Your LCL (lateral collateral ligament) is a vital band of tissue on the outside of your knee. Athletes are more likely to tear it, causing a lot of pain and other symptoms. LCL tears usually heal after three to 12 weeks, depending on severity. You have to take care of yourself, though. Use crutches, ice your knee and follow your healthcare provider’s instructions.
MEDIAL & LATERAL CRUCIATE LIGAMENT INJURIES
The medial collateral ligament is more easily injured than the lateral collateral ligament. The cause of collateral ligament injuries is most often a blow to the outer side of the knee that stretches and tears the ligament on the inner side of the knee. Such blows frequently occur in contact sports such as football or hockey.
When injury to the medial collateral ligament occurs, you may feel a pop and the knee may buckle sideways. Pain and swelling are common.
A thorough examination is needed to determine the type and extent of the injury. In diagnosing a collateral ligament injury, the doctor exerts pressure on the side of the knee to determine the degree of pain and the looseness of the joint. An MRI is helpful in diagnosing injuries to these ligaments.
Most sprains of the collateral ligaments will heal if you follow a prescribed exercise program. In addition to exercise, the practitioner may recommend ice packs to reduce pain and swelling, and a small sleeve-type brace to protect and stabilize the knee. A sprain may take 2 to 4 weeks to heal. A severely sprained or torn collateral ligament may be accompanied by a torn anterior cruciate ligament, which usually requires surgical repair.
How is a lateral collateral ligament (LCL) injury treated?
Most LCL injuries can be treated at home with:
- Rest and protect your knee.
- Ice or a cold pack.
- Wrapping your knee with an elastic bandage (compression).
- Propping up (elevating) your knee.
- Anti-inflammatory medicine.
Your doctor may suggest that you use crutches to limit how much weight you put on your leg. He or she may also suggest that you wear a brace that protects and supports the knee but allows for some movement.
You may need to be less active for a while. But doing gentle stretching and range-of-motion exercises as advised by your doctor will help you heal.
A severe tear may need surgery. But this usually isn’t done unless you also injure other parts of your knee, such as the anterior cruciate ligament (ACL) or meniscus.
Your treatment will depend on how severe your injury is and whether other parts of your knee are injured.
- Mild or grade 1.
These injuries may only need home treatment along with using crutches for a short time. You may also need to wear a hinged knee brace when your doctor says it’s okay for you to put weight on your leg. Many people are able to be active again after about 3 to 4 weeks.
- Moderate or grade 2.
These injuries may require using crutches and wearing a hinged knee brace. Many people are able to be active again after about 8 to 12 weeks.
- Severe or grade 3.
These injuries may require wearing a hinged brace for a few months, and limiting weight on the leg for at least 6 weeks. In some cases, surgery may be needed. Many people are able to be active again after about 8 to 12 weeks.
Your doctor may recommend physical therapy to increase the range of motion and strengthen your muscles.
The knee is the largest joint in the human body. And it is also a common location for injury, usually due to ligament damage. The reason for this is that the lower extremity skeletal structure is inherently unstable. If you consider how the bones are arranged for normal standing, walking, and running activities, it is easy to see how unstable the joints are between these bones. For example, at the knee, there are essentially two long-shafted bones standing end to end. The entire upper body weight must remain balanced over these small contact surfaces, a challenging task, especially with the body in motion.
The lower end of the femoral condyles is rounded. These rounded edges sit on top of the tibial plateau. While the rounded surface provides a much smoother contact for the rolling motion during flexion and extension, it decreases the amount of actual contact between the tibia and femur. A greater amount of contact is valuable for spreading out the compressive load of body weight. As a result of minimal bony contact, soft tissues play a much larger role in joint stability.
Numerous soft tissues such as the quadriceps, hamstrings, joint capsule, tendons, and meniscal cartilage provide stability for the tibiofemoral (knee) joint. However, the main work of maintaining stability in the knee joint falls on the supporting ligaments. There are four primary stabilizing ligaments of the knee. In this issue, we will take a look at two of these, the anterior and posterior cruciate ligaments, which are the two deepest ligaments at the center of the knee joint. These ligaments play a major role in proper knee function and are routinely susceptible to sprain injury.
The term cruciate is Latin for “shaped like a cross.” The two ligaments are aligned in opposing directions and cross inside the knee to maintain the anterior and posterior stability of the knee. Let’s take at the anterior cruciate ligament first.
