Your Medial Collateral Ligament (MCL) is a ligament that runs down the inside of the knee. This ligament connects the thigh bone (femur) to the shin bone (tibia). It supports and protects the knee from being pushed inwards.
Just like ankle sprains, you can sprain the ligaments in the knee. This simply means the ligament has been placed under excessive stress, either through a large stretch, or a large hit to the outside of the knee (such as a tackle in sport).
A sprain means that some parts of the ligament are damaged, but not torn apart completely.
A MCL tear means the ligament has been torn apart.
The good news about the MCL, is that unlike the ACL (which we’ve all heard of!), it has a great blood supply! This means it has a much better ability to heal completely. Often, even complete MCL tears can be treated without surgery due to this healing ability.
Below is a picture of the position that MCL sprains normally occur in.
Furthermore, MCL sprains commonly occur at the same time as other knee injuries - such as a meniscus tear or an ACL tear.
How bad is my MCL sprain?
MCL sprains/tears are diagnosed based on how severe the injury is, using Grade 1, Grade 2 or Grade 3. Grade 1 is an excessive stretch of the ligament, while Grade 3 is a complete tear of the ligament.
Grade 1 MCL sprains require a short period of rest (48-72hrs of walking only), followed by 1-3 weeks of exercise rehab, depending on the symptoms.
Grade 2 MCL sprains require a short period of rest (48hrs - 72hrs of walking only), followed by 4-8 weeks of exercise rehab - there is a lot of variation here, mainly because individual injuries can be so different. Sometimes a knee brace that restricts your knee from fully straightening and bending will be used to allow the ligament to heal.
Grade 3 MCL tears often require surgery, particularly if the patient has plans to return to sport as soon as possible. Sometimes, a brace that restricts your knee movement will be used after surgery. With time, the brace is gradually unlocked to allow more range of motion at the knee.
Not all MCL Grade 3 sprains / tears need surgery.However, if you have another injury at the same time as your MCL sprain/tear, the treatment can be different. Therefore, it is best to consult with your physiotherapist, Sports Doctor and potentially your Surgeon to discuss your options.
What does exercise rehabilitation look like after an MCL sprain?
Phase 1: Protect the knee and restore normal movement.
This phase involves allowing the knee to heal. However, this doesn’t mean you should do nothing for 4 weeks!
With guidance from your physio, you can usually start some exercises from Day 1. However, some MCL sprains require you to keep the knee from bending excessively, so you must seek medical advice before you do any form of exercise.
In Grade 2 or 3 sprains, this early phase often involves being on crutches, to give the ligament a chance to heal without putting your body weight through the knee.
This phase ends when you have full flexibility of the knee, and minimal to no pain with walking.
Phase 2: Strengthen the knee
This phase is arguably the most important. Due to the rest required after an MCL sprain, the muscles around this area of the knee can become weaker. Strengthening these muscles will not only support the knee’s ligaments, but will reduce the chances of re-injury later on.
The most important muscle groups in an MCL rehab are the hamstrings, adductors, glutes and quads.
Your rehab should get harder each 1-2 weeks as you get stronger. If your rehab is easy or doesn’t change, this is a problem!
You will also need to work on your fitness while you are unable to run. With guidance from your physio, this may involve riding a bike, using a ski erg or crosstrainer, or swimming/running in the pool. To make sure you are getting stronger, we test the strength of the muscles on both legs. This makes sure you aren’t left with 1 weaker leg. This is done using a dynamometer and/or force plates that we have in the clinic at Melbourne Sports Physiotherapy.
We always say, if you’re not testing, you’re guessing!
Phase 3: Return to Run
This phase involves being exposed to jumping and landing on one leg - after all, running is just a series of hops.
As you return to running, we need to make sure that your running technique of your injured side is the same as the other side - it’s amazing how the body compensates when you are injured.
If you play a change-of-direction sport, running in straight lines is not enough, no matter how fit you are.
Your rehab should include change of direction drills. See below for an example:
Just because this is the running phase, doesn’t mean you should skip on the strength training. In fact, your strength training will be even more important during this phase, as we not only get your knee accustomed to running, but also prevent you from getting a hamstring/quad/calf strain in the process!
Phase 4: Return to Play
Once you’ve passed your Return to Sport testing with your physio, which should include strength testing &hopping testing, you’ll be provided with a plan to work your way back to playing your sport.
This does not mean you go from a running session by yourself to a full game on a Saturday!
What will usually happen is that you start with part-training, working your through small, non-contact drills into more open drills with contact. You should ideally work your way back to at least 2 full training sessions before you return to playing part of a game. Once you’re well adjusted to playing a part-game, only then will you be cleared to return to play fully.
How long does it take to recover from a MCL sprain?
Gr 1: 4-6 weeks.
Gr 2: 1-3 months.
Gr 3: 4-6 months. If you’re aiming to return to a change-of-direction sport, it can take 4-6 months to return to play.
These timelines can vary greatly, depending on your injury history, whether you had surgery, and how consistent you are with your rehab.
We can’t speed up this process for you, but you can certainly slow it down for yourself by not working hard in your exercise rehab.
Do you need advice for your MCL rehab? Are you unclear about what you need to be doing to get back to the things you love? Our physiotherapy team can help you get a clear, structured plan together. Book in online or call the clinic to get started.
Laprade, R. F., & Wijdicks, C. A. (2012). The management of injuries to the medial side of the knee. The Journal of orthopaedic and sports physical therapy, 42(3), 221–233. https://doi.org/10.2519/jospt.2012.3624
McManimon-Myers, M. (2018). Surgery and Conservative Treatment of the ACL-MCL Injured Knee.
Razi, M., Soufali, A. P., Ziabari, E. Z., Dadgostar, H., Askari, A., & Arasteh, P. (2020). Treatment of Concomitant ACL and MCL Injuries: Spontaneous Healing of Complete ACL and MCL Tears. The journal of knee surgery.
How can we help you?
At Melbourne Sports Physiotherapy our goal is to get you moving pain free as soon as possible.
But, we also want you to actually move better and live a healthier, more active and fulfilling life!
If your sports, fitness training or work has been wearing your body down, book in with one of our expert therapists so we can help you reduce your pain or stiffness, and get you moving well again.
If you are showing some signs of this condition, or simply want help and education to prevent this from happening in the future, then book in with one of our highly experienced therapists today!