Lionel Pannunzio PT / SCS
Medial Collateral Ligament Injury In Soccer - Rehabilitation - Weston - Florida
Medial collateral ligament (MCL) injury is one of the most common knee injuries, especially in young athletic patients.
Anatomy of the Injury
The medial collateral ligament (MCL) is a broad, thick band found on the inside area of the knee. It runs from the upper/inside surface of the shin bone (tibia) to the bottom/inside surface of the thigh bone (femur). This ligament stabilizes the joint on the inside of the knee. The MCL is one of the most common knee injuries in competitive and recreational soccer. It can occur by itself or in combination with other ligaments.
Incidence and statistics
Lundblad M, Waldén M, Magnusson H, et alThe UEFA injury study: 11-year data concerning 346 MCL injuries and time to return to play. Br J Sports Med 2013;47:759-762.
This study follow 27 professional European teams were over 11 seasons
This largest series of MCL injuries in professional football
In overall terms, 8029 injuries were documented. From those 8029 injuries, 346 (4.3%) were MCL injuries
The average lay-off was 23 days
Mechanism of Injury
It has been documented that most MCL injuries (75%) occurred with a contact mechanism, where the two most common playing situations were being tackled and tackling.
Other Common Mechanisms
Outside stress to the knee (i.e. when the soccer player's foot is caught while preparing to kick the soccer ball with the side of the foot).
Combined outside force and outside rotation force to the knee (i.e. when your player's cleat is stuck while attempting to cut away from that side).
Direct blow to the outside part of the knee (i.e. from a side tackle).
Non-contact through fall to the side with the foot firmly fixed.
How Does it Feel?
When you experience an MCL injury, you may feel:
* Pain on the inner side of the knee
* Swelling and bruising at the inner side of the knee
* Swelling that spreads to the rest of the knee joint in 1 or 2 days following injury
* Stiffness in the knee
* Difficulty or pain especially when trying to bend or straighten the knee
* An unstable feeling, as though the knee may give out or buckle
* Pain or difficulty walking, sitting down, rising from a chair, or climbing stairs
Types of Injuries
There are 3 degrees of sprains to the MCL:
A grade 1 MCL injury is the least severe. It means that your ligament has been stretched but not torn. Recovery from a Grade 1 MCL injury can take from a few days to a week and a half to heal sufficiently for you to return to normal activities, including sports.
A grade 2 MCL injury means that your ligament has been partially torn. This usually causes some instability in your knee joint. It can take from 3 to 8 weeks.
A grade 3 MCL injury is the most severe type of ligament injury. It occurs when your ligament has been completely torn. Joint instability is common in a grade 3 MCL sprain. Healing time will be 6-12 weeks unless it is associated with damage to the ACL, in which case the recovery time may be longer
Most MCL injuries can be managed conservatively with good results
The average lay-off In Profesional Soccer was 23 days. In the amateur or recreational player the average time for recovery will be 6 weeks.
When the injury is solely in the MCL, player can recover without the need of surgey. The MCL is an extra articular ligament with good blood supply that warrants full recovery most of the time. On the other hand if the MCL is part of an array of injuries like ACL or meniscus, this other condition may need surgery but the MCL still will heal but itself. There are some cases that the surgeon will need to reattach ligament through a surgical procedure but it less common.
Early Stage (1-2 weeks)
Protect the area from further injury by avoiding soccer exercises that produce pain. A Full-Length-Hinged brace for Grade 2-3 sprains or Short-Hinged Brace for Grades 1-2 sprains is recommended to avoid stress on healing ligament. If ambulation is painful Crutches may also be prescribed for the same reason.
Player will rest from soccer activity but early rehabilitation and controlled exercises are mandatory for a timely and full recovery.
ICE on the inside of your soccer player's knee for 10-20 minutes every 1.5 to 2 hours for the first 2 to 3 days is also important to avoid an exaggerated inflammatory response. We want the inflammation process to follow its course to promote good healing.
Straight Leg raises to restore control of knee extension and improve quadriceps strength. Full Knee extension may painful but it needs to be restored asap. You can’t walk or run with a flexed knee. We like to do SLR in all planes for knee / hip strengthening
The MCL will get full tension at 90 deg of knee flexion and full extension. Player must respect these two angles and progressively forced the knee to get both ends of the movement.
Knee flexion as tolerated is also a must do exercise in the early stage.
Guidelines for Early Stage
Passive range of motion exercises to increase flexibility.
A knee brace to control joint movement.
Exercises to strengthen quadriceps muscles in the front of the thigh. Player will need muscle strength to provide support and stability of the knee joint when weight is put on it.
High seat bicycle is also allowed.
Crutches and/or a brace can be used but as the player progress and the knee functions more towards normal they will no longer be needed.
Return to Activity
This is a gradual process and may take some time.
The following is a list of guidelines to follow when returning to soccer activity.
Work towards full range of motion in the affected knee compared to the unaffected one.
Work towards full strength of the affected knee compared to the unaffected one.
Work towards jogging straight ahead without pain or limping.
Late Phase of Recovery
Continue with Strengthening exercises of the quadriceps , glutes , calves . Squats / deadlift / Single leg Squats are mandatory exercises
Post- Activation Potentiation (PAP ) is a phenomenon by which the force exerted by a muscle is increased due to its previous contraction. Post-activation potentiation is a theory that purports that the contractile history of a muscle influences the mechanical performance of subsequent muscle contractions.
For example, Squats or Deadlift to activate the Gluteal muscles before the jumps like in this video
Player’s workout routine should include any activity that challenges his or her ability to balance and keep balance on the affected Knee.
All functions of the knee must be restored before allowing field work. Player should be able to absorb load and generate power with the affected knee, be able to stop and change directions and be able to jump on affected side.
Field work Progression
sprint straight ahead without pain or limping.
45-degree cuts, first at half-speed, then at full-speed.
20-yard figures-of-eight, first at half-speed, then at full-speed.
90-degree cuts, first at half-speed, then at full-speed.
10-yard figures-of-eight, first at half-speed, then at full-speed.
jump on both legs without pain and you can jump on the affected leg without pain.
MCL is a very common injury in Soccer Players, youth and Adult
MCL can be treated without surgery to a full recovery
Strength and Balance must be restored before allowing player to return to practices and games
Lionel Pannunzio is a Physical Therapist Certified in Sports Injuries.
With more than 20 years of experience helping athletes return to their sports after an injury. He is the Owner of White Bay Sports Physical Therapy and Fitness,
conveniently located in the beautiful City of Weston,
where he treats Soccer Player, Runners and Athletes of all ages
Finally we would like to invite you to follow us at our:
Instagram Page where you will receiving information about your condition and other services we offer, always with the idea of keeping you healthy and fit to enjoy your favorite sport. Lionel PannunzioPhysical Therapist
Board-Certified Sports Specialist
Owner of White Bay Physical Therapy
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