Anterior Cruciate Ligament
The anterior cruciate ligament (ACL) is widely known because it is so frequently involved in knee injuries. Its inferior attachment is on the anterior intercondylar surface of the tibial plateau. Its superior attachment is on the posterior part of the medial surface of the lateral femoral condyle (Figure 1). It may seem challenging to remember these specific attachment points but what is most important is simply to remember that the ACL goes from the anterior aspect of the tibia to the posterior aspect of the femur.
It is also helpful to remember that this ligament becomes taut when the tibia is pulled in an anterior direction. Therefore, its primary function is to resist anterior translation of the tibia in relation to the femur. Just remember this simple formula: ACL = attached to the anterior tibia + resists anterior movement of the tibia.
Another primary function of the ACL is to prevent excessive medial rotation of the tibia in relation to the femur. These rotational stresses occur most often when the foot is planted and the body is turned toward the side of the planted foot (right foot planted, the body turns to the right). Many sporting activities involve a rapid change of direction where these rotational joint stresses occur.
The more common cause of ACL injury is an excessive anterior force to the tibia. One way that an anterior force impacts the proximal tibia is if a person is hit on the back of the calf, which then thrusts the tibia in an anterior direction. However, that is not the most common cause of excessive anterior tibial force. Many ACL injuries occur from rapid or high-force deceleration such as running and then suddenly stopping, which requires the quadriceps group to contract with a strong enough force to slow the body’s momentum. Because the quadriceps are attached to the proximal tibia, they exert an excessive pulling force on the proximal tibia in an anterior direction. This same high force load often occurs when landing from a jump.
Epidemiological studies have indicated that women are more susceptible to ACL injury than men. It appears that a number of factors may play a role in this discrepancy. In women, there is less space inside the joint and that can sometimes cause irritation of the ligament as it is pressed against other internal joint structures during knee movements. Some studies have found an increased incidence of hamstring recruitment during various activities in men compared to women, which resists anterior tibial translation and provides additional knee stability.
The ligament itself is also frequently smaller in women and therefore higher force loads may overwhelm the smaller ligament structure. Knee alignment is also a factor and the increased Q angle in women has been linked to a greater incidence of ACL injury. Q angle refers to the degree to which the femur deviates toward the midline in relation to a straight vertical line (Figure 2). The presence of genu valgum (knock knees) is also a factor that leads to increased incidence of ACL injury and is a postural dysfunction more prevalent in women than men as well.
Posterior Cruciate Ligament
As might be expected the posterior cruciate ligament (PCL) has a role just opposite that of the ACL. The lower (inferior) attachment is on the posterior intercondylar surface of the tibial plateau. The upper (superior) attachment is on the anterior part of the lateral surface of the medial condyle of the femur (Figure 3). As you can see the ACL and PCL create a cross inside the knee joint.
The primary function of the PCL is to prevent posterior translation of the tibia in relation to the femur. A similar formula can be used to remember PCL function and location: PCL= attached to the posterior tibia + resists posterior movement of the tibia. There are fewer injuries to the PCL than to the ACL mainly due to ligament structure and the fact that we are more frequently moving forward (anterior direction) so the ligament that is trying to restrain or decelerate forward motion takes on a greater role.
Due to its anatomical architecture within the joint, injuries to the PCL occur most often when the knee is significantly flexed or fully extended as these positions put the ligament under the greatest tensile load. The most common cause of injury to the PCL is referred to as a dashboard injury. This injury occurs when an individual is in the passenger seat of an automobile that has a head-on collision. The person is thrust forward and their proximal tibia slams into the dashboard, which forces the tibia back in a posterior direction. A similar force occurs when a person strikes their tibial tuberosity on something hard.
Treatment Strategies and the Role of Massage
Injuries to the ACL or PCL are generally treated the same. If the sprain is mild to moderate, (usually falling into the categories of grade 1 or grade 2), treatment will focus on physical therapy to regain stability as the ligament heals. If there is a sprain to the ACL, there will be greater emphasis placed on strengthening the hamstring muscles as they aid the resistance against anterior tibial translation. For a PCL sprain, there will be an emphasis on strengthening the quadriceps muscles as they work in conjunction with the PCL to resist posterior tibial translation.
