentioned earlier can be progressed by using a ball against a wall or with a band anchor to an object similar to before squeeze your quad for 10 seconds trying to straighten your knee completely the last goal is to normalize walking which means you can walk unassisted without a limp this requires full knee extension and good quadriceps recruitment as demonstrated by your ability to maintain full knee extension during a straight leg raise you can also practice standing on one leg by incorporating balance exercises a simple goal is being able to balance on a single leg for up to 60 Seconds in some severe cases if full weight bearing during walking is not possible crutches might be used initially to offload the knee joint Mid-Stage the mid-stage of rehab consists of strength dynamic balance and plyometric exercises in order to further increase your knee stability and better prepare you for running and return to sport I will review four exercise categories and within each one I will provide multiple exercise options for you to choose from based on your access to equipment symptoms preferences Etc before showing you these exercises I want to mention three things one most exercises in this stage will have two to four levels of progressions that you will work through you will not progress to the next level of an exercise until you have met certain criteria with minimal to no pain two tolerance to the exercises not time will determine when you can start mid-stage exercises can you perform the level one exercises without experiencing a significant increase in swelling or pain during the movement or the next day and three remember there's overlap between the stages so even after starting this stage you will continue to follow the principles outlined in the early stage category 1 quadriceps strength you need to eventually progress the straight leg raise and quad sets from the early stage to more advanced exercises in order to appropriately load your quad muscles option one split squat progression level one bodyweight squat your goal is to perform three sets of 20 repetitions lowering your hips to at least parallel if this is too hard start with an assisted squat to a comfortable depth and build up to unassisted over time level 2 split squat start in a split stance and slowly lower your back knee toward the ground if this is too hard you can shorten the range of motion or use your hands for assistance before progressing to level 3 your goal is to perform three sets of 15 repetitions through your full range of motion on each leg level three front foot elevated split squat elevate your front foot on an object two to four inches high and lower down driving the front knee forward aim for three sets of 15 reps on each leg and level four add weight to the previous exercise by using dumbbells kettlebells a barbell Etc perform for three to four sets of six to twelve challenging reps on each side option two lateral step down progression Level One Step Up use a step or object stack six to seven inches high place all your weight through the front leg as you step up trying not to push off the back leg if this is too challenging lower the height or use your hands for assistance your goal is three sets of 20 reps per leg level two lateral step down start with one foot on a step or objects and your other foot off to the side squat down into your heel gently tap to the floor and then stand back up aim for three sets of 20 reps on each leg and level three elevated lateral step down increase the height of the objects or perform on a box or bench to help stay more upright you can hold a weight as a counterbalance perform three to four sets of 8 to 15 reps on each leg the previous single leg options require more control and have a greater chance for a dynamic knee valgus which will load the affected tissues therefore you may consider starting with the squat progression begin with body weight squats progress to a goblet squat with a dumbbell or kettlebell and eventually to a barbell back squat progress through these levels following the parameters shown you can continue to program these squats through the duration of your rehab however you will need to be able to eventually tolerate and control single leg exercises especially if your goal is to return to sport finally the isometric leg extension from the early stage can be progressed by moving through your full range of motion against resistance if you find this too hard or uncomfortable at first you can shorten the range of motion or even perform without weight Category 2 additional strength exercises your hamstrings calves and other hip and trunk muscles are important for running jumping and other aspects of sport and similar to your quadriceps can further increase your knee stability here are some options for each muscle group for the hamstrings you can perform knee bent or straight variations such as standing knee flexion with an ankle weight seated hamstring curls a Romanian deadlift or Roman Chair variations another option I like is this slider progression start with a double leg eccentric slider Bridge up and slowly straighten your knees lower down and repeat build up to moving through your full range of motion and then progress to a double leg slider where you keep your hips up the entire time next you will move on to single leg eccentric slider and finally to a single leg slider for three to four sets of four to eight reps on each leg to emphasize calf strength here are two progressions option one knee straight progression start with double leg heel raises from the floor then progress to a single leg next you will increase the range of motion you move through by performing a deficit single leg heel raise and finally level four is the same as the previous movement but now you will add weight perform for three to four sets of six to twelve reps on each leg option two knee bent heel raise progression from a seated position place a barbell dumbbells or another type of weight just above your knees start with your feet on the floor and then progress by placing them on an object about two to four inches high perform these with a slow tempo through your full range of motion lastly here are three progressions that train your glutes adductors and Associated trunk muscles option one hip thrust progression start with the double leg Bridge progress to a single leg bridge then to a single leg hip thrust and finally to a weighted single leg hip thrust you want to fully straighten your hips and squeeze your glutes at the top of each repetition option two side plank progression start with a short side plank isometric progress to a side plank isometric and then you can perform a side plank with hip abduction where you slowly lift and lower the top leg under control finally option three is a Copenhagen plank progression while this might seem intimidating especially following an MCL injury it is a safe exercise if progressed appropriately furthermore it can be an effective option for improving your tolerance to lateral forces here's a four-step progression level one squeeze a ball between your knees or ankles build up to maximal effort with minimal to no pain level 2 short Copenhagen plank isometric set up in a side plank with your top knee on a bench or chair if the inside of your knee is sensitive to pressure you can use a pad or pillow for support level three Copenhagen plank isometric straighten your legs and place your top ankle on a bench or chair if you find this too challenging or uncomfortable you can