Rehabilitation strategies are a major part in the healing process for almost all injuries as the aim is to reduce pain and swelling, restore full mobility, improve strength and stability before a gradual return to full training. Rehabilitation is especially beneficial for MCL tears as it prevents weakening of the muscles surrounding the knee, providing more support and creating less stress on the knee.
Rehabilitation involves progressive mobilisation - to restore full range of movement through active and passive movement. This should be progressive, slow and quite pain free. It should also include graduated exercises - stretching, conditioning and total body fitness (flexibility, strength and endurance). Grade 1, Grade 2 & Grade 3 have different rehabilitation strategies to ensure optimal recovery for each grade of a MCL tear. Grade 3 tears can result in surgery of the ligament. This rehabilitation plan may not suit those post-surgery as they have a complex-specialised plan. Athletes may not be able to compete for up to 6 months post-surgery. Physiotherapy for MCL tears can be also useful in conduction with this rehabilitation plan. Some include:
|
Grade 1
Week 1: Apply RICER. Go for slow walks (if there is no increased pain). Introduce sports massage techniques, e.g. using slow movements, stroking the leg from the shin to the thigh and around the knee joint with light pressure for 2-5 minutes, gradually applying deeper pressure on the up strokes.
Week 2: Slow jog (if no increased pain), begin strengthening exercises (as below): Passive knee extension - Lying on your back, put a towel under the heel of your injured leg, relaxing leg muscles slowly straighten your knee. Hold for 2 minutes and repeat 3 times, several times a day. This excersise helps to increase mobility to the knee joint. Prone knee bend - Lying on your stomach put your legs straight out behind you. Bend your injured knees that your heel is trying to touch your buttock. Do this in 2 sets of 15.
After each exercise apply cold therapy and stop if pain persists. Other dynamic stretching can include exercises such as knee extension, half squats, step ups and calf raise. Maintaining aerobic fitness such as cycling is also an important step in the rehabilitation process. This should be done every alternate day.
Week 3: Sports massage should be done every 3 days. Build on dynamic stretching which includes leg extensions, leg curls and lunges to help get the knee back to its full range of motion and to create equal strength in both legs. Increase the intensity and repetitions to about 10-20 reps. To increase agility, running should now resume including sideways and backwards running and changing varies of speed from sprinting to jogging. Plyometric exercises should also be incorporated such as changing direction drills, jump squats and hopping movements. This works to increase power in the muscles. Week 4 and beyond: Maintain sports massage weekly. With continuing with strength exercises gradually, the athlete should be ready to commence full training and compete in competition. Strapping and taping the knee can provide extra support, but should not be reliant as it can ultimately weaken the joint. |
Grade 2 & 3Week 1 to 4: Do not bear weight on the knee, using crutches if necessary. Wear a knee brace to protect the medial ligament whilst applying cold therapy and compression. Apply RICER. Mobility excersises can be done in the knee brace e.g. Knee extension mobility (see below). This should only be done to maximum 30 degrees as it could damage the ligament more.
Sports massage techniques can also be used after the first week (Same as those for Grade 1 tears). Exercises that should be done (depending on pain) include:
Prone hip extension - Lying on your stomach, put your legs straight behind you. Whilst tightening your abdominal muscles, thigh muscles and buttock, lift your injured leg and hold for 5 seconds. Repeat 20 times. Straight leg raise - With your legs straight in front of you lie on your back. Bend your uninjured knee and place the foot flat on the floor. Tightening your thigh muscle of your injured side, lift your leg whilst keeping it straight and your thigh muscle tight. Slowly lower your leg to the floor. Repeat 30 times.
These excersises will help to increase mobility of the knee joint, strengthen surrounding muscles and control swelling. Remember to apply cold therapy after each excersise and rehabilitation strategy.
Week 4-6: Cold therapy should still be continued along with compression to decrease swelling. Ultrasound techniques can be used to help speed up the recovery process. Range of motion exercises should continue. These include mini squats, lunges, hamstring curls, step ups, hip abduction etc. Swimming or using a stepper can help maintain aerobic fitness as athletes should still keep aerobic fitness high so they do not have decrease in performance when returning to play.
Week 6-10: After doing excersises maintain applying cold therapy, and also wearing a brace or support to regain full range of motion and strength. Running can resume if comfortable with no change in direction in week 6, at about week 8 begin to change direction and speed. Continue sports massage to about 2 to 3 times a week along with the strengthening excersises mentioned in Week 1, increasing intensity and duration. Plyometric drills such as agility drills can begin easing into normal training. Week 10 and beyond: Sport-specific drills should now be performed along with full training without a brace or support. Full strength and mobility should allow for an athlete to compete in competition. |