What is the MCL ligament?
The MCL is a thick, wide band of tissue that runs on the inner aspect of the Knee and connects the thigh bone (Femur) to the shin bone (Tibia). Its main role is to minimise excessive internal rotation (inward rotation) of the knee and is commonly injured in acute pivoting sports such as soccer, rugby, netball, and dance.
The types of fibre torn (superficial vs deep), location of tear (top, middle, bottom), laxity of the ligament and any other tissues damage within the knee determines timeframe of injury. Clinical physiotherapy testing can accurately diagnose an MCL tear, and rule in or out any other tissue damage that might occurred. Usually, the closer the injury is to the middle of the joint, the greater the instability. MCL injuries typically occur when there is a strong contact or force that connects from the outside of the knee, straining the MCL ligament in a ‘valgus (inward) direction. The MCL can also occur from no contact such as pivoting excessively with large amounts of force causing rapid and forceful strain on the ligament.
The philosophy of MCL rehabilitation is to:
Progress -> Stiffen -> Strengthen
Research shows that early aggressive rehab in minor MCL tears, and diligent bracing plus modifications to weight bearing and early rehab in moderate to large MCL tears have superior benefits to recovery and stability. Avoiding rotational movements and overloading the joint will lead to maximum ligamentous healing. Rehabilitation desensitises the joint and further stimulates ligament remodelling. No discomfort and no laxity are good signs to accelerate rehab through the phases of rehab training.
Strength, movement control, cardiovascular conditioning, pitch based rehab, recovery, nutrition and manual therapy are all key areas performance physiotherapists provide and guide during MCL rehab. The principles of rehab specific to MCL are:
- Atrophy/hypertrophy: Maintain/regain the mass & strength required
- Capacity: Athlete’s ability to perform repeated actions
- Peak force: Ability to perform maximum isolated actions
- Rate of force development: Ability to perform explosive actions
Injured tissue induces a loss of normal cellular process called ‘homeostasis.’ Rehabilitation aims to restore ‘homeostasis’ within the injured tissue. By having a performance mind set, and seeing a performance-based sports physiotherapist, the goals of MCL rehabilitation should:
- Return player to what they were at a minimum, and improve performance once returned to sport
- Achieve limb symmetry upon all levels of testing (strength/power/jump/speed)
- Cope with excessive performance related demands (worst case scenario’s in sport)
When playing any sports, it is important to consider the Ground Reaction Force (GRF) that is impacted on the body. See below the amount of GRF enacting on Body Weight (BW) on impact:
- Jogging = 2x BW
- High speed running 2.5x BW
- Sprinting = > 3x BW
GRF is defined as the force placed on the limb by the ground during contact. This force is dissipated as it moves up the limb because of the coordinated efforts of soft tissues, subchondral bone, and articular cartilage. Therefore, the influence of ground reaction force on each joint is dependent on its location, its congruity, and the material properties of the tissues in that area.
It is important to consider the excessive demands GRF has on the body when moving through higher speeds of running. Therefore, the athlete needs to be exposed to these forces prior to returning to team training or matches. This can be achieved through structured, progressive on field and off field exercise and running prescription.
Changes of direction Torque at the knee and other sport specific demands GRF has against body weight is even more than running alone. If you are playing a multidirectional sport, be prepared to experience the following forces through different degrees of cutting:
- Shallow change of direction angle = 2.7 x BW
- Sharp change of direction angle = 3.1x BW
- Kicking = velocity = 500 degrees per sec
- Tackling – force and mass combined of player A and player B
It is important to factor in all the paradigms of your sport and its demands; physiologically and psychologically. Fear avoidant behaviour when returning to sport can increase injury risk e.g. not feeling confident going into a tackle, sprinting at top speed or repeating multiple sprints consecutively. Thus, gradual exposure to training and games is critical to improve confidence and ensure the body can withstand those demands, and more if needed.
Book online with us to have your knee assessed by your performance physiotherapy team. You will be given a thorough, ongoing action plan to return to your sport and be supported throughout the process of rehabilitation and ongoing sports performance.