Outline · [ Standard ] · Linear+ MCL injury - 2nd degree, How long before beginning rehab ?

I am a 40 yo weekend warrior who began playing soccer again after a 10 year layoff. I had been playing for 6 months solid without incident and then I had someone slide tackle me as I was striking the ball with the inside of my foot.
I am diagnosed with a second degree MCL injury. I was able to walk after the incident, but my knee was swollen for about 1 week and there was surface tenderness as well. I am now 3 weeks post-trauma and there is still slight swelling, but I am finally able to walk up and down short stairs with little pain.
I am now able to swim at this point, but not able to bend my knee and push off of the wall. I am able to stiffen and straighten my entire leg without any pain at all.

I am looking for opinions as to what I should be doing in the way of therapy at this point or is it too early to get aggressive ? I am anxious to start ROM exercises, but I am worried about whether or not I will do more damage than good. I read somewhere that said I should do very little rehab for the first 6 weeks. Is this right ?

I would suggest that you definitely do some rehab.

The caveat to that is that you don't do anything that causes pain. I would stick to stationary bike (start at 5 minutes) and only strengthening exercises that enable you to keep your affected leg planted; e.g. shallow squats , leg press, both with little to no weight, around 10 reps, and within pain limits. Also, some non-weight bearing range of motion within pain limits should be done whenever possible.

You should not have pain during the exercises and if you see an increase in swelling after (within hours), you should cut back the exercises by 50% until you can do them with no increase in swelling.

As you do the exercises start once per day. For every two time you are able to do the exercises without pain and without an increase in swelling, increase either the time on the bike or the number of reps or the number of sets by 50%; increase only one of these per session.

Does that make sense?

I am a 40 yo weekend warrior who began playing soccer again after a 10 year layoff. I had been playing for 6 months solid without incident and then I had someone slide tackle me as I was striking the ball with the inside of my foot.
I am diagnosed with a second degree MCL injury. I was able to walk after the incident, but my knee was swollen for about 1 week and there was surface tenderness as well. I am now 3 weeks post-trauma and there is still slight swelling, but I am finally able to walk up and down short stairs with little pain.
I am now able to swim at this point, but not able to bend my knee and push off of the wall. I am able to stiffen and straighten my entire leg without any pain at all.

I am looking for opinions as to what I should be doing in the way of therapy at this point or is it too early to get aggressive ? I am anxious to start ROM exercises, but I am worried about whether or not I will do more damage than good. I read somewhere that said I should do very little rehab for the first 6 weeks. Is this right ?

I would suggest that you definitely do some rehab.

The caveat to that is that you don't do anything that causes pain. I would stick to stationary bike (start at 5 minutes) and only strengthening exercises that enable you to keep your affected leg planted; e.g. shallow squats , leg press, both with little to no weight, around 10 reps, and within pain limits. Also, some non-weight bearing range of motion within pain limits should be done whenever possible.

You should not have pain during the exercises and if you see an increase in swelling after (within hours), you should cut back the exercises by 50% until you can do them with no increase in swelling.

As you do the exercises start once per day. For every two time you are able to do the exercises without pain and without an increase in swelling, increase either the time on the bike or the number of reps or the number of sets by 50%; increase only one of these per session.

Does that make sense?

To some degree....as I am worried about re-injury the most.....a friend of mine had a 3rd degree MCL injury from skiiing and he was immobilized for 13 weeks before even starting rehab. What's interesting, is that even with that severity, surgery was not prescribed. He did finally heal to 95%.
I am also going to consider using an aqua-jogger in the pool as in a floating environment, I can finely control the range of motion applied.
Thanks for your response.

To some degree....as I am worried about re-injury the most.....a friend of mine had a 3rd degree MCL injury from skiiing and he was immobilized for 13 weeks before even starting rehab. What's interesting, is that even with that severity, surgery was not prescribed. He did finally heal to 95%.
I am also going to consider using an aqua-jogger in the pool as in a floating environment, I can finely control the range of motion applied.
Thanks for your response.

A 3rd degree is another story. Your second degree can be rehabed but pain and swelling is your guide. Start slowly, increase slowly.

Surgery is very rare in MCL tears.

An aqua jogger should be fine but I would still start with stationary bike with little to no resistance. Water offers a lot of resistance and may be too much initially.

Good luck!

A 3rd degree is another story. Your second degree can be rehabed but pain and swelling is your guide. Start slowly, increase slowly.

Surgery is very rare in MCL tears.

An aqua jogger should be fine but I would still start with stationary bike with little to no resistance. Water offers a lot of resistance and may be too much initially.

Good luck!

Thanks again....just today I was able to jog easy up and down a flight of 60 steps that had only 6" risers. This workout is done with a tight ACE knee support and I feel little pain from it. However, the reason is because it does not flex my knee beyond 120 degrees...which is my max right now. I am worried that biking will be painful as it will require about 90 degrees....quite a distance from where I am at right now. I think I need to ease into the 90 degrees in the water which gives me complete control over the amount of flexion applied. I will try to get onto my stationary bike sometime this weekend.

