Injury to the Medial Collateral Ligament (MCL) may involve a strain, partial/full thickness tear or full rupture of the ligament.
This blog post contains exercises to help rehabilitate the injured knee following a Medial Collateral Ligament (MCL) sprain.
In This Blog Post:
Symptoms
The main symptoms associated with a MCL sprain include:
- Pain/Tenderness inner knee region
- Swelling
- Limited knee range of motion
- Giving way/Instability
Causes
Generally speaking – Injury to the MCL occurs when there is a sudden pivoting motion when the knee is in an inward collapsed position.
Test For MCL Injury
a) Knee Valgus Laxity Test
Instructions:
- Stand up right.
- Have your feet wide apart.
- Lunge away from the side that you are testing.
- Keep most of your body weight on the side with bent knee.
- Use your hand to push the side of the knee towards the ground.
Exercises To Fix Medial Collateral Ligament Sprain
STEP 1: Reduce Load
STEP 2: Provide Support
STEP 3: Address Inflammation
STEP 4: Gentle Movements
STEP 5: Releases
STEP 6: Strengthening Exercises
STEP 7: MCL Loading
STEP 8: Advanced MCL Loading
STEP 9: Strengthen Foot
STEP 10: Strengthen Hip
STEP 11: Hopping
STEP 12: Re-Introduce Pivot
STEP 13: Return to sport-specific exercises
STEP 14: Address Posture
STEP 15: Surgery
1. Reduce Load
a) Reduce The Amount Of Walking
As walking may aggravate the pain in the MCL, you may need to consider reducing the amount of walking in the acute stage.
(Keep in mind: This DOES NOT mean that you should completely avoid walking altogether. This will likely lead to the muscles in the leg getting weaker.)
b) Use Crutches
Walking with the assistance of using crutches can help reduce the amount of your body weight that is placed on your injured knee.
Note: As your knee improves – aim to wean off the use of the crutches as soon as you are safely able to.
c) Reduce Exposure to Aggravating Activities
Reduce exposure to, modify or completely avoid activities/movements/positions that aggravate the pain.
These activities may include:
- Running
- Using Stairs
- Squatting
- Sports
As the knee improves – gradually return to these activities at an appropriate pace and intensity.
2. Support
In the early stages – it is recommended to support the knee to minimize the chance of further injury to the MCL.
Here are a few ways to provide support to the knee:
a) Knee Brace
Wearing a knee brace can help provide external support to the knee.
When fitting the brace, it is important the correct size is used so that it is comfortably to wear.
b) Taping
(You will need a someone to help you apply this tape.)
Instructions:
- Lie down on your back.
- Start with the knee in a slightly bent position.
- Place anchors above and below the joint line.
- Apply the tape in an “X” orientation.
- Apply tape going through the middle of the “X”.
- Re-apply anchors.
Note: If you are allergic or sensitive to sport tape, you may need to avoid taping your knee.
c) Compression Sock
This will apply a light compression which will help stabilize the knee and minimize swelling.
3. Address Inflammation
A significant amount of inflammation in the knee can be very sensitive and painful.
This may limit the ability to perform the suggested exercises on this blog post.
Here are some simple ways to reduce inflammation:
a) Anti-Inflammatory Gel
Apply an anti-inflammatory gel to the inner part of the knee.
Do this 3 times per day.
b) Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
If deemed appropriate by your Primary Care Provider, you can consider taking an anti-inflammatory medication consistently for at least 7-10 days.
Keep in mind – there are different strengths/types of NSAIDs and is best used if the prescribed medication is appropriate to the severity of the inflammation.
c) Cold Therapy
Apply an ice pack to the inner knee region for at least 10-15 minutes.
Do this 3-5 times per day.
Note: Do not apply the ice pack directly to the skin as you may develop an irritation on the skin.
d) Try Natural Products
It is suggested that taking turmeric, ginger, chia seeds and/or fish oil capsules are natural ways to help reduce the inflammation.
