If you felt sharp pain over the inside part of your knee that occurred whilst your knee slipped or was pushed inwards at an awkward angle chances are good that you have an MCL sprain. The most common presentation in people is pain and swelling over the inside part of your knee after a specific moment in time injury which pushed your knee inwards towards your other knee. Your knee might be painful to touch on the inside and in more severe sprains it can feel loose or wobbly when walking on it. The position that will feel most comfortable is slightly bent, whereas straight or fully bent will likely hurt.
What is the MCL?
The MCL is a ligament that attaches from the inside top part of your shin bone to the bottom part of your thigh bone. The ligament is a taut band of fibrous tissue that helps stabilise the inside part of the knee joint. As in all good science, physio included we like to grade their severity. Grade 1 is a minor sprain or tear, Grade 2 is a partial tear of the fibres and Grade 3 is a complete rupture of the ligament.
How did this happen to me?
Most often the MCL is damaged by a specific incident from an external source (like another player in a sport) e.g. a blow/force to the outside part of the knee pushing the knee inwards.
You can see in this photo that the force of the Brazilian players tackle pushes the Korean player’s knee inwards. If this force is greater than what the ligament is designed to withstand then there will be a tear. MCL injuries can also occur without impact for instance changing direction when trying to step can lead to similar valgus forces on the knee.
What will happen during the first physiotherapy appointment?
During your initial hour long appointment with a physiotherapist here at Fixio Dee Why we will take a thorough history of the injury and any previous relevant injuries. During our assessment of the injury we will then differentiate the injury from other common injuries that can also occur over the inside part of the knee. It is relatively common to have multiple structures damaged in the one incident and in more serious MCL injuries other ligaments and structures are likely impacted such as:
- Medial Meniscus
- Pes anserine bursitis
Here at Fixio we will give you an accurate diagnosis and timeframes for recovery during the first session. Then, we’ll begin treatment right away, and start discussing an ongoing treatment plan that is manageable for you and tailored to your needs.
What does treatment involve?
For MCL injuries we focus on two key aspects of treatment: reducing your pain and inflammation during the healing phase, optimising healing and then strengthening your muscles around the knee and lower limb to ensure this doesn’t reoccur.
In the initial stages of treatment we will generally focus on the RICE method. Relative rest from aggravating activities, utilising Ice to help with the pain and inflammation, compression by using Tubigrip or skins around the joint, a period of elevation so your knee is above your heart to help with the inflammation around the joint. Generally this will be done for the first 2-7 days depending on the severity of the sprain. For grade 2-3 sprains you will be in a hinged knee brace to protect the ligament as it heals. It is also important at this stage to encourage active range at the knee joint as much as possible without aggravating your symptoms. Focusing on other parts of your lower limb and core strength is vital to prevent decline in those muscles as well as being great for your mental health. Walking in the pool without pain can be a great way to assist in recovery.
Surgery for MCL injuries is extremely rare. Generally surgery is only considered an option for:
- Elite level athletes
- MCL injuries that involve other ligaments at the knee such as the ACL or PCL
- Ongoing knee instability after a structured progressive knee strengthening program with a physiotherapist for > 6 months
The next part of treatment involves strengthening the knee and getting you back to what you love. This can include a progressive lower limb strengthening program, utilising a stationary bike and core exercises. Strengthening all lower limb musculature with particular focus on the quadriceps, hamstrings, Adductors (groin muscles) and hip muscles will help reduce the chance of further injury. This part of treatment is very specific to the individual, for someone wanting to get back to playing touch football this would involve a return to straight line running as pain allows and also sport specific drills such as stepping and graded plyometric (jumping) training.