Treatment & Exercises for MCL Strains

[Music] hi guys this video is about MCL strains or medial collateral ligament strains of the knee which is the liquid ligament that runs over the inside of your knee what I've got to look at is the anatomy the mechanism of injury because if you understand the mechanism you'll know why you need to avoid certain things during the recovery period we're going to look at healing times how long can you expect it to take to get better depending on what else you've injured together with the MCL and then lastly I'll talk you through the treatment process and specifically the rehabilitation exercises good so my name is Mariah for those of you don't know me I'm the physiotherapist from sports injury physio comm we can get online physiotherapy assessment as well as treatment of your injuries so have a look at the description of this video if you want the link to the website now anatomy of the MCL and it's interesting because things always train changed with regard in medicine and physiotherapy and things as we learn more so even for the medial collateral ligament the MCL we've now realized that actually it's more than just one ligament there when I studied I'm pretty sure we only knew about the superficial and the deep MCL ligaments we didn't know about the posterior oblique once you'll notice there that's a picture of your knee on the left-hand side kind of looking from behind at an angle at your right knee so what it's showing is there is two ligaments the S stands for superficial at the front that's just a per fishel MCL running there but then you've also got a fat one that comes to the back kind of and that's the post or oblique ligament and both of those work really hard to give you loads of stability on the inside of your knee and then if you cut them away and take them fully away you'll notice that they're on the right-hand side of your screen is a tiny look at little ligament that's deep and that's the deep MCL and that attached also to your meniscus medial meniscus on that side now for interest sake this is just for clinicians really it's academic importance really is what they've shown or what they have shown more consistently through the researchers you know how you test for the aBCL with the knee fully straight and you provide the valgus force and then you test it with about twenty to thirty degrees bend in it so what they're saying is if you find it's lacks in both those positions especially the straight one it's more likely that you've turned the posterior oblique ligament as well whereas if they only have pain laxity in their thirty degree knee bend position it's more likely just the superficial MCL that you've strained but to be honest that really doesn't matter for your to know specifically like that for your treatment because treatment is according to symptoms and according to what the patient reports for you so it's just for interest sake good so the mechanism of injury now if I can demonstrate this to you it's very much mechanical if you think about it let me just get this thing out of the way there we go that's better so if we look at the knee you can picture that ligament coming over the inside or those three ligaments stabilizing the inside of the knee so it's forces that push the knee from that side that's going to force it into that position you'll see that that's when they're really gonna have to work so usually you tear it if there's either impact from the side or if you step off something in your knee suddenly goes into that position and it was ready for it it's anything where you get a sudden force inwards but you can get a chronic strain as well where because of the way you walk or the way you run if you don't have instability around your builders or your foot just collapses too much you're constantly the knees taking more strain more strain more strain on the inside rather than taking it through the leg in a position which distributes it more evenly that can actually cause a chronic strain of your MCL as well and that's quite a common one that you can see in runners or walkers if the paint comes on over a length of time and we'll talk a little bit about that more where rehab is concerned so why is it important to understand that it's those strains that makes the knee turn in that usually causes the injury because especially during the first few weeks of treatment you want to avoid forces that pushes the knee in or makes it carrying more weight on the inside because you want the ligament to knit and the fibers to to heal so keep that in the back of your mind now also because of the mechanism of injury of it usually being forced into a rail this force and a bit of rotation you can also get it's quite common to get ACL so and here in cruciate ligament and medial meniscus injury together with the MCL injury but it is totally possible to have a pure medial collateral ligament injury on its own as well so healing times luckily your MCL actually has really good blood supply especially the superficial one so they may heal quite quickly for a ligament and the healing phones for your MCL if it doesn't have anything else going on it's between four to eight weeks so four weeks for a less severe one eight weeks for more severe one but because of the mechanism of injury you can injure your meniscus you can injure your anterior cruciate ligament as well and as soon as you've got those two together with the MCL your rehab time will be a bit longer another thing is you can get bone bruising so during that force where you've especially if it's a traumatic one where you get a sudden sharp pain there because of something you've done the bone surfaces can squash together and you can get a bruise in those bones just like you can get a bruise in other parts of your body and bone bruising takes longer to heal then the ligament itself so your pain can persist for much longer so you may it may take about between two and four months for that bone bruising to go so you may still get in that area even though the ligament has