STEVE JACKOWSKI

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How I Rehabbed my MCL Tear

10/24/2016

93 Comments

 
PictureSame spot different day
It was a spectacular day on the north coast.  A friend I hadn't seen in years came up to surf with me and there were only four of us out in perfect shoulder-high waves with a few plus sets.  An hour into the session, I raced down the line hoping for a barrel in the section ahead, but at the last second, the water under the section drained with the dropping tide and I tried to turn down and out. 

Unfortunately, the back rail of my board hung up and did an el-rollo with my foot while my knee went in the opposite direction.  I felt a major tearing.  I paddled back into the lineup and talked to the physical therapist who was surfing with us.  He suggested that from the symptoms, it was a MCL tear - one of the most common surfing injuries.  He also said that if the injury didn't involve other ligaments or the meniscus, it likely wouldn't need surgery.  

Ironically, a few minutes later, my friend hurt his back, so we hobbled up the cliff together, disappointed at the number of uncrowded perfect waves we were going to miss.  

I raced home, showered, iced, and elevated my leg, then waited patiently for the arrival of Karen's son and daughter-in-law, both Osteopaths and specialists in Neuromuscular Medicine. They were planning to spend part of the weekend with us.  Two rounds of disc golf were scheduled for the next day and I envisioned being able to play.   Little did I know.

Picture
In the meantime I did research on the internet to understand what the MCL was and what the prognosis might be.  

The MCL is a ligament that runs on the inside of the knee.  It is frequently injured in soccer, football, and rugby in a tackle where the foot is planted and the knee is struck from the outside, tearing the supporting ligament on the opposite side.  

Mine was caused by my foot being pulled upward by the wave as my knee went downward and my body rebounded upward causing the same effect - a tearing on the inside of the knee.   

I also discovered that MCL tears have three classifications:


Grade 1 - a minor strain with recovery times of a week or two
Grade 2 - a significant tearing of the MCL with recovery times of 4-12 weeks
Grade 3 - a complete rupture of the ligament with recovery times of 12-16 weeks.  

The primary test used to diagnose MCL strains is called a Valgus test.  Basically, your knee held steady while your lower leg is pushed outward.  If your leg flops outward with little resistence, little pain, and just keeps going past 45 degrees (even 90 is possible), you have a complete tear (Grade 3) of the ligament.  

If your knee is stable and there is good resistance to the outward pressure, though painful, it is most likely a Grade 1 strain.  

If your knee is unstable and your leg moves independent of the knee, but encounters resistance, it's a Grade 2 tear.

Mine was Grade 2 as there was significant instability in my knee.  I was surprised that there wasn't significant swelling, but it appeared the wetsuit provided good compression and the cool water didn't hurt.  

The Docs arrived and confirmed my diagnosis.  They did some Osteopathic treatment to help realign the knee and to encourage fluid flow.  But according to Karen's son, I was likely looking at 12 weeks for full recovery and certainly wouldn't be playing disc golf any time soon.  Of course I didn't want to believe him.  I'd never had an injury that was that debilitating and I couldn't imagine this one would be.  

That night I tried to sleep in bed, but just the weight of a single sheet was too much if I moved my leg to the side.  For the next two weeks, I slept in a recliner chair with my knee elevated.  


Karen's son also recommended an offload brace.  Unfortunately, the medical supply store didn't have any so I made do with a hinged knee brace.  It helped, but with my now very swollen knee, the hinges pressed on the MCL.  I later saw an offload brace and wished I spent the money (my insurance deductibles are ridiculous).

Partly because of insurance, but even more because I like to think I can solve every problem myself, I decided to do my own rehabilitation.  I must admit that after all I'd read about unnecessary knee surgeries and their complications, I was skeptical of entering that process.  But, I had the opinions of two Osteopaths (see my previous post on Why I Believe in Osteopathy) and a physical therapist, so I wasn't going into this completely blind.   Based on their input and the analyses provided by sports medicine websites, it was almost certain I had an MCL tear with no other complications.  So, from what I can see, it was just (!) a question of rehabilitation.  

After studying  numerous physical therapy and sports medicine sites, I ultimately settled on the 
Sports Injury Clinic.  I also used Summit Medical Group's exercises.  In particular, the initial stretching and strengthening exercises helped tremendously, particularly the passive knee extension (which hurt like hell), the heel slides, and the leg raises.  I did the knee extension and flexion along with the heel slides several times a day until I got enough consistent flexibility to walk with minimal pain.  Ultimately, I moved on to more challenging exercises.   My progression went something like this:

First four days - RICE - the swelling was so bad I really couldn't do even the most basic exercises.
Beginning day 5 - easy stretching exercises, especially knee extension and heel slides.
Second week - added strengthening exercises with bands.  
Third week - started increasing walking distances and began gym workouts (bike and weights).
Fourth week - added Plyometric exercises (one legged jumps).

Picture


By the fifth week, I was feeling pretty good.  The swelling was almost completely gone and although my knee would get stiff if I sat for a while, doing the passive knee extension and flexion after getting up seemed to work well.  I bought a brace with a strap, and decided to try to surf.  The strap is cool because you can wrap it around the weak parts of your knee to provide much more support.  It stretches so you can make it really tight and it velcros to itself.  

