Medial Collateral
Ligament Sprain
Immediate post-injury phase
- Protection
- Protected ambulation; partial to full weight-bearing
- Bracing (As ordered by physician)
- Grades 1 and 2 with full ROM
- Grades 2 and 3 with –10 to 75 degrees of motion
- Standard ice, compression, elevation, evaluation for associated injuries
Early post-injury phase
- Continue bracing as described above
- Continued protected ambulation PWB to WBAT
- Modalities as needed (whirlpool, ice, electrical stimulation, biofeedback)
- Exercise
- Grades 1 and 2
- Patellar glides and tilts with calf and hamstring stretches
- Active ROM through pain-free limits
- Isometrics for quads and hamstrings (PNF and spectrum)
- Bicycling
- Resisted hip, ankle, upper body and uninvolved leg exercises
- Grade 3
- Patellar glides and tilts
- AROM –15 to75 degrees for 4 weeks, then full ROM
- Isometrics for quads and hamstrings, including PNF’s
- Resisted hip, ankle, upper body, uninvolved leg exercises
Immediate post-injury phase (begin for all grades once full ROM obtained; generally 3-6 weeks)
- Discontinue brace for ADL
- Bicycling with high seat and low resistance; start with 5 minutes and progress
- Flexibility exercises as needed
- Physiologic knee extension (0-45 degrees)
- Leg press supine with sports cord and leg machine
- Mini squats
- Resisted knee flexion, hip and ankle exercises
- Proprioception activities (BAPS, profitter, etc)
- Swimming (free style-no breast-stroke)
Return to sport
- Continue with previous activities to increase flexibility, strength, and muscular and cardiovascular endurance
- Continue proprioceptive activity
- Begin functional strengthening program (sport specific plyometrics program)
- Slow speed to high speed
- Bilateral to unilateral support
- Low to moderate heights
- Soft to hard surfaces
- Functional activities progression
- Walk/jog (flat track)-start at ½ mile, walk curves and jog straightaway-progress to 2 miles
- Straight jogging (flat track)- start at ¼ mile and progress to 2 miles
- ¾ speed running (flat track)- start with 20 yard sprints, doing 4-10 reps
- Full speed sprinting- 20 yard sprints, doing 4-10 reps
- Backward jogging- 20 yard jog, doing 4-10 reps
- Backwards ¾ speed running- 20 yard run, doing 4-10 reps
- Backward sprint- 20 yard, doing 4-10 reps
- Lateral slides (defensive drills) ½ to ¾ to full speed
- Zig-zags ½ speed (soft cuts)-5 yard increments for 20 yards, progress 2-5 times
- Zig-zags ¾ speed (soft cuts)-5 yard increments for 20 yards, progress 2-5 times
- Zig-zags full speed (soft cuts)-5 yard increments for 20 yards, progress 2-5 times
- Linebacker drills- ½, ¾, and full speed; backward, forward, side-to-side in 10 yard increments, progress 2-5 times
- Backward zigzags- ½, ¾, and full speed, 10 yard increments, progress 2-5 times
- Figure eight’s- ½, ¾, and full speed; progress from large circles to smaller circles then to faster speeds, progress 5-10 times
- Criteria for return to sport
- No signs of inflammation
- Full ROM and normal flexibility
- Isokinetic testing- bilateral comparison of peak torque and work within 85% of non-involved limb and ham to quad ratio of 65%
- Functional tests
- Vertical jump (bilateral and unilateral comparison)
- Standing broad jump (bilateral and unilateral comparison)
- Completion of functional progression leading to full participation in sport
- Protective bracing as ordered by physician
- Lateral knee guards
- Functional knee braces
Maintenance (continue flexibility and strength training)