(Although it is difficult to say how effective this is at reducing inflammation, it may be worth a try at least!)
e) Cortisone Injection
The cortisone injection consists of a steroid (cortisone) and an analgesic substance.
The aim of the injection is to reduce the inflammation and reduce the pain by numbing the area.
Talk to your Primary Care Provider to see if the cortisone injection is appropriate for your knee injury.
4. Gentle Movements
Following a MCL sprain, it is important to keep the knee moving through its normal range of motion.
The aim of this is to:
- Reduce stiffness
- Minimize loss of movement
- Improve circulation
- Encourage quicker healing
Note: Move the knee as much you as can comfortably tolerate without causing any pain.
a) Knee Flexion/Extension
Instructions:
- Lie down on your back on the floor.
- Bend your knee by sliding your heel towards the back of your hips.
- Then – Straighten your leg completely by sliding your foot away from you.
- Perform 30 repetitions.
b) Tibial Internal/External Rotation
Instructions:
- Sit down on a chair with your knee bent to 90 degrees.
- Keep your knee pointing forwards throughout this exercise.
- Pivot your foot in and out.
- Perform 30 repetitions.
5. Releases
The next step is to gently massage the painful area to increase circulation, encourage healing and desensitize the injured area..
a) Massage
Instructions:
- Sit down on a chair.
- Using your finger tips, apply a gentle pressure in the area of pain.
- Perform gentle circles.
- Continue for 1-2 minutes.
6. Knee Strengthening Exercises
Following an injury to the knee, it is generally a good idea to perform exercises that preserve the strength in the knee structures.
Make sure that there is no pain when performing any of the following exercises.
a) Knee Extension
(This exercise will strengthen the Quadriceps muscle group.)
Instructions:
- Sit down on a chair.
- Straighten your leg completely.
- Aim to feel the contraction of the thigh muscles.
- Hold this position for 5 seconds.
- Repeat 20 times.
- Progression:
- Use an ankle weight or resistance band.
b) Knee Flexion
(This exercise will strengthen the Hamstring muscle group.)
Instructions:
- Stand up right.
- Hold onto something for balance.
- Keep your knees together throughout this exercise.
- Bend your knee as much as possible.
- Aim to feel a firm contraction in the back of the thigh muscle.
- Hold for 5 seconds.
- Repeat 20 times.
- Progression:
- Use an ankle weight.
c) Forward Lunge (Supported)
Instructions:
- Place your foot onto a step.
- Have both of your hands supported onto a wall that is in front of you.
- For the leg on the step, keep the knee in line with your toes throughout this exercise.
- Lunge forwards as much as you comfortably can.
- Provide as much support from your hands as required.
- Perform 20 repetitions.
- Progression:
- Allow the knee to move more forwards.
- Gradually reduce the amount of support being provided by your arms.
- Hold onto a weight.
d) Step Up
- Place your foot onto a step.
- Shift your body weight onto the foot.
- Without using momentum, step up onto the step.
- Straighten your leg completely.
- Feel the contraction in your thigh muscles.
- Perform 20 repetitions.
- (If required – You can hold onto something for balance.)
e) Step Down
Instructions:
- Stand on top of a step.
- Hold onto a stationary object for support.
- For the leg that is on the step, keep the knee in line with your toes throughout this exercise.
- Slowly reach your other foot down to the floor.
- Return to starting position.
- Perform 20 repetitions.
- Progression:
- Perform the exercise slower.
- Use a higher step.
- Use less arm support.
7. MCL loading
The following exercises place an appropriate amount of load directly through the MCL to encourage healing of the injured ligament.
You may need to consider introducing the following exercises at a later phase of the rehabilitation if they are too difficult to perform.
a) Ankle Squeeze
Instructions:
- Lie down on the floor with your legs in a straightened position.
- Place a small object between your ankles.
- Squeeze the object between the ankles as hard as you can without causing any pain or knee instability.
- Hold for 30 seconds.
- Perform 3 repetitions.