I paddled out into easy, mushy rights and lefts.  My first wave was a right (backside for me), and as I started my bottom turn, I felt my knee give and pull.  It hurt like hell but the pain subsided quickly,  I decided to try a left and had no pain at all until I did an aggressive cutback.  I stuck with lefts for the next hour and surfed cautiously.  Unfortunately, I discovered that when you duck a wave, the wave pulls at your legs, sometimes to the side, and when that happened it definitely hurt.  I was sore after the session but I was glad to have surfed.  Still, I knew I wasn't ready.  It wouldn't take much to re-injure my knee in the surf.  Anything unforeseen would do real damage.  

I worked hard with the exercises and the gym the following week and tried again.  This time the waves were small but quick and mostly lefts.  I had a great time until I tried a right.  Again, driving off the back leg hurt.  It wasn't unstable like it was the week before, but still.  

It's now been eight weeks.  This past week, I was able to make full backside bottom turns and aggressive cutbacks on my lefts.  I surfed four really fun days.  On the last day though, I punched through a large set and got tossed around by the last wave.  I really felt it in my knee.  It didn't tear, wasn't any worse later, but I know that I can't let up on the strengthening exercises.  I still have a ways to go for 'full recovery'.  In the meantime, I can hike, dance, and play disc golf (took 4th in a tournament yesterday with no pain).  

Mistakes I made.

Realistically, Karen's son was right.  It's going to be 12 weeks for full recovery, particularly for surfing.  I seriously underestimated how much inward force you put on your knee in a backside turn or frontside cutback.  I seriously underestimated the force of the ocean, which is a very stupid thing to do.  And at the beginning, I tried to do too much too soon.  I'd try to push walking and tried to do the harder strengthening exercises when I wasn't ready.  Each time I did, it set me back a couple of days with renewed swelling and loss of flexibility.  

Overall though, I'm almost there.  Still, perhaps you can avoid some of the mistakes I made.

Set your expectations - it's going to take longer than you think.
Don't do too much too soon.  Be very cautious as you restart any activity.
Spend the extra for the best brace possible.

And, I think the main reason for my successful recovery is the dedication to the daily (or more) stretching exercises, and consistent and progressive strengthening exercises.  

The good news is that if it's an MCL tear with no other damage, you can rehab it yourself. But above all, you need Patience, Patience, Patience!

Update January 2018.

It's been a year and a half since I first injured my MCL as described above.  The rehab program worked, and I was back to full activity with maximal stress (surfing, extreme skiing, etc.) within 4 months (with a lot of hard work in rehabbing it).  Everything seemed fine and then, six weeks ago, while Salsa dancing on a rough surface, my foot caught in a fast turn and I felt my MCL pull.  It was too painful to continue dancing so I stopped.  By time I got home, my knee was hugely swollen.  I started the RICE treatment, but underestimated the severity of the injury.  Yes, it was only a grade 1 injury - there was no looseness under the Valgus test, but almost any activity caused huge swelling.  I consulted my muscular medicine doc and he informed me that re-injuries are often worse from the point of view of healing time.  Unfortunately, he was right. 

I hate being sidelined from the surf during one of the best seasons we've had in years.  And, not being able to run, dance, ski, etc. is depressing at this time of year.  

So here I am, six weeks later.  The pain is gone.  Most of the range of motion has returned (with lots of stretching), and I'm working on strengthening.  The plyometric exercises are still tough.  I did try surfing and easy front side is okay but I can tell I'm not quite ready for more aggressive turns.  I will be giving skiing a shot this week (now that there's a bit of snow in the Sierra).  In the meantime, I'm working hard on the strengthening and I now realize that to avoid re-re-injuring my knee, I need to keep up these exercises even after I'm back to 100%.  They're going to become part of my daily routine, much like core strengthening has.  Core strenghthening  resolved all of my back problems and I expect I can avoid further knee injuries if I keep up these knee exercises too.  

So, a final word of advice.  Once you're back to normal, don't stop your strengthening and range of motion exercises.  Do them regularly and hopefully, you can avoid a re-injury that will sideline you for several weeks.


93 Comments
Karen Noel
10/24/2016 10:54:39 am

This is amazingly thorough and great information. But I feel I must stress the following: I live with this man and I have never seen anyone as dedicated to healing as he is. He was so conscious of what he had to do each moment of the day that, even with his 'mistakes', I imagine his healing has been the fastest and most thorough possible.

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DG
1/17/2018 08:09:55 pm

I got a Grade II MCL sprain three weeks ago skiing, this post helped motivate me and made me be realistic about my recovery timeline. Thanks for writing this, always nice to read other's stories to know that we're not alone with our injury.

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Steven Jackowski link
1/17/2018 08:17:45 pm

Hang in there. Surprisingly, it will heal. However, after a year of resuming my very active lifestyle with skiing, whitewater kayaking, surfing, etc. I reinjured my MCL about 5 weeks ago. This was just a grade I, but it's taking a while to heal. My doc said that reinjuries take longer than you'd expect. After 5 weeks, I can play disc golf and hike. I can surf with a brace if I take it easy (front-side only), and I'm hoping to try it out skiing next week (with a brace to begin with). Ironically, I sprained it again dancing on a rough surface. I think my mistake was not keeping up the strengthening exercises after I felt it was fully healed. This time, I'm making them a part of my regular routine. I don't want to go through this again.

