Bodyworks: Medial Collateral Ligament Injury

How to recognise it, how to overcome it


Posted: 5 June 2000
by Patrick Milroy

Symptoms
Although any force from the outside may sprain the medial collateral, the usual cause in runners is a twisting of the knee while the foot is stuck in a pothole or if the foot has suddenly slipped on a greasy surface. This will cause acute pain on the inner side of the knee. In some runners a more chronic injury can occur if they have knock-knees, or those who always run on a camber. Continuing to run will not only prolong your pain but could cause secondary injuries through a change in your gait.

Signs
Although it may be sore to pressure, your doctor may not be able to demonstrate any local swelling. Depending on how severe the sprain is, there may be an effusion. However, runners who sprain their medial collaterals use their quadriceps muscles less as a result, and develop wasting, particularly of the inner quads. Your doctor will need to exclude cartilage and cruciate injuries, as they often occur in conjunction with collateral tears.

Medical investigation
As these are mainly directed to exclude other injuries they are only going to be appropriate if the sprain does not resolve. An X-ray with the knee stressed inwardly may demonstrate a complete tear, but arthroscopy or scans of the knee are necessary to eliminate further damage.

What else could it be?
Any condition affecting the area around the inside of the knee should be excluded; meniscal cartilage tears and cruciate ligament injuries may be obvious; damage to a hamstring muscle insertion or a bursa may spring less readily to mind.

Self-treatment
Any runner not using RICE by now must have been living on another planet! In this case, ice is a mainstay not only of treatment but also of rehabilitation. If you cannot walk with the injury you may require crutches in the early stages, but try not to become too reliant upon them. A severe tear may be strapped initially to immobilise it.

Medical treatment
While it is important to heal the torn ligament, rehabilitation should also involve the restoration of power, strength and bulk to the quadriceps muscles which take the elastic strain when the knee is forced inward and hence protect the ligament from further injury. As full movement is restored, the physiotherapist will use quadriceps contractions and ultrasound with progressive cycling-type exercises. Proprioception, described as an awareness of where the body is in space, must be restored with specialist exercises before the injury can be considered fully cured.

Recovery time
Depending upon the severity of the injury and any associated problems, cure can take any time between a few days and several weeks. Minor injuries may heal if not raced through and some training might be possible while rehabilitation exercises are being diligently performed (one hopes!).


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Medial Collateral Ligament
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I have a niggling knee injury which although not particularly painful is irritating and awkward. Although I can't remember when the damage occured, I woke up one morning unable to put any weight on my right leg.

The symptoms are a dull ache on the inside of the knee cap. My foot seems to twist 20 degrees outwards on impact and I seem to be running on the heel.

I have reduced the training considerably and bought a pair of Nimbus which seems to be helping.

Any ideas ?
Posted: 10/09/2003 at 18:37

rest and go see a sports physio
Posted: 10/09/2003 at 18:49

thanks
Posted: 11/05/2004 at 18:26

I'm sure I have a medial collateral ligament injury. Pain on inside of knee and lesser behind the knee. Question is should I see a physio or a sports therapist who could massage the area to increase pliability. Not sure who to go and see or even if I should just rest up until it goes. Any advice gratefully received.
Posted: 29/03/2005 at 20:23

been to see phsio today with a knee injury.

sore on the outside and inside of the knee,also behind the knee,also a bit of swelling

physio said i'd strained the ligament r/s of the knee,also the tendon that goes over the bursa?? and connects femur to the tibia, said with injury i had could be 2-3 weeks.

also saw my doctor first thing this morning who is also a runner and he prescribed max strength ibuprofen 4oomg 1 tab 3 x a day with food.
Posted: 29/03/2005 at 21:00

I've been suffering from MCL injury for 4 wks now. Tried RICE and pills to take the pain away but it is not getting any better. The Physio has given me exercises to do but after completing these the pain gets stronger then subsides after a couple of hours. I have another visit on Fri 13th and hope she can sort me out because this is getting really frustrating. Running has come to a halt, cycling/swimming is possible but I WANNA RUN.
Posted: 07/05/2005 at 21:48

Huff'npuff i really sympathise with your predicament.ive not run now properly since last dec and it's killing me not getting out there.

saw physio last week and he said another 4-5 weeks before i can start light training.
i'm going to miss the Manchester 10k which i was so looking forward to doing also the Blackpool half in June.

mine is also MCL strain also light tendon strain.

just be patient Huff, what is a few months out when we have the rest of our lives to run!