already healed that's where it can be useful to have scans because it can explain why your pain is carrying on longer than what you expect it to carry on but honestly for a pure MCL strain I don't tend to send my patients for scans for that because you can easily diagnose it through the history they give you and certain movements and things you do and the healing time or that the new process is quite simple to be honest so if we look at treatment the treatment approach for this will depend as with most things very much on the severity of your injury and also a little bit about with regards to the mechanism of the injury so if we think that it's a chronic overuse strain instead of a cue tear you maybe focus on rehab or on the hips and things a lot more initially and get them going quite quickly without overuse one whereas when it's a cutie you want to maybe protect the knee a little bit more and it may be secondary that you look at the instability and things that is not that because it's not part of the initial injury or the injury mechanism necessarily that they have they're cute a I'm not sure if I'm clear there but you'll see in a minute what I mean with that so we get roughly three grades of NCL tears we're great one it's very - strain great - significant number of fibers that's torn but not that many great three it's fully off so you've got quite a bit of instability there now even grade threes that's fully torn off that's really well with conservative management and the research is definitely on the side of conservative management here but you do not have surgery before you've tried conservatively to get this better you don't necessarily need to use a brace but braces can be very useful especially if you've got a grade three so they used to stick people in plaster casts and really rigid braces where it doesn't allow any movement of the leg thinking that we'll help the ligament to knit and to heal but loads of studies have now shown that you do not want to immobilize that leg fully because if you do that actually you mess with the collagen turnover so you're getting the collagen that replaces the torn fibers in that ligament is of a poorer quality they're not as strong and you get fewer of them being formed so you're much better off being placed in a hinged brace where the knee can move forwards and backwards but the side to side motion is limited to an extent so it's got those hinges on the sides and you can immediately start weight bearing because what they've shown with that is that actually stimulates the collagen to be produced much more quickly it helps to realign that collagen because remember the first if you've listened to any of the healing videos that I've made initially when new cells are formed for to replace injured ones they kind of just formed randomly that they they not organized properly so through careful movement the body realized those fibers in the direction that it needs it to be and it strengthens it so using a hinged brace really good for grade three especially but rigid braces and full leg casting should be totally avoided now how long to wear a hinge brace when you've got a grade three tear is also a little bit up in the air stone so some studies have worn it for six weeks to help stabilize that whereas other studies on younger players so these were school students they're only worried for one week before they took it off and did they react properly or moved around without it I think there's two things that would guide my well there's three things really that will guide my decision with regards to that one is if it's a really really you know painful knee and the extent of that grade three if there's any code other things that you can tell that it's just making that knee feel a bit more and if the patient reports to you that it feels really unstable I would probably wear that brace for a longer time rather than a shorter time second the age of the patient so it was basically kids that only wore at for a week and kids recover really quickly whereas adults don't recover that more quickly because their bodies don't replace cells that that quickly so I guess the younger population may get away with shorter bracing whereas all the people may need a little bit longer bracing and then thirdly and probably the most important factor for me for how long I would get somebody to wear brace is the symptoms they report so if they're really comfortable that knee doesn't feel as if it wants to give a work give way they can do their exercises without the brace on really good without any sensation of giving away I would start weaning them off the brace so it's there's no clear cut you have to wear it this long but make sure if you're going to use a brace it's definitely a hinge brace and not a solid brace then also they need to take the brace off when they do their exercises so if you're doing your rehab exercises it's without the brace on because you want to teach that leg the stability and how to control it properly of course within the first week if it feels really unstable and you don't feel secure on your leg absolutely do it with your with your brace on but you need to start doing your rehab exercises after that very carefully without the brace on okay braces are really just there so that when you walking around outside and you're doing activities where you're not necessarily 100% concentrating or there's a there's a chance of somebody bumping into you that it supports gives you that extra support I haven't used brace as much in my career so far because for most people a brace is really uncomfortable so especially for my older patients when they come in and these braces are bulky if you're wearing a brace that gives you proper support they're really bulky things they don't always fit everybody's thighs properly so I would tend to rather explain to them that it's really really important for the next one two three week that we avoid that valgus force that turning in force so we could put you in a brace but if you're gonna be really careful and