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BF
10/11/2019 05:27:11 am

Same story, left knee MCL Grade 1-II. Its been 7 weeks and I'm still not fit to really run or get back to doing what I want to do. I think the most frustrating bit is reading about how its typically 3-6 weeks to recover. What!?!? Not true. And I've been good about rehab efforts. Its getting there but just taking forever.

Thanks for sharing your story.

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Steven jackowski link
10/11/2019 05:33:26 am

You're welcome. Hang in there and be rigorous about rehab, but patient. It will get better but it takes time. For me, knee stabilization using bands really helped. Good luck!

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Surgeons for sports injuries link
10/17/2019 10:06:55 pm

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GES
11/12/2019 02:25:29 pm

49 yr old male. complete grade III tear of MCL 7 weeks ago playing in my FIRST over-50 soccer game. got immediate MRI, knee brace, and PT. similar PT progression of range of motion and RICE, then stationary bike, then small amounts of weights, then elliptical, then some slightly more progressive/dynamic movements with resistance bands -- all under PT supervision. just left 7 week check up and Dr says its healing nicely. have a big ski trip in 11 weeks (will be 18 from injury) so i am working toward that. Dr said i should be able to play all sports in spring without a brace. he said i can't really re-injure it in short term, if i wear the brace when working out. i don't wear it just walking around. he said i could push the workouts, and just let pain be my guide. my advice - give it these injuries time. wear brace whenever in doubt. i have played all sports my whole life - ski, surf, soccer, golf, tennis, swimming, EVERYTHING, and hate to be sidelined...but again, my advice is take your medicine, give it time to heal, and then COME BACK STRONG!

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Angie
12/5/2019 11:32:53 am

I was in pain early September and got an MRI on both knees. Showed overused, mild/moderate MCL sprain. I've been doing PT once a week since Sept 9th. The first 3-4 weeks I was feeling good and thought I am getting better. Took the boys sledding, shovelled snow, walked around Halloween and my pain came back. I'm almost 3 months out doing PT and do strengthening at home. Although I can walk and tolerate the pain, twinges etc. I am still not completely close to healing. The past week I am sleeping uncomfortably and feeling stiff, locked on my left knee in the middle of the night especially on the lateral side which is the worse knee btw. I can bend my knees, do the stretches and strenghten from PT work out fine, but I'm wondering if you ever felt your lateral side locking or stiff at night where it wakes you up. Does it usually feel like it's a meniscus tear after 3 months of PT or in general. I definitely can't ski this season, but just trying to find some comfort. Please advice Thank you.

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Steven Jackowski link
12/5/2019 08:51:46 pm

Hi Angie,

You may be a victim of doing too much too soon. I would have to say yes to both of your questions. I did feel my left knee locking from time to time, almost always stiff, and it definitely woke me up, At three months I thought I was substantially better but quickly discovered (in my failed attempts to surf), that I'd set myself back. I'm not sure what PT you're doing, but twice a day, I did heel slides, leg lifts (forward, side, and back), toe raises on stairs, squats, single leg hops, side to side hops, stationary bike and more. However, the most effective were the knee stabilization exercises with resistance bands. And, as I mentioned, I did reinjure it and that recovery took longer than the first. Since then, I regularly do the knee stabilization exercises for maintenance. I'd also suggest a brace when you're doing anything other than linear movements - at least for a while. Don't lose faith, but do keep in mind that it take longer than you want it to.

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Wayne
1/10/2020 07:03:09 pm

Thanks for sharing your rehab story, Steve! It was really helpful. I torn my MCL (Grade 2) 3 weeks ago skiing and recovery is slower than expected (the doctor said 4 to 8 weeks). May I know your MCL pain is near the femur or near the tibia? Mine is near the tibia and from some Websites it seems like it's harder to heal. Thanks!

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Steven Jackowski
1/10/2020 10:51:27 pm

Hi Wayne,

Most of my pain was dead center, though I had a lot of pain near the femur for quite a while. Be patient and find a good physical therapist or go with the sites I mentioned in my article. Mine was closer to 16 weeks and the second injury took almost as long. Since then, I'm religious about my knee stabilization exercises and have had no problems. Still, don't push it. It may take longer but you'll have a better outcome if you're faithful to the exercises and don't return to full activities until you're really confident.

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Wayne
1/11/2020 09:34:59 am

Thank Steve!

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Angela Clarke
4/18/2020 06:52:33 am

This post is extremely helpful-it's very depressing to not be able to run during Quarantine. I will start using the strengthening exercises regularly as you suggest once I'm back to 100% to prevent re-injury. I came for the post on your MCL, but wow, what an interesting life you have! Hope you and your family are safe and well and thank you for the great info.

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Steven Jackowski link
4/18/2020 08:27:18 am

Hi Angela,

Thanks for the kind words. It's been a couple of years and I've had no further problems. Aside from the limits of shelter in place with all the park closures, I continue with full activity. Oddly, the thing I miss most is the Salsa Dancing at the Santa Cruz Wharf with Karen. We do some dancing at home but dancing outside is hard to beat.

Once you're at 100%, I strongly recommend adding at least the lateral stabilization exercises to your daily routine. I think that's why have been injury free, even with a few more bad surfing falls.