Posted: 07/05/2005 at 23:55

I sympathise folks. I have had knee problems in both knees that affected my training for the London Marathon and Titchmarsh 10K. I went to my very good doctor who said it was iliotibial band syndrome which is very common if you overtrain as I had been doing.He gave me lots of good exercises but it was difficult to get the knee better with the training. In the end I struggled through training with part walking & had to do this for the Marathon but not the 10K. My fitness lessened and I got very frustrated. But now I am concentrating on getting better because I want to enjoy pain free running again & who knows even run the whole Marathon one day. It will get better I'm sure so hang in there.....
Posted: 08/05/2005 at 14:01

I have a niggling ache on my left knee which I think has been a result of vortraining for the marathon (which I successfully ran. It is very stiff in th emorning and this subsides throughout the day. However, I am constantly aware of the ache on the inner lower side of knee - especially going down stairs. Any ideas? I can run but it hurts a little and I'm scared I do more damge. I don't want to lose my cndiiton thoug and its now 4 eeks since I've done serious training.
Posted: 09/05/2005 at 19:19

Dear Yvonne,

This sounds very similar to my problems which I have in both knees. I really advise going to see your doctor (try and find one who knows about running) or a good sports physio. If you can't afford the latter your GP might be able to refer you to an NHS physio. The thing is it is worth getting the expert advice because it certainly put my mind at rest.

If it is the thing I have, it should get better over time. My doc reckoned that once the inflammation had died down &I followed his exercises I would be able to run my usual 3 miles with no problem. Even if it isn't the same thing I have, it is probably treatable and s/he can give you the tools to sort it.

I am still taking ibuprofen off and on, icing and compressing my knees. My right is a lot better but my left still niggles. It let me do 1 mile the other day before hurting again so I am going to rest it some more and hope it will improve over the next couple of weeks. I know how frustrating it is not being able to run, I lost 3-4weeks of my marathon training and at least 6 weeks before that due to back and knee problems. But I have learnt the hard way that sometimes we just have to let our bodies recover and get stronger before putting them through such gruelling training.

Good luck!

Virginia
Posted: 10/05/2005 at 10:59

Dear Virginia,
many thanks for your message. Tonight I will go to my athletic club where we have a physio so I'll have him check it out. I really have no faith in the "normal" doctors as they jsuttell you to rest as soon as they hear you are a runner. It is very frustrating when you can't train but on the otherhand one must not do irreversible damage or prolong the injury. After the club physio has a look I'll decide how to treat further. I don't mind paying. When distance running becomes part of your daily routine I find myself getting irritated over small things (due to not being able to run...). Well that's my excuse.
I'll keep you informed.
Thanks again.
Ciao
Yvonne
Posted: 10/05/2005 at 11:24

I have a discomfort just above my right knee that flares up every now and again. Resulted from an old football injury some 5 years ago. Had phsyio treatment which lasted for about six weeks. Can run with the problem without any discomfort but feel the slight soreness after a run. Has anyone got a clue as to what this persistent niggle is.
Posted: 10/05/2005 at 11:48

I've been suffering from dodgy knees since about 2 weeks before the marathon. My right knee was bad but the pain seems to have gone over to my left and I can't run on it at all. I can only assume it is my ITB playing up. I went to the docs last night and I was disgusted at the comeback I got. I told the doc I thought it was my ITB and he replied blanky "What's that then?" I couldn't believe it!! He told me to take Ibuprofen which it what I've been doing anyway and rest it! What a waste of my time!!!
Posted: 10/05/2005 at 14:13

My sentiments exactly. As you will all knwo knee injuries are one of the most common injuries for runners and probablt all have one knee niggle at one point in time whether minor or serious. It is frustrating when you take time to go to the doc. and you are told to jsut rest etc.
I'll speak to my phsio tonight and see what he says. I do this with a little resistance bacausebefore the marathon he happened to see my schedule and thought it was a bit much - now I need to eat humble pie. However, the main thing is our health. Like Virgnia said you really need the advice of an expert or fellow running doc.
Posted: 10/05/2005 at 14:34


AMB
I did the Great North Run last year and 4 weeks before the run i had knee pain in my right knee, my doctor told me to rest it and not to do the run. I did rest for 2 weeks and then did afew 3 mile runs before the big day. On the day I managed 10.5 miles and then had to run and walk the rest of the way, I ended up with 2 bad knees.
It took 2 months to actually get to see a physio on the NHS. I have got back into my training and have just got up to 7 miles, but today the pain in my right knee has started again, I am gutted.
Posted: 10/05/2005 at 21:52

Dear AMB,

I know just how frustrating this is. Every time I got over something during my marathon training, something else kicked in. I have now decided to try and strengthen everything before going for long runs again. One thing my doctor said was that if my knee hurt I had been overdoing it and to try and reduce mileage for a while, do strengthening exercises and try again. I didn't have time to do this when training for the Marathon, but now I am going to do this over the next year.... Hope things get better for you soon

Virginia



Posted: 12/05/2005 at 16:03


HM4
Hi,

I've got a dodgy knee (damaged 2 ligaments in the one knee skiing) and found the exercises the A&E Dept gave me horrible and didn't do them. I rested took ibuprofen for the pain & inflammation. I also took a couple of other tablets brought from the local health food store. Arnic which helps with inflammation and glucosamine & chronditrin (sorry about the spelling) which are meant to help rebuild soft tissues.

I've not been skiing for 5 years (since the last time I damaged my knee) however have been able to start running again.