- Progression:
- Repeat exercise with knees in a slightly bent position.
b) Tibia Internal Rotation Isometric
Instructions:
- Sit down on a chair.
- Have your knee in a slightly bent position and foot on the floor.
- Place the inner side of the forefoot against a stationary object.
- Bring your knee slightly in towards the midline so that your knee is pointing inwards and the foot is pointing outwards.
- Make sure that this position does not cause any pain or knee instability.
- Push the inside of your foot into the stationary object as hard as you can without causing any pain.
- Aim to feel gentle tension in the inside of your knee.
- Push for 30 seconds.
- Perform 3 repetitions.
- Progression:
- Apply more pressure.
c) Resistance Band
Instructions:
- Anchor a resistance band to a stationary object at ground level.
- Loop the other end of the resistance band around your ankle.
- Stand side ways with the injured side closer to the anchor point of the resistance band.
- Side step away from where the anchor point until there is an appropriate amount of tension on the resistance band.
- Stand up right and hold onto something for balance.
- Allow the resistance band to pull your leg towards the side without causing any groin pain.
- Keep your leg straight throughout this exercise.
- Bring your foot across your body.
- Aim to feel a muscular contraction in the inner leg region.
- Perform 20 repetitions.
- Progression:
- Increase resistance on band
- Add Speed to the movement
8. Advanced MCL Loading
The following exercises place additional load on the MCL.
Note: Apply as much pressure as you safely and comfortably can manage. Over stressing the MCL can lead to further injury.
a) Foot Slide
Instructions:
- Assume a side lunge position with the injured knee in the straightened position.
- Have the majority of your body weight on the knee that is bent.
- Push the inner side of the foot on the injured side firmly into the floor.
- Whilst pushing the foot into the ground, slide this foot towards the other foot.
- Aim to feel a contraction on the inner leg region.
- Perform 20 repetitions.
- Progression:
- Increase the amount of pressure when pushing into the ground.
b) Copenhagen Exercise
(Note: This is not an easy exercise. This exercise is usually implemented towards the end of the end phases of rehabilitation.)
Instructions:
- Lie down on your side with your injured side on the upper side.
- Support your upper body by placing your forearm (of the lower side) on the floor.
- Place the inner region of the ankle/foot (of the upper leg) onto the chair.
- Keep this leg in a straightened position.
- Have the other leg on the floor.
- Push the inside of the ankle/foot into the chair.
- Use the other leg that is in contact with the floor to provide support.
- Lift your hips off the floor.
- Aim to feel a firm contraction in the inner side of the leg.
- Hold for 5-10 seconds.
- Perform 5-10 repetitions.
- Progression:
- Add Speed to the movement
9. Strengthen Foot
Having good control and strength of the foot can help place the knee in a position where there is less pressure on the MCL.
Here are some exercises you can try:
a) Short Foot
Instructions:
- Stand with your feet facing forwards and shoulder width apart.
- Whilst keeping your toes relaxed, proceed to scrunch the under-surface of your foot.
- Drag the base of your big toe backwards towards the heel.
- Keep the base of the big toe in contact with the ground to prevent this area from lifting.
- Gently push the big toe down into the ground.
- If performed correctly, you should be able to feel the strong contraction of the muscles in arch of your foot.
- Hold this for 5 seconds.
- Repeat 20 times.
b) Single Leg Balance
Instructions:
- Stand up right.
- Balance on one leg.
- Continue for 1 minute.
- Progression:
- Close your eyes
- Look over shoulders
- Move a weight around body
- Reach the other foot away in different directions
- Catching/throwing ball
- Stand on an uneven surface
For more exercises which target the foot:
See Post: Foot Strengthening Exercises
10. strengthen Hip
Similarly to the foot (as mentioned in the previous step), having good control and strength of the hip can help place the knee in a position where there is less pressure on the MCL.
Here some exercises that strengthen the hip:
a) Clam Shells
Instructions:
- Lie on your side with your hips and knees slightly bent.
