Treating a sprained knee the RIGHT way, from the start, means you heal faster, stronger and have less chance of re-injury. In this series I want to show you what a sprained knee is, the most effective initial treatment and the best rehab exercises to get you back to what you love.
Knee sprains are known by a few different names:
- Medial collateral ligament sprain (MCL)
- Lateral collateral ligament sprain (LCL)
- Ligament tear
- Ligament sprain
How common are they?
Now, to avoid confusion right from the start. As there are 4 main ligaments in the knee that are commonly sprained, I cannot generalize treatment and rehab exercises to them all in one post. So, this post is about the collateral ligaments of the knee (LCL and MCL as shown in the image at the top) and not about the inner cruciate ligaments (ACL and PCL)
What and where are the collateral ligament?
The collateral ligaments are on either side of the knee, as shown to the right and act to resist your knee bending too far in, or out. As you can see by the pie chart above, the medial collateral ligament is far more commonly injured. There is a simple reason why the MCL is far more commonly injured too – Not often does someone come from between your legs to impact on the inside of your knee – It is much easier and likely for the impact to occur on the outside of your knee (stretching and tearing the inside ligament).
The collateral ligaments are most often injured in sports that involved, twisting, side-stepping and contact such as skiing, hockey, football and rugby. Generally they are injured when landing and twisting with the foot planted or when the knee is forced in (MCL) or out (LCL).
What does it feel like?
Signs and symptoms:
- Localized tenderness on the inside (MCL) or outside of the knee (LCL)
- Pain with weight-bearing and limping
- The knee feels unstable
- Muscle spasm
- Swelling in around the knee-joint in moderate – severe cases
What else could it be?
- ACL or PCL sprain – did you hear a pop?
- Meniscal tear – is there clicking, catching or locking?
- Medial plate fracture
It is important if any of these are suspected to get it checked out by your local Physio.
Surgery or conservative treatment?
Good news. The treatment of collateral ligament injuries has evolved from aggressive surgical treatments to mostly non-operative management with surgery only for chronic MCL deficiency that failed non-operative treatment or more severe, complex injuries. (4)
Sprained knee recovery time:
The general recovery time for a grade 1 and 2 sprain is 2-6 weeks (if looked after properly) and keep in mind, even if it feels bad now, if you do all the right things you will get a lot better, so persevere. Not taking knee rehab seriously often leads to far too many chronic knees, long-term disability and other injuries so YOU NEED TO TAKE THIS SERIOUSLY!
Grade 3 sprains (high grade tears) often need to be in a brace for 4-6 weeks to allow the ligament to heal up well first, so if you have a lot of laxity in your knee and very poor movement, it would be worth checking out a good brace like this one.
Self – treatment – Initial management:
In the first 72 hours it is very important to follow the RICE and HARM principles – This can take weeks off your recovery.
- Rest – From running etc.
- Ice – 10 minutes at a time, no more, every hour you are awake.
- Compression – Eg Tubigrip.
- Elevation – Get your knee above your heart when possible.
HARM increases blood flow to the area, worsening inflammation and so causing more secondary damage and a longer healing time. Keep moving (within reason of course) – It is important not to baby sprained knees and start weight-bearing through them as soon as possible to normalize movement and decrease loss of muscle activity. If necessary, you may need to be on crutches for the first 24 hours (if very painful and you really have tried to walk on it) then move to partial weight-bearing and then full weight-bearing.
Footwear: Wearing good supportive footwear with heel and arch support (such as your runners) is great as this aligns the knee correctly, takes the pressure off the injured ligaments and lets them heal well. DO NOT WEAR HIGH HEELS FLIP-FLOPS – please.
AND THEN: Click over to the next post in this series: Rehabilitation exercises to get YOU 100%.
Check out this quick balance and stability test when healing well to check if your hip strength is holding you back (especially if you have had a lot of lower limb injuries lately).
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