make sure that you don't walk on uneven ground don't get a hit from the side or anything like that then you can get away without wearing a brace and normally if I really explained to them to avoid those twisting actions avoid any uneven grinder things they very good at looking after that those needs and I've not had anybody injure themselves through that and they've been able to get away without wearing braces if I ever it's just it's a really unstable knee I would make them wear a brace now let's see so early weight bearing is important we've spoken about those ok so if we look at rehabilitation your first aim was a torn MCL is to get your range of movement of your knee back so flexion and extension and it's as easy as just gentle movements I tend to tell my patients for the first day to just let it settle so I won't get them actively moving things I'll tell them to move it as you feel you want to move it but from day two I get them to do bend extend bend extend usually on the bed is quite comfortable because you can support your leg and just gently extend and Bend extend and Bend but you can do it and sitting where you just it's the thing it's got a added benefit that you get your quad muscle work movement where you just extend your leg you see that can you hold it hold it hold it and bend it and often for the MCL straightening the leg can be more painful than bending the knee actually so you don't force it within that first period you do what you can do with it but you try to get your full range now if you've got a mild strain you to get that full range within a few days if it's a more severe strain it may take you a week or a little bit longer than that but just keep it moving get that full range through that knee you also want to start working on on getting the quads firing so that exercise I've just shown you where you just extend like hold it there for a period of time bend it back can be a brilliant one to start getting that functioning then also we want to use it in a close straining position because that's open chain so when we walk as close chain because your foot is planted then then you go down on your foot do you prepare yourself for words so things like this is all early stage by the waist guys so for early stage to get that done it's just slow double leg squats but you'll notice that I'm not necessarily even going low you just go to where you feel comfortable to do it hold it hold it hold it come back up but now remember this ligaments job is to provide stability on the inside so you want to now start teaching the rest of your body to control that knee properly so that the poor ligament doesn't take all the strain so when you're doing a squat it's not just about going down and up it's about thinking and looking at where your knees moving so knee moving line with middle of toes so you've got a nice straight line so you don't want to see them moving in or moving out as you do that so start using these early stages to teach yourself that movement baton it very much depends on your foot stability as well as your strength of your glutes where your leg is going to move when you're on one leg and when you're walking and running so you can also in these early stages start working on glutes strengths or stuff like double leg glute bridges side leg lifts all of those low load exercises and just get the glutes firing and start getting them awake or waking them up balancing exercises super important but depending on the severity of your strain you may want to wait a few days and this can start immediately so when you're balanced you definitely think about not allowing that leg to move in or out and when we think of balancing exercises it's not boom going to the most difficult one you can think of I think to really get my patients to just they think about their pelvis alignment standing on two feet so this is straight then you slowly shift your weight over tend to have a little knee bend when I do that and then you just left the other leg a tiny bit off the floor so that much where's my that much so it's not getting up in there because often when people do that they start going all over the place so make it quite nice and safe and easy at the start and you want to see that this leg is nice and solid and you just go for five to ten second holds before you rest eventually you want to build it up to thirty seconds or whatever you can do closing your eyes looking turning your head from side to side you can even do things then like a single leg deadlifts and stuff where you really make it difficult to keep your control but always the idea is that knee needs to stay in perfect alignment that it's not turning in and foot needs to stay that it doesn't roll in because that teaches you control again okay so that's so kind of the starter exercises then from there on we need to work on control or strength of the quad strength of the hamstring strength of the gluts calf string so you can start with all of those exercises at whatever level you can feel doesn't impact your knee so if you've got access to a German brilliant because you can already start with quite heavy knee extensions as soon as you've got the range leg curls car phrases because none of that will affect this too but the that ligament directly if you're doing it with good form you want to be able to do squats through full range eventually and you also want to build up to doing them with quite a bit of weight extra once you can do that you have to move on to single leg stuff so because when you run and when you walk you don't do it on two legs at a time you do it on one leg at a time so you need to teach your body that control again so the the order in which we do it is you get your range of movement first comfortable then just bodyweight squats nice and stable you're happy with them cry bodyweight lunges but you're not lunging into the position you're literally assuming the position just dipping in and out but the whole time thinking about that me cap aligned with middle of the foot we're working in a