Hope this information helps in some way.
Posted: 14/05/2005 at 20:53

helen ive started taking glucosamine & chondroitin with vit C and msm,obtained from healthy direct online.also got some arnica gel mixed with aloe vera.

it's now about 2 months since being diagnosed with MCL strain and the swelling is just easing off.physio reckons another 4-5 weeks before i can start any light training but i think he was just trying to cheer me up!
Posted: 14/05/2005 at 22:04


HM4
Kippers,

Sorry to say this I think you are right. After I did my knee in I still carried on teaching from the bottom of the ski slope and used the best pupil in the group to do the demos for me. It was very frustrating so I stopped teaching. Since then I've not put a pair of skis on. I am starting to think about skiing again but don't want to injure myself as I know I will have to stop running. Decisions, decisions.

Have you tried visiting your idependent health food shop. They may be able to recommend something else for you.

Hope your knee gets better soon.
Posted: 15/05/2005 at 11:10

I was in the last mile of a long run yesterday (doing Edinburgh marathon) when I went down a steep hill and my left knee just became really painful so much so I had to stop and limp down although once I'd got back on the flat things seemed ok again. It feels very niggly this morning and can feel it walking down stairs - anyone any ideas, just rest or see a physio?
Posted: 15/05/2005 at 11:41

helen,i have tried other supplements in glucosamine form and found healthy directs better.i have started taking flaxseed capulets and garlic.

we have a holland and barretts in bolton so might give them a visit.
Posted: 15/05/2005 at 18:47

I ahve been taking old fashioned cod liver oil - no seroius injries on cold/flu this winter

Is that a coicidence?
Posted: 15/05/2005 at 18:55


HM4
Kippers,

I've found the branches of Holland & Barrett neare useless. The best advice I've had has always been from independent stores. However I hope you don't have the same experience because they are such large name.
Posted: 15/05/2005 at 20:21

OOK,my main problem was overtraining,working 6 nights a week over winter and training 6 nights a week for 8 weeks.

when i finally get back out there i will be doing more x training,circuit classes etc.

Helen i had an aromatherapy massage last friday,and the lady i go to also is a Reiki master.

after my massage i had 10 mins of Reiki on my knee and it has really helped, the soreness has eased quite a bit!
Posted: 15/05/2005 at 20:44

started running again after a twenty year break to see if icould get near to my best half marathon time of 1 hour 13. 4months in ihad my ten mile run down from 1 hour 30 to 1hour 9. going great guns my left knee was hard to walk on the day after my best time.tried to run injury off the next day but had shooting pain on inside of knee .had the same injury 12 years ago i think its medial ligament strain .gave it6days big mistake back to square one .
Posted: 06/11/2006 at 20:15

If you have any knee ligament problems, my experience might make you take it more seriously. 

I have had ligament problems for years, following a fall which damaged my medial and cruxiate ligaments.  I coped OK for a while, joined a friendly club, trained regularly and ran short distances (10K) quite happily with some analgesics, shoe orthotics and use of a hinged knee brace.  I had physio when it felt bad and did all the usual strengthening exercises regularly.  It all helped.

But maybe I should have done more about this old injury and sought earlier surgery.  I've now been told that I've got knee valgus (the knee is bending inwards when I'm standing because the ligaments are so damaged) and also advanced osteoarthritis - the X ray was a nasty surprise because it hadn't felt any worse over the last few years.  I have been told I can never, ever run again and that I must now have a knee replacement.

All I read about knee replacements makes it sound like a lousy option.  Does anyone ever run or take part in sport again after such surgery?  As far as I can see, I'll be lucky to toddle round the shops, let alone run or walk in the mountains.

Mind how you go.... 


Posted: 02/09/2007 at 17:54

Heather,

I'm a Physiotherapist who works with an orthopaedic surgeon. I have had people who have had knee replacements get back to playing tennis, Hill walking and biking. Get a good surgeon. Find out people who have been to him before and see what his results are like. You should definately manage way more than a toddle to the shops.

Jane


Posted: 24/10/2007 at 12:11

Hi,

I have pain on the inside of my left knee, feels like a bruise right on the bone and sore/tender when touched. I can still run but very sore night/day after.

Could this be MCL?

Any advice would be appreciated.

Chris.


Posted: 05/12/2007 at 14:56

The MCL stretches from the tibia to the femur over the inside of the knee, and has a fairly long course over the tibia before its attachment.   It also forms part of the knee joint capsule itself (as opposed to the LCL, which is outside).  All the knee ligaments serve to stabilise the knee, so ignoring injuries can lead to more serious and long term problems.

 It could be MCL strain - is the knee swollen?  Anything more than a trivial injury to part of the knee within the capsule is likely to cause swelling. 

Best advice (as always with joints) is if you aren't sure of the cause, rest for at least a week or two, ice and painkillers, then try gentle training again.  If this doesn't resolve it, you'll need to get someone to actually look at it for you.

Good luck

 (Dr) Simon


Posted: 05/12/2007 at 16:34

Hi Simon.

No i dont have any real swelling just a bruise like pain. Anyway will take your advice and see how i get on.

Thanks

Chris.


Posted: 05/12/2007 at 17:13

How much take to recover the ACL broken on half?I use a brace all day and night long and make gymnastic.I have 5 weeks from my accident and doctor says that i need another 4 weeks tonproceed in this way.DO I will be recovered after that?
Posted: 30/03/2012 at 15:01

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