Exercises for a Torn MCL

MCL injuries are fairly common, and happen when there is a direct blow to the lateral, or outside, surface of the knee, causing a sprain or tear in the medial collateral ligament (MCL). The MCL is a flat ligament that lies on the medial side of the knee and connects the tibia to the femur. There is also a small internal part of the MCL that branches off and joins the medial meniscus in the knee.

Treatment

• The best treatment for an MCL tear or strain is to follow the "Athletic Trainer's Creed," which is rest, ice, compression, and elevation (RICE). Many times, you will feel a popping sensation on the medial side of the knee when you damage the MCL. It will usually be a bit painful, and the next day could be extremely painful depending on the degree of the injury.

  Even before you get an MRI of the knee, you can start with the RICE program. Rest the knee, ensuring you stay off it as much as possible. If necessary, you should get crutches and use them to support your body weight while walking. Sit as much as possible with the knee extended and propped up. If possible, elevate the knee above heart level to help reduce the swelling. Place an ice pack on the knee for 15 to 20 minutes every few hours to decrease the swelling. Be sure to use a thin piece of material between your knee and the ice to avoid getting frostbite. If it is OK with your doctor, you can also take ibuprofin or another NSAID to reduce the swelling in the knee and help reduce the pain. Compress the knee using a neoprene knee brace or an ACE wrap. This will also help strengthen the knee if you do need to walk on it, and help to reduce the swelling.

Range of Motion and Proprioception

• After you see an orthopedic doctor and get an MRI of the knee, the doctor will probably advice seeing a physical therapist to work on your range of motion and begin strengthening the knee. You don't want to start strengthening the knee before it is ready, as you may cause more damage to the MCL by putting additional stress on it.

  The first step in recovering your full strength of the MCL is to ensure you have a full range of motion in the knee. You will need to work on full flexion and extension of the knee and be sure you are able to fully complete both. If it is too hard to extend and flex the knee with it hanging off a table, you can sit so your foot is supported by the table and slide your heel forward and back on the table to increase your range of motion.

  As your doctor and physical therapist allow it, you can begin to put weight on the injured leg, eventually leading up to bearing full weight on the injured leg. When you are bearing weight on the leg, it is very important to remember to turn your foot before stepping when you change direction, as turning the leg with the foot planted may cause further damage to the now healing MCL.

  Once you can fully bear weight on the leg, you will need to work on your proprioception, or balance. This will start to engage the muscles around the knee, which in turn will help strengthen the muscles to support the MCL. You will start by balancing on one leg and may use a cane or the edge of a table for support if necessary. After that becomes easy, you will start to balance on the one leg on a foam mat. This will increase the instability and force your leg muscles to work harder to support you. Once you master the foam mat, you can start to balance on a bosu ball, as that provides more instability.

Stretching and Strengthening

• It is very important to make sure you stretch the muscles that surround the knee, including those of the calf, quadriceps, and hamstrings. If you do not stretch these, they may compensate for the lack of use of the MCL, leading to shortening and tightening of the muscles, which may lead to future leg problems.

  Once you have full weight-bearing status on your injured leg, you will be able to perform calf raises and calf stretches, hamstring curls, and leg extensions. Once you can do these easily against gravity, the doctor or physical therapist will recommend you perform these with ankle weights or other additional resistance, which will make your muscles work harder, and therefore increase your muscle strength.

  Straight leg raises are performed by sitting upright with your leg out straight in front of you on a table or on the floor. Tighten your quadricep muscle, then lift the leg off the table, hold for three counts and place the leg back on the ground. Repeat for a total of 30. Once this becomes easy, add an ankle weight of one or two pounds. Continue increasing weight every week or two weeks. You should also do leg raises with the foot turned out to the side, then lay on your side and lift the leg upward, then also lay on the opposite side and raise the leg up toward the other leg.

  Eventually, you will be able to do squats, which will help build up the hamstrings, glutes, and quadriceps. Start out doing squats against the wall, as this helps take some pressure off the knee. Later on, progress to performing free standing squats, making sure your knees do not pass your toes, as this could cause injury or undue strain to the knee.

  You can't really strengthen your MCL since it is a ligament, and due to the lack of bloodflow in the ligaments, they won't regain tightness after being stretched out. Therefore, the best thing you can do is strengthen the muscles that help the MCL function, so they can take on some of the responsibility and allow you normal function of the knee.