straight line okay once you can do those things easily you add weight to it you see can I build this up with a bit of weight then from there you want to make it a bit more unstable so then you start working single leg squats for single leg supported squats or single leg stance from a chair is quite a nice exercise where you make it high enough and you try to get up and down on one leg but you're keeping that knee in perfect alignment your choice of exercise will depend on the person in front of you I mean for my older patients if you just want to garden and walk their dogs I'm gonna give much less athletic exercises that I am for the younger person who needs to go running and play football okay and I won't necessarily train into such a high and unstable level for the person who just wants to walk and doesn't do sport with a pivot and stuff so as soon as you've got your control on a single leg in a straight line then you've got to start adding in rotation forces because that mean that ligament needs to be able to withstand those and again it can be as easy as standing on one leg and pulley system with you pull okay Oh lunging in different directions putting a band around your knee that pulls it into a certain direction while you're doing the lunge or a step up all of those things can be really useful now if you're doing a sport where you've got to run and you've got to change direction and stuff you have to make sure that you first get back to jogging in a straight line are you comfortable so as soon as soon as you've got your full range in your knee and you can do a nice comfortable squat you can start with a run walk and just test that out but remember when you run walk as well you want to make sure that you don't feel your knees turning excessively you're thinking about your form knees pointing forwards while you're running keeping your it's light if you're comfortable running in a straight line you have to start doing some gentle changes of direction but if you somebody who does an agility type sport like football for instance you start by just running slowly in and direction and slowly changing direction before you do it to the other side and as you get better controlling that you speed it up because the faster you do it the higher the fall so you've got to do a few sessions with slow first you want to do other jealousy drills like grapevines and stuff as well but all of that you start with slow and work your way up to fast if you're just a runner and oops er good hey tickling my nose just somebody who runs so you're doing distance running and things so you're not really on about changing direction and stuff like that you just start with getting back to easy running easy pace running thinking about form because especially if you're running slower it's much more easy to collapse into poor form where that then oh yes for the guy who does sports and quick changes of direction and especially if you're doing jumping type things you have to work in hops and jumps in different directions you'll start with double leg hops straight directions sideways and stuff and then move on to single leg hops because that's higher load good so there was one question from somebody in the on my sports injury page where he said he had injury to his knee about ten years ago and he had keyhole surgery for the cartilage and that worked really well and then six months ago he twisted quickly I felt a sharp pinch on the inside of his knee and he sent me a picture so it looks as if he's pointing to to the upper portion of the MCL MRI scan showed absolutely nothing in the cartilage and the surgeon suspecting ligaments what to do so what I would do with that is I would definitely start working on good glute strength so doing starting with double leg bridges working up the single leg bridges thinking about your when you do those I would work on double leg squats until you're comfortable with them make them maybe into goblet squats and things to get some weight through that and once you're happy with that work on to single leg supported squats where you really make sure your knee moves in good alignment doesn't turn in or out and it doesn't cause you pain while you're doing it at the same time you start working on single leg balance then you get your balance really good so that once you good with your single leg supported squats and your balance you can put it together and you can make it an unsupported single leg squat that's then more taxing on your balance and your your learn through there so yes that's pretty much what I would do is I would work on really good glute strength work on your you're supported movements first that you get your pattern of your leg moving properly and then quad strength and balance in single leg activities and then when you do go for runs or walks make sure that you think about where that leg moves and if you feel that it's still turning in despite you trying to be good with those things and you feel that may be coming from your foot and may be worth getting somebody to check if there's a bit of over pronation going in your foot or maybe your shoe just needs to be slightly more supportive on the inside that it doesn't allow so much turning in so there's a few things to think about there excellent let me know if you've got any questions and if you need more help with the injury you're always welcome to consult me via video go link is in the description of this video take [Music]

Channel: Sports Injury Physio

Views: 179,560

Keywords: mcl strain, mcl knee injury, mcl knee injury treatment, mcl knee exercises, mcl knee pain exercises, mcl knee sprain, mcl knee pain treatment, mcl knee rehab exercises, mcl knee rehab, mcl knee recovery time, mcl knee injury recovery time, medial collateral ligament knee exercises, medial collateral ligament knee rehab, medial collateral ligament knee injury, medial collateral ligament knee rehabilitation, medial collateral ligament knee pain treatment

Id: pMtaeuOW7JE

Length: 25min 47sec (1547 seconds)

Published: Sun May 24 2020