An in other sports such as soccer, when

 An athlete can injury their
MCL in any type of sports or physical activity. All it takes is a
sudden twisting movement on the knee when it is planted on the
ground. But the sports that one will typically see a MCL sprain in is
football, when a player is tackled awkwardly, tennis, due to the
sudden turning when chasing down the ball, basketball, landing
awkwardly after jumping for a shot or a rebound, and in gymnastics,
once again landing awkwardly during a routine. But again an MCL
sprain can be seen in other sports such as soccer, when going for the
ball. Some statistics on knee injuries include that 18-23 percent of
all football injuries involve the knee, 20-34 is the typical age
range an athlete gets an MCL sprain, 25% of all knee injuries in an
emergency room involve a collateral ligament, and about half of all
knee ligament injuries do not involve contact with another athlete
(Brown, 2009).
The MCL or Medial Collateral
Ligament, attaches above the joint line on the medial epicondyle or
thigh bone and below on the tibia or to the shin bone. The primary
purpose of the MCL is preventing the leg for over-extending inward or
Valgus but also functions as a knee stabilizer and rotater. An injury
to the MCL usually involves a strong force that causes the knee to go
inward to far, overstretching the MCL. This overstretching causes
different levels of injuries depending on the severity of the
contact. This contact can be from another player or as discussed
earlier just from landing wrong and the athletes knee ends up going
inward to far.

There are three different
grades of injuries involved with an MCL sprain. There are
respectfully known as Grade 1, Grade 2 and Grade 3 MCL sprains. With
a grade 1 MCL sprain, less then 10% of the ligament is involved. It
is the least severe of all the MCL sprains and only involves
overstretching of the ligaments. The athlete may show signs and
symptoms such as point tenderness, pain on the inside of the knee,
swelling and stiffness. Some bruising maybe involved but this usually
results 24-48 hours after injury. A grade 2 MCL injury is a partial
tear of the MCL but the ligament is still intact. An athlete with a
grade 2 MCL injury could have immediate bruising as well as swelling
due to internal bleeding. Also the joint will have some instability,
as well as the symptoms involved with a grade 1 injury. The most
severe MCL injury is a Grade 3. With this injury a complete tear of
the MCL is involved. The knee joint will be complete unstable and the
athlete will be unable to bear any weight on that joint.

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As a physical therapist,
there are a couple different tests that can preformed to determine if
the injury is involves the MCL or not as well as the severity of an
MCL injury. When assessing an athlete for a MCL injury watch how the
athlete is able to bear weight on the injury is the first key
observation. Also obtaining a history of the injury is important.
Some key questions to ask are:
What were you doing when the
pain started?
What position was your body
Did you knee collapse?
Did you hear a noise such as
a popping or crunch or did you fell any type of sensation such as a
sharp pain?
Next step is to palpate the
area. The trainer would have the athlete in the supine position with
knee flexed at 90 degrees. The trainer then would palpate the knee
looking for instability as well as if there is any pain response.
Next the trainer can preform some test such as a range of motion
test, resisted muscle test and the Valgus stress test. The Valgus
stress test is a key test in testing an MCL injury. With the Valgus
stress test the athlete is laying in the supine position The trainer
then holds the ankle firmly and places the other hand over the the
head of the fibula. The trainer then will apply pressure pushing the
knee inward. The test will be preformed with the knee at 0 degree and
30 degrees of flexion. At 30 degrees the MCL is isolated while at 0
degrees the posteromedial capsule and cruiates are tested as well.

Once a MCL injury is
determined, imaging could be need to determine the level of injury
involved. But once an injury to the MCL is figured out the most
beneficial thing a trainer can do is RICE (Rice, Ice, Compression and
Elevation). Also pain relievers such as Tylenol and Motrin can help
elevate any pain and help reduce swelling. Also a knee brace can be
worn to help stabilize the knee joint to reduce further injury. An
athlete should be instructed to use crutches in order to not have any
weight placed on the injury. Depending on the severity of the injury
surgery might be involved. If more then one ligament is involved
reconstructive surgery is usually needed, but if the injury is
isolated to the MCL surgery is usually not involved.

If an athlete suffers from
an MCL injury, recovery is important to prevent further
complications. If a grade 1 injury is determined the athlete usually
will have a recovery period of 1-2 weeks. During this time it is
important to do range of motion exercises to maintain and regain
strength to the ligament. With a grade 2 MCL injury the recovery time
tends to range from 4-6 weeks. With a grade 2 injury the athlete
could benefit from ultrasound therapy as well as deep tissue friction
massaging. A grade 3 injury could range anywhere from 6 weeks to 4
months to heal. A grade 3 injury tends to sideline a athlete for that
season unfortunate due to the long healing time. During the healing
process with a grade 3 a knee brace is beneficial to provide
stability. Also focusing on exercises to that increase movement,
strength and circulation help the healing process.

An MCL can be a very painful
and disablitating injury. But an athlete can do certain things to
help in preventing an injury to the MCL. Though these steps can’t
prevent an injury 100% they can help as a preventing measure and
reduce the occurrence of an MCL injury. Such things include avoiding
sudden increases in intensity, duration and frequency with
excersising. Also wearing shoes that have strong lateral support and
education on sport-specific techniques to strengthen the knee joint
area. Some things an the athlete can add to the warm up routine as a
preventive measure are lateral squats

Forward Lunge

Backward Lunge:

Knee Hugs:
Surgery tends not to be a
requirement for a MCL injury unless it is a grade 3 tear. With a
grade 3 tear a small hole is drilled on the side of the knee. From
here the ends of the ligament is attached to the bone using stitches
and/or screws. The ends of the ligaments will also be sewn together
the reattach them.

For a grade 1 injury there
are 4 different phases of rehab. The first weeks goals is to control
swelling through RICE and NSAIDS. Phase 2 last from 1-2 weeks post
injury. The goals during this phase is to eliminate the swelling and
begin with range of motion exercises. The hope after this phase is
that the patient is able to begin with jogging. Phase 3 ranges from
2-4 weeks post injury. During this phase the goal of physical therapy
is to regain full strength in the MCL and to begin sports specific
exercises. Phase 4 of a grade 1 MCL injury ranges from 3-6 weeks post
injury. During this phase the goal is to return to full range of
motion and stregthstrength exercises. As well as the ability to
return to any sports they were playing prior to the injury.
A grade 2-3 MCL injury is a
more server injury with the need of longer rehab. Will there are
still 4 phases of rehabilitation each phase will last longer with a
more server injury. Phase 1 last 4 weeks with the goals during this
phase to be to control swelling and gain range of motion more then 90
degrees. During the later portion of this phase rehab can begin to
focus on weight bearing exercises, with partial during week 2 and
full weight bearing by week 4. The goal during week 4 is to begin
normal walking while using a knee brace is highly recommended.

Phase 2 last 2 weeks. During
this phase the goal of rehab is to completely reduce the swelling.
Other goals include achieving full range of motion and full weight
bearing on the injured knee. By the end of phase 2 the goal is to
have the injured knee to have as much strength as the uninjured knee.
Removal of a knee brace is important during phase 2.

Phase 3 last 4 weeks with
the goals being regain full range of motion and strength. The
physical therapist would want the client to be able to begin light
jogging during this phase. By week 10 the goal is to have the injured
athlete to return to sport related exercises.

Phase 4 is the final phase
of a grade2-3 MCL injury. This phase will last 2 weeks and the goals
are to have the athlete return to full sport specific training and
competition without a brace. Also the athlete will want to have full
strength and mobility in the injured knee.


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