Ask The Doctor Answers 2

Answers for the 2011-12 Season


Question #1
Name:
Danny
Question:
What’s the best way to rehab a torn MCL in my left knee

Danny,

The rehab for a torn MCL varies depending on how bad the tear is in the ligament.  There are three types of tears and they follow a grading system that goes from small to large tears in an ascending numerical scale.  Your physician will be able to help you gauge this and give you a plan for treatment which can include an athletic trainer or physical therapist overseeing the rehab process directly in a clinic.  I will quickly break down the three types of tears and how they are treated in a general fashion, but keep in mind that each treatment plan will be handled a little differently for each person.

Grade 1 Tears - A grade 1 tear of the MCL ligament involves a stretching of the ligament causing micro tears of some fibers in the tissue.  This is not considered severe and can be treated fairly conservatively with ice, and potentially crutches and an immobilizer for no more than a week.  Often you can start the rehab process the next day and maybe not even miss a game.

Grade 2 Tears - A grade 2 tear is determined by having the presence of minor laxity in the ligament due to a partial tear in the MCL fibers.   This may require 7-14 days of immobilization depending on the tear and laxity of the MCL.  Rehab for the knee can begin as soon as the inflammation goes down and this can take up to 4 days.

Grade 3 Tears - A grade 3 tear of the MCL is when the ligament is completely torn.  There is significant laxity in the knee.  A brace will be required for around 3 weeks and the rehab will begin mostly non-weight bearing exercises for the first month.  After that, there will be a very gradual progression of activity.

Rehab - The best way to rehab your knee from an 1st or even 2nd degree MCL tear is to begin with a gradual progression of exercise.  Your physician will give you an idea of how fast you can progress.  A good start while you are still dealing with immobilization or with pain is to do Straight Leg Raises, Short Arc Quads, and other non-weight bearing exercises.  As these become easy and your pain allows, you can begin more strengthening exercises such as using a band.  When your function and pain allows you should progress to weight bearing exercises ie. Single Leg Squats, Lunges to 90 deg, and Balance Work.  A lot of this should focus on the last 30 deg. of extension because when there is an injury, the VMO muscle, which is part of the quad, shuts down and begins to atrophy and lose neuromuscular function.  This muscle is primarily responsible for that last 30 degrees of extension (straightening of the leg). 

Hopefully that gives you a general blueprint for your rehab progression.  Consulting your sports medicine physician is important for a proper diagnosis so that a treatment and rehab schedule can be set properly.  Good rehab plans are determined by taking into consideration an accurate diagnosis, what demands are being placed on the MCL, and what amount of time is appropriate for the best healing of the tissue based on that diagnosis.  The most important thing during rehab is that you listen to your body.  It will let you know what it can and cannot do.   The goal of rehab is to place demands on the tissue so that it affects how the ligament fibers heal together.  You want them to heal in such a way that allows the same function as before the injury without over stressing it and causing a slower and poorer healing process.  It is a bit of a finesse game of finding the happy medium between too much and too little.  I hope that answers your question Danny.  As always, Valley Orthopedic Associates are here to help you if you need further guidance for any injury that may come up.

Thank you for your question Danny and we hope to see you at a T-Birds game this season.

Sincerely,

Dr. Michael Allison, MD, MPH
Phillip Varney, MA, ATC, AT/L