Take care and be patient (both with the rehab and the confinement).

Steve

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Steve Baker
4/25/2020 11:37:27 am

Great article Steve, I am an active 73 year old and am just not ready to sit around...not willing to let the old man in, as Clint Eastwood said....Grade one mcl tear. Started out with RICE and am slowly getting better,with some exercises and stretches but need to step it up and do them really consistently, which your article gives me the confidence to do them. My pain is less daily, but doing too much and then a little more pain afterward scares me that I am doing more damage than good. I don't overdo it. I guess my question is how much pain while exercising etc is okay and not doing damage. Does the old adage apply...no pain no gain...Thanks, oh yeah, is the stationary bike okay and good even with a little pain....

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Steve Jackowski link
4/25/2020 02:16:12 pm

Hi Steve,

As noted in the article, mine was a grade 2+ - my knee would move outward more than 45 degrees - so my experience may be different. As for pain, my suggestion is that you avoid it as much as possible, particularly during the first few weeks. Work on flexibility and range of motion taking it to the point of tightness but not to the point of pain. Or, just to the point of pain and then back off. Heel slides and sitting with legs outstretched, ultimately a pillow under the heel for the stretch. The exercise that worked the best for me was knee stabilization - I tied surgical tubing bands to an object and to my uninjured ankle, then stood with my injured knee slightly bent and did reps of moving my good leg forward, back, and to each side. This forced my injured leg to strengthen the supporting muscles.

As for biking, that should be okay - again assuming it doesn't cause pain. Lateral motions are the problem. Ultimately you can do plyometric exercises like hopping on one foot - forward backwards and to the sides, and do side to side jumps. But again, if it starts to hurt, you've done too much.

The good news is that the MCL will heal itself (even a grade 3). The key is to let it heal, but to maintain range of motion so the fibers don't shorten too much.

But as I said in the blog, the biggest risk is doing too much too soon. I, too, am older and my fear of prolonged inactivity (and the associated loss of strength), made me push it, setting me back each time. You will get the best results and the fastest complete recovery if you exercise patience, patience, and more patience! Work on range of motion and strengthening without pain.

Steve

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Julian Martinez
6/20/2020 08:53:08 am

what knee stabilizer exercises did you do during rehab and currently after healing

Steven Jackowski
6/20/2020 09:03:42 am

Hi Julian,
Not sure why I can't reply to your comment, but hopefully you'll see this one. For knee stabilization, I used bands (actually tubing), attached to a low object (e.g. a furniture leg). The main exercise is to put the band on the good ankle facing where you attached it and then pull your foot back 10-20 times, turn 90 degrees and pull to the side 10-20 times, turn 90 degrees and pull forward 10-20 times, then turn again and pull to the opposite side 10-20 times. Your weak leg will work really hard to do this and if you're feeling pain, ease up on the tension on the band. I usually do the opposite leg (hoping I won't injure that one by keeping it strong), then repeat for 2-3 sets. you can vary the intensity by standing closer or further away from where the band is attached. Even now, years later, I try to do this every other day or so.

Steve Baker
4/25/2020 04:25:27 pm

Got a MailerDaemon back from my replys...

Thanks for your reply. It gives me confidence that somebody has gone before me and had success. It sounds spot on to me. You have
the best site dealing with the aftermath of the injury, and the fact you have gone through it, and made the mistakes of pushing to hard, and also having g ot it right.
Like you stated at the end of your article PATIENCE PATIENCE PATIENCE. God, give me patience.... and I want it now!!!
Thanks again,
Steve
Steve
I have another question for you. What do you know about healing a meniscus tear? Have you ever had one? Would you know if they harder or easier to heal than the mcl. Is the rehab the same for the meniscus tear as a mcl tear? Mine might be a meniscus tear instead of the mcl.
Thanks,
Steve

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Steve Jackowski link
4/25/2020 06:43:40 pm

Hi Steve,

Hopefully it's not a meniscus tear. My physical therapist friend and my two muscular medicine docs said that in most cases if there's a significant meniscus tear, surgery is required. Minor tears can heal themselves with RICE. Apparently, they don't heal well by themselves though I have heard about platelet injections that may help. From what they said, an MCL tear is often complicated by a meniscus tear and without an MRI, it's hard to know if you have one or both. I'd suggest giving yourself six weeks of conservative MCL treatment and if it's not getting better, then check on the meniscus tear. On the other hand if an MRI is available that may be the best way to be sure.

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Melinda Perritano
5/16/2020 03:17:08 pm

Hi Steve — My PT opined I have a grade 1 or 2 MCL tear (my insurance wouldn’t approve an MRI. I did everything you recommended (rice). It’s been 3 weeks and I can’t walk normal because my leg won’t pick up or flex at the backend of a step so I’m walking straight legged. It’s very painful when I attempt to force it to do so and I’m not successful. How many weeks until you were able to bend your knee and walk without a limp. Any other advice? Thank you!

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Steve link
5/16/2020 04:07:44 pm

Hi Melinda,

Hopefully you've been doing the heel slides and knee extensions. I did these multiple times a day during the first few weeks to gain mobility/flexibility. Never go past the point of pain. If you feel pain, back off.