either start with your top leg at Shin level or use your bottom leg for support build up to three sets of 60 seconds on each side and level four work up to the long Copenhagen plank where you lower and lift your bottom hip and leg under control Category 3 dynamic balance once you can stand on one leg for at least 30 seconds without losing balance you will progress to Dynamic variations that expose your knee to rotational and lateral stress here are three options option one three-way RDL progression start with a single leg RDL without letting the other foot touch the ground for level two you will perform a three-way RDL where you reach your arm in three directions to the left middle and then to the right only reach to the left and right as far as comfortable for your knee and finally for level 3 you will progress the previous Movement by adding a knee Drive perform for three sets of 30 to 60 seconds on each leg option two y balance stand on one leg and then reach your opposite foot in three different directions creating a y shape you might start with smaller distances but eventually you want to challenge your balance and knee stability by reaching as far as you can in each Direction perform for three sets of 30 to 60 seconds on each leg option 3 rotation progression stand on one leg rotate your torso as far as you can in One Direction and then rotate as far as you can in the other direction start with small rotations and work up to your full range of motion to make this more challenging you can add resistance by holding a band perform these for three sets of 30 to 60 seconds on each leg category 4 optional plyometrics although there are no specific guidelines for an MCL injury research examining plyometric training after ACL reconstruction recommends you meet four criteria before starting these exercises one you have full knee extension range of motion two you have at least 120 degrees of knee flexion three you can demonstrate a good bilateral squat and four you have quadriceps strength of at least 70 percent compared to your uninjured side these jumping and deceleration drills will start with a vertical or forward component and progress to movements that expose your knee to rotational and lateral forces here are two progressions option one double leg progression start with box jumps since these will reduce Landing impact forces then progress by removing the box and Performing vertical jumps for maximal height finally you can progress to a tuck jump to further increase Landing intensity or try 90 degree rotational jumps emphasize maximal effort for each jump and perform for two to three sets of eight reps at each level option two single leg progression level one lunge pushback start with your feet together and step forward as if you're performing a lunge control the deceleration with your forward foot and then push back to the start level two forward step and land jump forward off one leg and land on the other while demonstrating a controlled Landing step back and repeat level three lateral step in land same as previous but now jump to the side making sure you stick The Landing step back and repeat and level four lateral step and jump jump off one leg land on the other and then immediately jump back to the starting leg for each level perform for two to three sets of six repetitions on each leg other exercises that often come up in the conversation of MCL rehab are lateral and curtsy lunges these can be a consideration for improving confidence in lateral and rotational movements involving deeper knee flexion however they're likely not the best option for developing strength adaptations due to their Mobility requirements and or inability to be sufficiently loaded progressing to lateral and rotational movements are key components of plyometric and return to sport drills and are probably sufficient for most people Late Stage/Return to Sport if your goal is to return to sport the previous exercises are a great starting point for improving your tolerance to jumping and Landing as well as developing certain performance attributes however before returning back to full competition there are two additional components you will want to implement the first is linear running start with jogging in a straight line progress to running and eventually work up to sprinting speeds second is cutting and multi-directional drills these will expose your knee to lateral and rotational forces at progressively faster speeds lastly understand that return to sport follows a Continuum you will start by engaging in sport specific drills before eventually progressing back to your sport however it is not until the final stage that you perform at or above your pre-injury level expect this process to take several months in order to safely build up the volume and intensity of your training Programming in terms of programming let's start with the early stage focus on regaining your knee flexion and extension range of motion restoring your quadriceps function and normalizing walking while constantly monitoring your symptoms choose one or two exercise options for each category and perform these every day multiple times a day once symptoms allow you will begin the mid-stage exercises and perform these at least two to three days a week here's an example of a two-day program on Tuesday you can work your way through the split squat hamstring slider Copenhagen plank standing heel raise and three-way RDL progressions then on Friday you can perform the lateral step down hip thrust side plank seated heel raise and trunk rotation progressions you can include the optional Plyometrics at the beginning of your workout once you meet the specific criteria running cutting and other sport specific drills can either be performed on the other days or prior to the resistance exercises it is important to remember that there's overlap between each stage for example you will still work on your knee range of motion even after you start the strength dynamic balance and plyometric exercises you will also continue to perform these mid-stage exercises even after you begin sport specific drills if it's helpful you can think of these stages more as a Continuum than separate entities Summary I know there's a lot of information packed into this video so let me summarize by providing you with the six main takeaways one most MCL injuries occur in isolation and are commonly graded on a scale from one to three two assuming another knee ligament like the ACL is not involved non-operative management is usually recommended as the first line of treatment regardless of severity three rehabil consists of three overlapping stages which focus on gradually increasing your exposure to lateral and rotational forces four the early stage will focus on regaining the extension inflection range of motion restoring quadriceps function and normalizing walking while trying to minimize flare-ups and control swelling five in the mid stage you will perform strength dynamic balance and plyometric exercises two to three times a week these will further improve your knee function and ability to handle various stressors and six the late stage is intended to increase the volume intensity and complexity of your training in order to adequately prepare you for return to Sport and competition thank you so much for watching if you enjoyed this video do us a favor and tap that like button subscribe to our Channel and even turn on notifications if you have any questions or comments drop those down below until next time foreign