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Medial collateral ligament injuries are especially prevalent in particular sports. The movements and rules of sports will influence the injuries that are most commonly seen. Sports that require sudden changes of direction when running, low tackles from the side or lifting a heavy weight from squat positions, are at high risk of MCL injury. In many sports, these injury trends are monitored and research is done to find out how best to prevent them, as well as treat them. In some cases, due to the severity of injuries, rules of the sport are altered to make play safer.
Rugby and NFL (National Football League), have many similarities in the movements and actions of the players. They, therefore, have similarities in the injuries that are most common amongst the players. Sudden changes of direction when running at high speed, to dodge or catch an opponent, can put high lateral force through the knee.
Tackles will also stress the knee, when force is suddenly, and often unexpectedly applied to the leg when the foot is planted and fixed to the floor with studded shoes. The direction of the force will impact which structures in the knee are stressed and at risk of injury. A force to the outside of the knee that pushes the knee inwards will put the MCL at risk, along with other structures like the meniscus.
In NFL, an MCL injury is the most common injury among players, with 13% developing this injury during their career (Logan et al, 2018). And in rugby union, MCL injuries in professional players account for 25% of days missed from play (Dallalana et al, 2007).
Strength and conditioning that is sports specific is the most effective way to prevent an MCL tear in sports like rugby, which are high risk for these types of injury. Specific exercises to strengthen the knee will include exercises for the quadriceps, hamstrings, adductor, calf and glutes. These muscles control the movement of the knee, and need to be strong enough to cope with the forces of the sport. Agility drills including quick changes of direction and single leg control, will improve the coordination, reaction speed and make the knee more resilient to the demands of the sport.
MCL tears are the most common knee injury in elite soccer players, with most injuries sustained through a tackle. Similar to rugby and NFL, football entails a lot of sudden changes of direction and pace, that can put a lot of pressure on the medial collateral ligament.
This study found that 86% of MCL injuries in elite soccer players were classified as moderate to severe. A recovery meant a median of 33 days were lost from play, but the majority reported a full return to play and only 3% suffered re-injury (Lavoie-Gagne et al, 2021).
Breaststroke poses high forces on the ligaments on the inside of the knee and can cause pain and injury to the MCL.
Often swimming is recommended as a good non-impact alternative to another sport such as running, during the period of rest after an MCL injury. In these cases, straight leg kicking might be ok with mild injuries after the initial rest period, but breaststroke is to be avoided.
Increasing adductor strength (the inward movement of the leg from the hip) and strengthening the muscles around the knee can help to build more tolerance to the forces caused by this stroke type, and prevent injury to the MCL.
Cycling, or using an exercise bike, is a good form of exercise when recovering from an MCL injury. The positions that most stretch and stress the MCL are avoided: full extension and flexion, rotation, and inward movement of the knee.
Check that you have a good set up on the bike so that you do not over extending your leg if your saddle is too high, or bending your knee to much if your saddle is too low. As you rotate the peddles check that your knees move in a straight line and do not move inwards towards the top tube.
While golf is a low-impact sport it does require a twisting movement through the knee. Though golf is unlikely to cause an MCL injury it may irritate an existing injury.
It is not recommended to play golf with an acute MCL injury. In most cases, it will be advised to return to play only when the knee is pain-free to walk, and has no pain on a valgus stress test of the MCL. Typically this will be 3-4 weeks into the recovery of a Grade 2 tear.
When returning to play it might be best to wear a protective brace for the first few weeks, or rounds of golf. This will provide additional support, and this can be gradually weaned off.
In Jiu Jitsu, injuries are common. The back and neck are most likely to be injured, and the next most common is the knee. This study of amateur and professional Brazilian Jiu Jitsu fighters found that 38% of knee injuries are to the MCL caused by valgus stress or hyperextension of the knee (Juliano Eustaquio, et al 2021).
The knowledge gained from this and other studies can help to develop sport-specific protocols of strength and conditioning to help prevent this common injury.
This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.