Most MCL tears, particularly Grade 1 and 2, heal well without surgery, and physiotherapy is the cornerstone of rehabilitation. Advanced physiotherapy focuses on a structured, progressive, and individualized approach to restore full knee function, strength, stability, and return to activity while minimizing the risk of re-injury.

Phases of Rehabilitation and Advanced Techniques:-

Phase 1: Acute/Protection Phase (Typically 0-2 weeks post-injury)

• Goals: Reduce pain and swelling, protect the injured ligament, and maintain initial range of motion.
• Interventions:
  • RICE Protocol: Rest (avoiding aggravating activities), Ice (cryotherapy to reduce inflammation and pain), Compression (elastic bandage or compression sleeve), Elevation.
  • Bracing/Immobilization: A hinged knee brace may be used, particularly for Grade 2 or 3 tears, to protect the MCL from valgus (inward) stress. Crutches may be used to reduce weight-bearing if pain or instability is present.
  • Electrotherapy: Modalities like Therapeutic Ultrasound, Low-Level Laser Therapy (LLLT), or TENS (Transcutaneous Electrical Nerve Stimulation) may be used to promote tissue healing and pain modulation.
  • Gentle Range of Motion (ROM) Exercises: Passive or active-assisted exercises within pain-free limits to prevent stiffness, such as heel slides (sliding the heel towards the buttocks while lying down) or prone hangs (lying on the stomach with the lower leg hanging off the bed to promote extension).
  • Isometric Exercises: Gentle muscle contractions without joint movement (e.g., quadriceps sets where you press the back of your knee into the bed, or hamstring sets). These help maintain muscle tone and activation without stressing the healing ligament.

Phase 2: Subacute/Early Strengthening Phase (Typically 2-6 weeks)

• Goals: Restore full knee range of motion, improve muscular activation and strength, and begin basic proprioception training.
• Interventions:
  • Progressive ROM Exercises: Gradually increasing knee flexion and extension using exercises like wall slides (sliding down a wall into a mini-squat) and continued heel slides.
  • Stretching: Gentle stretches for surrounding muscles like quadriceps, hamstrings, and calves to maintain flexibility.
  • Closed Kinetic Chain (CKC) Exercises: These exercises are crucial as the foot remains in contact with a surface, making them generally safer and more functional for knee rehabilitation.
    • Mini Squats/Wall Squats: Gradually increasing depth while maintaining proper knee alignment (avoiding valgus collapse).
    • Leg Presses: Performed on a machine with controlled resistance.
    • Step-Ups/Step-Downs: Starting with low steps and progressing to higher ones.
    • Glute Bridges: To strengthen hip extensors and core.
  • Proprioception Training: Exercises to improve balance and body awareness, which are vital for knee stability.
    • Single-Leg Balance: Starting on a stable surface, then progressing to unstable surfaces like foam pads, wobble boards, or BOSU balls.
    • Balance Squats: Performing squats while maintaining balance.
  • Manual Therapy: Patellar mobilizations to ensure the kneecap moves freely, and gentle soft tissue release for surrounding tight muscles.

Phase 3: Rehabilitation/Dynamic Stability Phase (Typically 6-12 weeks)

• Goals: Develop dynamic knee stability, enhance strength and endurance, and prepare for higher-level functional activities.
  • Advanced Strengthening:
    • Lunges: Forward, reverse, and lateral lunges to challenge strength and stability in multiple planes.
    • Single-Leg Deadlifts: To strengthen hamstrings and glutes while improving balance.
    • Calf Raises: For ankle and lower leg strength, contributing to overall stability.
    • Resistance Band Exercises: For targeted strengthening of hip abductors and adductors (e.g., crab walks with a band around the knees).
  • Neuromuscular Drills: Exercises that challenge coordination, reaction time, and dynamic control.
    • Lateral Shuffles: To improve side-to-side stability.
    • Agility Ladder Drills: For quick footwork and controlled changes of direction.
    • Controlled Pivoting Drills: Gradually reintroducing rotational movements with emphasis on proper technique.
  • Cardiovascular Conditioning: Stationary cycling, elliptical training, or swimming (avoiding breaststroke kick initially) to maintain fitness without excessive stress on the knee.
  • Plyometrics (Controlled): Introduced cautiously for athletes to build power and explosiveness (e.g., jump squats, lateral hops, box jumps with controlled landings). Focus on proper landing mechanics.

Phase 4: Advanced Functional Training/Return to Sport (Typically 12+ weeks, highly variable)

• Goals: Restore full sport-specific or activity-specific function, prevent re-injury, and ensure readiness for high-impact activities.
  • Sport-Specific Drills: Mimicking the movements and actions required in the patient’s specific sport or demanding activities.
  • Cutting Drills: Gradually increasing the speed and intensity of changes in direction.
  • Deceleration Drills: Training the muscles to absorb impact effectively during stopping and landing.
  • Jumping and Landing Mechanics: Refining technique to minimize stress on the knee.
• Progressive Load Management: Systematically increasing the volume, intensity, and complexity of training to prepare the knee for real-world demands.
• Strength and Conditioning: Continued focus on overall lower body strength, core stability, and endurance.