The flexibility is the most important to being able to walk. Once you have essential range of motion, you can start strengthening. However, if you go to fast, you're subject to reinjury. I made that mistake more than once. Hence my recommendation to accept that it's going to take longer than you think. The slower you go, the faster you'll ultimately heal.

If you haven't already, do check out the link to the exercises near the top of the post: <a href="https://www.sportsinjuryclinic.net/sport-injuries/knee-pain/acute-knee-injuries/medial-knee-ligament-injury-exercises">Sports Injury Clinic</a>.

Above all, patience, patience, patience!

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Steve link
5/16/2020 04:09:19 pm

Melinda, sorry - the HTML didn't go through. Please copy and paste this link to the exercises:

https://www.sportsinjuryclinic.net/sport-injuries/knee-pain/acute-knee-injuries/medial-knee-ligament-injury-exercises

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Steve
5/16/2020 04:11:13 pm

And, sorry for the typos (e.g. to vs too).

Steve

Eileen Blackburn
9/19/2020 05:06:47 am

I broke me tibia and injured my MCL July 4th. I put no weight on for 7 weeks. The MCL hurt much more then the break. I didn’t start using the brace until week 9 (second opinion). 11 weeks today and still as much pain as day 1. It hurts when sitting. Hurts with knee straight hurts with knee bent. For the first two weeks I did not know it was broken and carried on as usual. Nail slides hurt a lot. So I haven’t been doing them. Dr said if pain is a 5 don’t do it. Help!

KC
5/30/2020 10:41:44 pm

I love this post. I have been rehabbing a ? grade II-III MCL tear from surfing sustained in Costa Rica in March. I am doing the PT myself due to coronavirus. I did not get an MRI, but I had a crazy fall/wax malfunction/heard a pop, and experienced pain and swelling, esp. day 2-3. To answer your question above, I could not walk until 7 weeks, and I still feel some occasional twinges when walking. I was straight leg walking/limping until that point. I actually tried some light jog/walking at 8 weeks, and I felt pain on the femur MCL attachment point (so I stopped). Now I'm at 10 weeks and tried some light swimming in the ocean today. Reverse breathstroke and forward breathstroke both def hurt and surprised me with twinges. I was hoping to be able to surf by 11 weeks. Not sure. May try skateboarding at 11 and surfing at 12. Considering an IndoBoard to help train... Good luck!!

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Steve
9/19/2020 11:48:51 am

Hi Eileen,

I'd suggest you check out the video links I posted above. First and foremost is getting range of motion, then strength. I would start with just straightening your leg as far as you can - reach the point of pain and back off just a bit. Hold for 60 seconds are repeat. Do this several times a day. As you get some range of motion and the pain decreases, start the heel slides. Again, you don't have to fully extend at first. Do this multiple times a day and over the course of a week or two you should see improvement in range of motion. At that point, you can begin the strengthening exercises. In my experience, getting stronger really reduced the pain. But if I went too fast and as your therapist suggested, the pain went beyond a 5, I lost ground. Still, you can't expect to get through this with zero pain. If you don't work on range of motion and then strength, you won't improve. Unfortunately, as far as I know, this injury won't heal itself completely without these efforts. I know it can be discouraging, but stick with it and just expect that it will take much longer than you hope.

Anthony Byrne
6/7/2020 03:25:18 pm

Steve & everyone,

This post was a perfect one to stumble on. Exactly a month ago to the day I had a pretty rough skydiving accident. MRI confirmed a high grade 2 MCL tear with a torn MPFL and some torn cartilage with some additional strain on the tendons. I started working out again last week and definitely over did it. Looks like I’ll be taking it easy and doing my PT for months to come!

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steve
6/7/2020 11:00:38 pm

My one last piece of advice is patience, patience, patience! If you take it slower, you'll ultimately heal faster with better results. It's too tempting to think we can work harder to improve. Not in this case. Good luck!

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Mari
6/15/2020 06:44:10 pm

I injured my MCL while Hiking uphill in Hawaii and had an x-ray and the first doctor I saw told me I had MCL tear and started immediately wearing a brace and RICE. One week later started PT for exactly 8 weeks, then... got worst. It hurts everyday and I m barely able to walk. I started doing some aerobic exercises in the pool almost everyday plus PT exercises and I m still with lots of pain. Now I am waiting for next week to get a second opinion with a different doctor because I think I also injured the meniscus when I fell.
Do you think I should stop the pool exercises?
Thanks

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Steve
6/15/2020 10:52:02 pm

I'm not sure what specific pool exercises you're doing but generally, if you're not pushing too hard, I would think they could be helpful. As I indicated in my blog, the biggest problem is thinking you can work harder to get better. This injury takes patience - patience that most of us don't have, particularly if we're really active. For me, the things that helped the most were the heel slides and knee extensions. I did these 2-3 times a day until I had a full range of motion without pain. At that point I started strengthening exercises. Progressing without pain (aside from the extensions) is critical. If you have pain, you should probably back off. If the pain got worse, you probably have the wrong physical therapist. Although I strongly believe in physical therapy, you need to have a good therapist who looks at your particular physiology and doesn't just offer a standard protocol for improvement. At this point, I'd suggest starting over. Go slowly. Work on the extensions and flexibility and then move slowly towards strengthening. I think my example (including my mistakes and setbacks) is a good place to start. Convince yourself this is going to take 3-4 months (as hard as that may be), and work incrementally towards a longer term recovery. Not only will the recovery be more solid, you'll likely do better than you expect. If you think it will be sooner, I can guarantee it won't.