In more severe sprains surgery may be required to repair the damaged ligament. Even though the ligaments lie deep within the knee joint surgical repair of the cruciate ligaments has advanced dramatically and the patient can achieve a much quicker return to function. Exactly how long it takes to get back to the activity will depend on the severity of the injury and what type of activity the person is trying to regain. Obviously, it will be easier to get back to normal walking than it will to competitive athletics. Even then, the return to sport can occur in just a couple of months in many cases.
Of course, a primary question that comes up for massage therapists is what role massage can play in addressing cruciate ligament injuries. In many cases, massage is very helpful in addressing ligament sprains. Deep friction applications encourage tissue healing and help manage scar tissue in the repair process. Of course, that strategy is not applicable to ACL and PCL injuries because the ligaments lie deep within the knee joint and are inaccessible to palpation.
While these ligaments are inaccessible it does not mean that massage is of no benefit in treating cruciate ligament injuries. One of the key adverse events that occur as a result of ligament injury is a disturbance of proper biomechanical coordination around the joint. This biomechanical dysfunction can often involve muscle tightness and lost range of motion as muscles attempt to overcompensate for instability. This is where massage can play a key role in cruciate ligament rehabilitation.
The massage therapist that uses a wide variety of techniques to focus on the hamstring and quadriceps muscles and surrounding connective tissues can help maintain optimum neuromuscular balance throughout the healing process. Balance and motor control are complex systems, and massage can help in pain reduction and neuromuscular reeducation throughout the healing process. Massage can also be helpful in reducing tightness or any adverse tissue reactions that may occur as a result of physical therapy or other treatment techniques.
Blood Flow Is Essential For Healing
Your situation isn’t hopeless. You can stop the pain and speed up the healing of your LCL injury. All you need is rest and proper treatment.
Blood flow is the most critical element in rapid recovery. Unfortunately, when we’re injured, blood flow to the affected area is severely impeded. Normally we would stimulate our blood flow by being physically active, but when we’re injured, this can cause further damage. With a Knee Wrap, you can stimulate nutrient-rich, oxygenated blood flow to your injured LCL while you’re at rest.
Massage for Lateral Cruciate Ligament
- Rest and protect your knee.
- Ice or a cold pack.
- Wrapping your knee with an elastic bandage (compression).
- Propping up (elevating) your knee.
- Anti-inflammatory medicine.
- Rest your knee.
- Apply ice. …
- Compress your knee by wrapping it with an elastic bandage.
- Prop your knee up (elevate it) on a pillow to reduce swelling. …
- Take anti-inflammatory medications (NSAIDs) such as ibuprofen (Motrin® and Advil®) and naproxen (Aleve®).
Leg and knee exercises can improve range of motion and strength, as well as help, prevent further injury. Physical therapists may also recommend massage or other treatments to speed up recovery and reduce symptoms.
- Apply ice to the strained ligament to alleviate pain and swelling. …
- Use nonsteroidal anti-inflammatory drugs, NSAIDs, to repair strained ligaments. …
- Engage in physical therapy once swelling and pain have decreased. …
- Get surgery if the ligament is severely torn.
Exercises for rehabilitation of lateral knee ligament sprains should include mobility, stretching, strengthening, proprioception, and eventually sports-specific exercises. Initially, isometric or static strengthening exercises are done
Rehabilitation exercises for a lateral knee ligament sprain (LCL sprain). Strengthening exercises can begin almost immediately after the initial acute period has passed, as long as you avoid any sideways (lateral) stress on the knee.
Strengthening exercises can also begin as soon as pain allows. The further you can get with strengthening exercises prior to surgery then the more likely you are to have a faster recovery post-operation.
Isometric quadriceps exercise
- Contract the quadriceps muscles and hold for 5 to 10 seconds.
- Relax for about 3 seconds and repeat 10 to 20 times.
- It is especially important you feel the vastus medialis muscle on the inside of the knee working when doing this exercise.
- Place the fingers on the muscle towards the inside of the leg above the knee (vastus medialis oblique (VMO) muscle).
- It is important that this muscle is developed and this one should be felt contracting whilst performing the exercises.
Isometric quads in standing
As above but performed in the standing position. This exercise is performed from phase 3 onwards of the post-surgery rehabilitation program. These exercises should be performed on a daily basis.
Static/isometric hamstring contractions
- Lie on your front in the prone position.
- The partner or therapist provides resistance as the athlete contracts the hamstring muscles, hold for 3 or 4 seconds then relaxes.