- Whilst keeping your ankles together, lift your upper knee up as high as possible.
- Make sure that you do not move your pelvis.
- Block the hip with your hand if required.
- Only the leg should be moving!
- Aim to feel a muscular contraction on the side of your hip.
- Hold for 3-5 seconds at end range.
- Repeat 20 times.
- Progression:
- Wrap a resistance band around the knees.
b) Sitting Hip Abduction
Instructions:
- Sit upright on a chair with your knees bent to 90 degrees.
- Loop a resistance band around both of your knees. (see above)
- Keep your feet shoulder-width apart.
- Push your knees outwards.
- Aim to feel a muscular contraction on the side of your hip.
- Hold for 30 seconds.
- Perform 3 repetitions.
- Progression:
- Use a thicker resistance band.
c) Single Leg Hinge
Instructions:
- Stand on one leg.
- Maintain your balance whilst you hinge forwards.
- Return to the starting point.
- Aim to reduce the amount of wobbling as you perform this exercise.
- Perform 10 repetitions.
For more exercises which target the hip:
See Post: Hip Strengthening Exercises
11. Hopping
As you reach a stage in the rehabilitation where there is an adequate amount of strength in the hip/knee/foot, you can consider introducing hopping exercises.
I have listed the exercises in order of difficulty.
Hopping Progression:
(You can hold onto something for support when performing these exercises.)
- Bounce on the spot with both feet
- Small jumps on the spot on both feet
- Larger jumps on the spot with both feet
- Jumping forwards/backwards with both feet
- Jumping side to side with both feet
- Bounce on the spot on one foot
- Hopping on the spot on one foot
- Hopping forwards/backwards on one foot
- Hopping side to side on one foot
12. Re-Introduce Pivot
a) Pivot Exercise
Instructions:
- Hop on the spot
- Change directions (Clockwise/Anti clockwise)
- Continue for 30 seconds.
- Progressions:
- Take larger hops
- Move quicker
13. Sport-Specific
By this stage of the rehabilitation, you can start to gradually return to your regular sport-specific activities at a lesser intensity. (If Applicable)
Over time – Progress the intensity of your movements at an appropriate pace.
14. Address Posture
In some people, there are certain postures involving the legs which may predispose one to a MCL injury.
(Note: The presence of the following postures does not necessarily mean that you will develop an injury to the MCL.)
a) Knee Valgus
Knee Valgus is where the knee collapses inwards.
This knee position may place additional pressures on the MCL.
For more information on correcting this:
See Post: Knee Valgus
b) Foot Overpronation
Foot overpronation is where the foot/ankle excessively rolls inwards.
This foot position can cause the knee to collapse towards in the midline of the body (Knee Valgus) which may place additional pressures on the MCL.
For more information on correcting this:
See Post: Flat Feet Exercises
15. Surgery
If you have persisted with the recommended exercises and the knee continues to be significantly unstable and/or painful, you may need to consider getting a review with an Orthopedic Knee Surgeon.
Surgery involves the direct repair of the torn MCL or reconstruction using a graft from the hamstring tendon/donor.
However – Depending on several factors such as the severity of the injury, how unstable the knee is and timeframe to return to sport/activity, you may need to see the surgeon sooner than later. (If in doubt – seek medical opinion.)
Conclusion
Injury to the Medial Collateral Ligament (MCL) may involve a strain, partial/full thickness tear or full rupture.
Follow the steps mentioned in this blog post to give the best opportunity for your knee to recover.
What to do next
1. Any questions?… (Leave me a comment down below.)
2. Come join me on the Facebook page. Let’s keep in touch!
3. Start doing the exercises!
Disclaimer: The content presented on this blog post is not medical advice and should not be treated as such. It is not intended to be used as a substitute for professional advice, diagnosis or treatment. Use of the content provided on this blog post is at your sole risk. Seek guidance from a healthcare professional before starting any exercise and/or implementing any recommendation. For more information: Medical Disclaimer.
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