I'm now a few years past my last (re) injury. I'm diligent about my exercises even though I don't have a problem, and so far, have been able to continue my (extreme) sports without reinjury. Be patient, work on flexibility, take it slowly and then work on strengthening.

Good luck!

Steve

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Matthew
8/19/2020 10:03:21 pm

I am so grateful to have stumbled upon this post. Surprisingly, there is no YouTube content on specific MCL tears from surfing. July 18th, my right/front foot slipped off the deck of my surfboard while I was pumping hard, and I went down right into a splits with my right leg. I didn’t hear the “pop,” but felt the immediate and excruciating pain.

MRI 28 July: full thickness tear of the superficial MCL at its femoral insertion / sprain of ACL / cartilage fraying at the patella.

I, too, have made the mistake of going at it too hard. In fact, I’ve made things worse to the point that other parts around the injury are starting to hurt. I’m into week 5 right now, and it’s been hell on my mental state. I’m 41 but still really active, and it kills me to be indoors all day. I do some minor exercises. My range of motion still sucks. I sleep with a pillow under my leg since I can’t fully extend it yet. I’m a “straight legger.”

Part of me is worried that I’ll be like this for the rest of my life and never surf again, but to read all the comments, it’s nice to know that I still have a long way to go and that there’s hope for improvement.

Around November will be the 4 month mark. I’ll be psyched if I can start walking again in September. I’ll be even happier if I can be on a wave again on Christmas.

Thank you again for posting your article.

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Steve
8/20/2020 06:01:08 am

I'd never had this kind of injury that kept me out of the water and couldn't imagine not surfing daily let alone stopping for months. But I'm fully recovered though I regularly do the strengthening and stretching exercises as a preventative.

Hang in there. Do the stretches for range of motion, then begin to strengthen. Work hard on the patience. You'll get there.

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Louise Johnston link
8/24/2020 05:22:56 pm

That was a cracker of a read thank you for sharing, the comments are all super helpful too. I did a grade II Wake Surfing 7 weeks ago and 3 days (but who’s counting). I felt it go & thought - ooooh yep that didn’t tickle, but it was manageable. Then I woke up 2am beside myself in pain. Couldn’t roll over in bed, even breathing hurt haha I was in agony. My husband likened it to the carry on I made during labour contractions haha.

For me it’s not so much about getting back into the water or being able to play this season of footy etc.. it’s more my morning runs which set my days up beautifully once the kids are at school. I just got back from a 6km walk which is the furthest I’ve gone & it’s feeling good. I do however every now & again feel like something gets “caught” or snagged under my kneecap when taking a step - did you experience this? Do you have a recommendation for a brace for running? I was the same as you, the pressure on the MCL was too much for the rigid brace, it’s been strapped for the entire time however.

I’m treating it with respect & being as patient as I’ve ever known myself so I don’t set myself back. Thanks again for the read.

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steve
8/24/2020 05:36:54 pm

Hi Louise,

For the catching under the kneecap, I had that and sometimes pain over the kneecap when my IT band got too tight. This was before the MCL tear and intermittent over the years. Still, it's possible that you have a Meniscus tear which I've heard has similar symptoms. It it continues or causes pain, you might consider an MRI to check it out.

As for the brace, I used the one I described to help me with lateral stress in the early stages. You seem to be far enough along to where you may not need a brace if you start on relatively level soft surfaces and avoid downhills.

An excellent physical therapist and well-known competitive runner who I saw for another problem suggested I get to where I could walk a 10K at a rapid pace and then start alternating walking and running - very slowly - starting with 2 minutes of walking followed by 30 seconds of running and every week increasing the running by 30 seconds. This means a very long rehab, but it will allow you to assess the condition of your MCL. If it hurts, reduce the running - back off and build slowly.

By my calculations, you're likely less than half way through what you need to be fully functional. Work hard on the patience. The last thing you need is a reinjury - that can take as long or longer to heal.

Good luck and feel free to post your progress. We all benefit from each other's experiences.

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Augusto Medelius
8/28/2020 08:18:17 am

What brace did you use during your recovery and reinsertion to mild activity levels?

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Steven Jackowski
8/28/2020 08:31:53 am

Hi Augusto,

I used a hinged brace but I wouldn't recommend it. The hinges on the inside of the knee caused a lot of irritation of the MCL and the healing area. The local medical supply shop didn't have an offload brace and they seemed expensive, but if you can find and afford one, I'd highly recommend it for the early stages. Afterwards in the water and on hikes, I used the brace pictured in the blog. It's pretty standard but it had a strap you could use to tighten the area around the MCL to get more support. There seem to be quite a few on the market now, just do a search on knee brace with strap. Good luck and above all, go slow and be patient!