Sorry. I should have mentioned that when on the stationary bike you do not need to do full revolutions. You're not riding the bike to get a cardio workout, just to go through range of motion without weight bearing and without pain. Go as far as you can in one direction, stopping before any pain, and then go in the other direction.

It is good for the muscles to be performing this action, good for the joing surfaces to be contacting each other, good for reducing swelling (as long as you don't push it too hard!)

In a non weight bearing position, e.g. lying or sitting, is 120 degrees your max flexion? Is this due to pain or due to swelling restricting more movement?

Thanks again....just today I was able to jog easy up and down a flight of 60 steps that had only 6" risers. This workout is done with a tight ACE knee support and I feel little pain from it. However, the reason is because it does not flex my knee beyond 120 degrees...which is my max right now. I am worried that biking will be painful as it will require about 90 degrees....quite a distance from where I am at right now. I think I need to ease into the 90 degrees in the water which gives me complete control over the amount of flexion applied. I will try to get onto my stationary bike sometime this weekend.

Another thing I should have mentioned about the bike and your limited ROM is that you should raise the seat of the bike up as high as you can while still being able to reach the pedals. That way you will be required to bend your knees less when trying to perform full revolutions.

Sorry. I should have mentioned that when on the stationary bike you do not need to do full revolutions. You're not riding the bike to get a cardio workout, just to go through range of motion without weight bearing and without pain. Go as far as you can in one direction, stopping before any pain, and then go in the other direction.

It is good for the muscles to be performing this action, good for the joing surfaces to be contacting each other, good for reducing swelling (as long as you don't push it too hard!)

In a non weight bearing position, e.g. lying or sitting, is 120 degrees your max flexion? Is this due to pain or due to swelling restricting more movement?

Another thing I should have mentioned about the bike and your limited ROM is that you should raise the seat of the bike up as high as you can while still being able to reach the pedals. That way you will be required to bend your knees less when trying to perform full revolutions.

Thanks for the seat tip...it's a good point.
I've discovered a great exercise.....sitting on the edge of a pool with zoomer fins on my feet and just fluttering back and forth in an attempt to extend ROM. Works great....and I have full control of the resistance by adjusting my speed of motion.
I use both feet only to maintain balance.
Is it me, or are most of these PT forums dead ? I've posted to about the top 3 on my google search and yours is the only response....

Is it me, or are most of these PT forums dead ? I've posted to about the top 3 on my google search and yours is the only response....

You're right, most of the physical therapy forums I've been able to find are not very active. This is the only one I frequent anymore. It would be nice if it had more postings though. There seems to be a fair amount of people reading the posts but not many contributing.

Well, I finally got onto my stationary bike today....and I must say, I was "yelping" for the first few rotations. But then, my knee started to loosen-up and I was able to stay on the bike for about 30 minutes....with some resting intervals. Still, it was a moral victory for me....my leg got to about 80-90 degrees of flexion. It seems apparent at this point that I am already getting some scar tissue build-up, and stretching looks like the only way to keep it from reoccurring at this point.

Now able to run normally....and able to do a stair climb with 10" risers....no pain.
However, doing a perfect "frogstoke" aka breaststroke in the pool is still not possible....range-of-motion is still quite limited.
With all of this working out, I've discovered that nightly whirlpools followed by night-time icing is helping...a lot.
An Aqua-jogger in the pool has proven to be an excellent recovery device....complete control over ROM and very gentle resistance to the joint/ligament....just perfect.

Three weeks ago I went to the ER after stopping very suddenly while running playing softball. They told me it was probably a MCL tear. No MRI. Just XRAY. Nothing broken. I got crutches and immobilizer. I could not walk. When it happened I heard it pop and so did others. It was excruciating. I iced it a lot for a week and stayed totally off of it for 2 weeks. My swelling is better but there is still some residual swelling. Up until last night, I have done no ROM exercises. I have only done leg lifts, calf raises...stuff that doesn't require the knee to bend. I am lucky if I have a 45 degree bend in my knee right now. I can't full straighten it either. I did some squats with my back against the wall last night and also when sitting in a chair scooted forward with my feet planted. I did it to a point of discomfort but not beyond that. This morning my knee seems more swollen. Also, there has been continued swelling at the top of my knee on the outside of it (anterior lateral apical). I understand swelling remaining in the medial portion where my MCL is which is still tender to pressure by the way, but why is there still swelling in the anterior lateral apical portion of the injured knee? I have been walking arouind without the immobilizer or crutches today and yesterday, but it is a limp. I can put all my weight on the hurt leg (Left one). But my ROM is so limited. I am very distraught about this and need to know what to do to make this better. Of course I can't pivot or anything and a couple of times it has felt like it wanted to give out on me because I moved too quickly and mindlessly moved it a way I probably shouldn't have. I hurt it at night almost every night by jerking in my sleep and wake up in pain. I don't sleep with the immobilizer on. I am very disturbed because I have heard so many conflicting stories.

Thanks so much for your response.