“Man makes plans and God laughs.” Well my glorious plans for Spring renewal have been slightly (irony) modified based on my newly destroyed right knee. Unfortunately, I have a Class 2+ MCL tear due to an odd fall playing indoor soccer. As defined my doc, I have a nearly completely torn MCL and it is likely holding on by a thread. Fortunately, I don’t think there are any other parts of my knee damaged. I am also fortunate that I most likely won’t have to have surgery. I had a Class 1 or 2 tear before while playing rugby some 17 years ago and recovered just fine. However, this is much more severe and I can tell right away that it won’t be as simple as that recovery.
Per doctors orders, my right leg is completely immobilized at a 30 degree knee bend for a solid 3 weeks. I did get permission to start some swimming, if I can do it without pain.
It is coming along OK after a week in the brace. I tried swimming last night and was quite disappointed that I can’t really do much without discomfort or pain. For the first time, I am actually trying to follow docs orders since I am somewhat concerned about having a long term knee issue. (Truthfully, it feels so unstable and painful that I really can’t figure out a way to just fight through it and get back to some time of activity. So I really don’t seem to have many options.)
I will try to keep the site updated as I go through the injury to give a nice first hand experience on how it heals.
Although I haven’t gotten into my rehab with my doc yet, this seems to be the most comprehensive information available online:
For a grade 2+ and particularly 3 sprain it is important that the ends of the ligament are protected and left to heal without continually being disrupted. The rehabilitation guidelines for a grade 2+ or 3 medial ligament sprain (more severe) can be split into 4 phases:
Phase 1: immediately following injury
Duration 4 weeks. Aims to control swelling, maintain ability to straighten the leg bend the knee to more than 90 degrees, begin strengthening exercises.
Rest from all painful activities. Use crutches if necessary, non weight bearing to start with, then partial weight bearing from week 2 and by end of week 4 aim to be walking normally.
Wear a hinged or stabilised knee brace to protect the medial ligament. Apply cold therapy and compression. Apply ice / cold therapy for 15 minutes every 2 hours for the first 2 days and gradually reduce the frequency to 3 times a day over the next week. Pain free stretches for the hamstrings, quads, groin and calf muscles in particular. Mobility exercises should be done in the knee brace.
Sports massage (gentle cross frictions) may be possible from day 2 but allow a week for more severe injuries. As pain allows, static quads and hamstring exercises, double leg calf raises, hip abduction and extension. Knee extension mobility should only be to 30 degrees though. Maintain aerobic fitness on stationary cycle as soon as pain allows.
Phase 2: Following week 4
Duration 2 weeks. Aims to eliminate swelling, full weight bearing on the injured knee, full range of motion, injured leg almost as strong as the good one.
Continue with cold therapy and compression to eliminate swelling following exercises. Remove the knee brace at this stage. A simple stablized knee support is more suitable at this stage to apply compression to the knee. A therapist will continue with ultrasound and massage.
Range of motion exercises should continue along with isometric quadriceps exercises. Mini squats, lunges, double leg press, hamstring curls, step ups, bridges, hip abduction, hip extension and single leg calf raises can begin or be continued. It may be possible to begin to swim (not breaststroke!) or use stepper for aerobic fitness.
Phase 3: after week 6
Duration 4 weeks. Aims to regain full range of motion, strength, return to light jogging and by week 10 from injury, return to sports specific exercises.
Continue with cold therapy following training sessions. Wear a brace or support as required. Sports massage techniques to the ligament 2 to 3 times a weeks. Strengthening exercises as above increasing intensity and moving double leg exercises to single.
After week 6, no sooner, begin to run if comfortable, no sudden changes of direction though.
After week 8 begin to run sideways and backwards so by week 10 the athlete is able to begin to change direction at speed. For footballers, kicking may now be possible.
When confident enough plyometric drills, hopping, box jumps and agility drills can begin.
Phase 4: after week 10
Duration 2 to 4 weeks. Aims to return to full sports specific training and competition without a brace for support, full strength and mobility.
Gradually bring into training more and more sports specific drills, changing direction and plyometric, hopping and bounding exercises. Normal sports specific training can begin.