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Kailey Allen
9/23/2020 10:06:17 am

I suffered a knee injury almost 3 weeks ago now in a freak equestrian accident (horse spooked, started to bolt, and girth started sliding on me! Bad combo!). I saw an orthopedic around a week after (I'm a college student and scheduling everything is a pain), and I still don't have an "official" diagnosis. The earliest they could do an MRI is tomorrow (this friday makes 3 weeks after injury), although the doctor is very confident it's some kind of MCL injury. Although there's slight instability, the doctor expressed some concern that there's a chance I've got very nearly a full tear in there. He said he's seen many cases, especially in equestrian accidents, where the torn MCL ends up kind of wrapping around parts of the kneecap, which makes your knee actually feel more stable when you walk, but can cause a lot of pain when moving your knee all over. Has anyone ever heard of this before??? I get my MRI done tomorrow and consultation on Friday, so hoping it's a milder grade II, as I originally suspected! Also, within these 3 weeks, I've slowly worked on flexing and bending my knee gently, and have made sure to walk around some with my hinge brace on, but the only difference I'm seeing is in the swelling. My swelling has gone down A TON, but I'm still not able to flex or bend it much further than when it was all swelled up. Any thoughts on this, or ideas of gentle exercises I could do to help? Thanks guys, and I hope anyone with an MCL injury on here gets well soon! We're in this together!

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Steve
9/23/2020 02:40:20 pm

Hi Kailey,

I strongly suggest you follow the links in my original blog for initial stretching exercises, particularly the Summit Medical exercises. Heel slides, leg lifts, clam, etc. are critical for regaining range of motion before you start strengthening. As for the 'wrap around' possibility, I've spoken with doctors and physical therapists and none have heard of that but then again, maybe it is unique to equestrian activities. From what you've described, it does sound like a mild grade II. Unless there's additional injury, if you're religious about following the rehab program - increase mobility, the strengthen - you should recover well. But do be patient. It will take longer than you think and working harder will only set you back. Good luck!

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Kailey Allen
9/24/2020 03:11:17 pm

Thanks for the insight and reply! I was pretty skeptical when the doctor talked about that whole "wrapping" thing too, so who knows! My MRI went well today, and I have my consultation about the results tomorrow morning. I'm pretty confident it's a milder grade II tear as well, but I'll know for sure tomorrow. As eager as I am to be back in a saddle, all the research I've done on ACL and MCL injuries in equestrians has FOR SURE led me to the conclusion that this is NOT something I want to rush! I read some stories about people having grade I mild tears that got back in the saddle too soon, and now they deal with chronic knee pains and aches because of it (of those who ignored recommendations for more serious tears, some even gave themselves permanent knee damage)! Crossing my fingers for a diagnosis that gives me a shorter recovery time! Thanks again for your response!

Jon
10/1/2020 03:29:39 pm

Kailey, how’d your consultation go? My daughter is just about a week behind you on her injury (September 13). She twisted her leg sliding into home in softball. I guess Her cleat got stuck and her bottom leg (tibia) twisted Outward away from her upper Leg (femur). Whatever it was exactly that happened, it hurt a lot and she’s still limping on it 18 days later. She had an mri 10 days after her injury. Results showed a grade 2 mcl injury, Femoral condyle contusion, grade 1 oblique ligament sprain and a possible meniscus contusion. They couldn’t see a tear in the meniscus but there was a band like signal they said may indicate a contusion. I hope your results were favorable and that you’re doing better.

Steve, I know you mentioned by the third week you were already working on Some strengthening. Did it Hurt to walk during your third week? She’s been doing the leg lifts, crab etc. but the knee extension and heel slides cause some pain. Because of this, she’s stopped the heel slides and leg extensions. It still hurts to walk and she’s limping a bit with her brace. Trying to find the “happy medium” between doing the stretches but being cautious, as to not cause a setback.

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Steven Jackowski
10/1/2020 05:24:49 pm

Hi Jon,

The pain took quite a while to completely disappear. Getting that mobility is critically important. Heel slides and leg extensions will hurt. I think the important thing is to take any stretch just to the point of pain and back off an hold it there - that point of almost pain. You don't push past the pain but at the same time, this recovery isn't going to be completely pain-free. Anything that increases pain is bad - back off. If you can do an exercise with a bit of pain and afterwards it doesn't worsen, then you can very gradually increase what you're doing (a stretch, intensity, resistance, duration, etc.), Double check the videos in the posts. They provide excellent guidance, And certainly, if you have a good physical therapist, that person can provide the best advice for your daughter's particular case.

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Jon
10/1/2020 06:52:39 pm

Thanks Steve,

I’ll have her pick up with those other 2 exercises Soon. I know on summits website it says those exercises Can be started soon after the injury.

I know You were able to paddle out And surf at 5 weeks and It would be great to see her just walk normally at that time frame. Her jr. College softball starts up next semester (early next year) and it would be great for her to be near 💯. 🤞. In the meantime, she’ll be doing what she can to get healthy

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Steven Jackowski
10/1/2020 10:50:31 pm

Hi Jon,

As you read, while I paddled out at 5 weeks with a brace, it didn't go well. Patience is the key. Mobility/range of motion first, then strengthening, then challenges with plyometrics. Good luck!

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Prashan Thapa
10/8/2020 10:47:40 am

i had this grade 2 Mcl injury..about 4-5 months ago...although i can do all the excercises like jump rope, squats and lunges, running ..there is a slight but constant swelling on my knee...is it a bad sign or is it normal while the injury is healing?