- The angle of knee flexion is changed and the exercise is repeated.
- Once a range of angles has been worked the whole process is repeated with the foot first turned first inwards then outwards.
- This exercise targets the inner and outer hamstring muscles at varying angles of flexion or knee bend.
- This exercise will strengthen the calf muscles which consist of the gastrocnemius and soleus muscles.
- Rise up and down on the toes in a smooth movement.
- You should be able to progress quite quickly with this one but aim for 3 sets of 10 and build up steadily, a few each day.
- This exercise can be progressed later in the rehabilitation process by doing single leg calf raises and then single leg calf raises without leaning against a wall or holding onto anything.
- You can also perform these on a step as shown in the video, allowing the heel to drop down past the level of the step.
- This exercise works the buttock muscles and hamstrings.
- Stand with the band around one ankle and attached to a fixed point in front. Use something to hold onto if you need to.
- Keeping the leg straight extend the hip as far as comfortable and return to the start position. Keep the hips square on facing forwards and perform the exercise in a slow and controlled manner.
- You should feel it working the buttock muscles.
- This can also be done without a band on all fours lifting the leg up behind.
Hamstring curls with band
- Lying on your front with the foot pointing down over the edge of the couch, the athlete fully bends the knee.
- Provided this is pain-free, a resistance band or ankle weight can be used to increase difficulty.
- Squat down to about a quarter of the way down and return to the starting position. Aim for 3 sets of 10 to 20 repetitions.
- Progress this by going down to halfway (Phase 3 of rehabilitation) and then full squats (to horizontal) in the sports-specific stages. Increase the intensity by adding weight.
- Ensure stomach muscles are kept firm when performing squats.
- Standing one leg in front of the other as shown.
- Bend the front leg to lean forwards and return to standing.
- Aim for 3 sets of 10 to 20 repetitions.
- Increase intensity by adding weight.
- Ensure stomach muscles are kept firm when performing this exercise.
- Step up and down on a bench about 9 inches high.
- Step up with the recovering leg and step down with the same leg.
- Change round and do the same number of repetitions on the noninjured leg.
- The bridge exercise can be used for glute and hamstring strengthening after injuries to the hip or knee.
- Lay on the floor on your back.
- Bend your knees and place your feet flat on the floor, halfway towards your buttocks.
- Lift the hips and thighs off the floor to form a straight line between your knees and shoulders.
LCL sprain proprioception exercises
Proprioception is similar to balance but means the awareness of where your body (or body part) is in space. These exercises help in controlling the movement of the limb and preventing re-injury.
- The athlete begins by standing on the injured leg only for 30 seconds.
- Once this is accomplished the athlete closes their eyes to increase the difficulty.
- The next step is to balance on an unstable surface such as a trampette, wobble cushion, or half foam roller.
Functional exercises for LCL sprain
Plyometric exercises involve dynamic and sometimes explosive movements. They bridge the gap between basic LCL sprain strengthening exercises and returning to full training and eventually competition.
Resistance band jump
- A resistance band is wrapped around the waist and anchored or held behind the athlete.
- They then perform side-to-side or forward and backward jumps.
- The resistance from the band provides a challenge to the balance.
- The exercise can be made more difficult by increasing the thickness of the band or aiming to hop or jump further.
Hopping exercises for LCL sprain
- Many variations on hopping exercises are available. Start with a small hop on the spot and gradually increase the height jumped.
- Try hopping to the front, to the side, and backward.
- Try hopping from one leg and landing on the other.
- Equipment such as hoops, agility ladders, and minim hurdles can all be used to add further challenge.
- Start standing on a small step.
- Take one leg backward, touch the foot on the floor and push off with the forefoot to move it back onto the step.
- Alternate legs.
- This can be increased in difficulty by performing on a higher step or at a faster speed.
- Numerous exercises can be created using a box or step to jump over.
- To start the athlete may jump sideways over the box, moving rapidly from one foot on one side, to the other foot on the other side. This may also be performed front to back.
- A further progression is high jumps over the box, firstly landing on two feet and progressing to one.
Sports specific drills
- Practice drills that are used in training for your particular sport.
- Start off doing them slowly and under control. Gradually pick up the pace and competition level until you’re back to full training mode.
- Here is an example of a sports-specific drill that involves reacting, accelerating, and changing direction.
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