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Steve
10/8/2020 12:24:27 pm

If I recall correctly, it was quite a while before all the swelling was gone - long after my return to full activity. I think this is normal, but do keep an eye on it. RICE is still important and if it worsens, you probably need to back off. Great to hear you're back to full activity. I didn't seen plyometric exercises in your list. Lateral movement is most critical. Hopefully you're working on that and will continue lateral strengthening as part of your regular routine. See my note on reinjury... Good job!

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Andrew
10/21/2020 07:46:17 pm

Thanks for creating this Blog Steve!

I've found it really comforting reading through everyones experiences and challenges with MCL injuries.
I'm at week 7 after a grade 2 MCL tear (soccer) with no other complications. Under load ( running, change of direction, lateral hopping) have no stability issues, I've been diligent with the rehab on the surrounding muscles (VMO, quad, calves, hamstring etc) to create stability.
However, I'm still having some laxity at roughly 20-30deg under no load. The physician thinks the ligament has healed but just in a slightly looser configuration. This laxity is worrying me as its a fuctional movement for soccer players- being able to kick and trap with the inside of the foot under no load. Im really hoping that over the next 4-6 weeks the MCL can begin tightening back up again.

Did you have the same experience where the ligament felt functionally ok ie running, no pain and full ROM etc but that last little bit of laxity taking an age to tighten back up?

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Steve
10/22/2020 08:34:43 am

Hi Andrew,

Absolutely. I had looseness for quite a while. I kept working on strengthening the supporting muscles and kept up the plyometric exercises and stretching (that may sound counterintuitive) and over time it tightened up. Then again, it may depend on how loose it is and it may be worthwhile continuing with a brace while playing (but not exercising. stretching). If you have a good physical therapist, I'd suggest checking in with him/her. In my experience and that of friends, because they usually see rehab all the way through, they may have a better view than the docs. Last and not least, 7 weeks is early for this injury. Mine was 16 weeks before I felt fully able to surf at my most aggressive.

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Ben J
10/26/2020 04:00:43 pm

Great read! I would just like an opinion as to why do MCL’s tear if no actual impact or accidents happen? I’m 41 and I do lunges, squats, plyometrics regularly for years now. I run several times a week and play ice hockey twice per week.
I went to my game and recall when I felt the sharp pain/along side discomfort on the MCL. The troubles I’m having is I was skating in a straight line with no physical contact with anybody. I regret very much continuing to play for 30 mins more with the discomfort to find my leg so swollen the next day that I could not walk. My PT gave me very similar exercises as you offer or recommend on here. I am on week 6 now and still have a lot of pain and ligament catching or binding on something. I will definitely try strengthening twice per week. Anyway im just confused as what other reasons cause MCL’s to tear. Sorry for the long message. Thanks!

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Steve
10/26/2020 04:44:25 pm

Hi Ben,

In my experience and those of friends who've had knee injuries, very often, it's a subtle lateral movement at the wrong time that isn't even noticeable. I've watched the video replay of a friend who travelled 4 days on a boat to a remote surf spot. On his first wave, he blew out his knee without knowing it. When he paddled back out for his next wave, he couldn't even stand up and he ended up waiting 4 days to get to a doctor. He didn't see or feel anything and you can't see anything on the video. For him, it was an ACL tear that required surgery.

I think MCL injuries are even more subtle. I don't think we pay enough attention to the strength required on the inside of the knee. I certainly recognized it when I tried to surf for the first time after my initial injury. BTW, that reinjury was one where I didn't think anything was wrong. At leat until I tried to drive off my back (injured) leg.

In any case, I highly recommend a measured approach to recovery. As athletes, it's too easy to think that the harder we work, the faster we'll recover. Other than range of motion work, that's definitely not true with this injury.

Also, keep in mind that once injured, that knee is forever weakened. You'll recover to 100% but unless you work to continually strengthen, you'll likely reinjure it and that will be even worse.

Good luck in your recovery. And, patience, patience, patience!

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Ben
10/28/2020 02:47:50 pm

Thanks Andrew!
I was not aware that they were subtle injuries as it’s my first knee injury.

Today was my doctors visit and I don’t know how accurate Ultrasound imaging is but they said it was a high grade 2 tear.
I only have one last thing to ask that Forgot to ask in my first message.
Can Graston technique be done on a ligament? Nothing has helped me more in the past, but it was always on muscle.

Steve
10/28/2020 04:48:24 pm

Hi Ben,

Yes, it's surprising how much damage can be done with subtle movements. As for Graston technique, I don't see why it wouldn't help. I've seen it used primarily for tendonitis to reduce the stress on the tendon to allow healing. On the other hand, in this case, it may be difficult to get to the right spot, especially since the ligament must heal itself - effectively rebuild itself.. A high-end grade 2 is what I had and if you think about the structure, it's pretty miraculous that it can heal without surgery. This is not like a tendonitis where the attachment gets inflamed. The middle of the ligament has been torn. But, I unless it aggravates the injury by increasing inflammation or overly limits your range of motion, I can't see that it would be a problem. I'd still check in with a Physical Therapist.

Best of luck!

Steve

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Ben J
11/2/2020 06:25:24 pm

Thanks Steve! Take care.

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Greg w
11/6/2020 02:02:00 am

Nice to find another north coast Surfer’s take on this injury. I did it 3 weeks ago. No barrel section, high tide shore pound. Meager waves too. Never thought a chest hi wave could wreck my autumn surf season. Surfing has put me in a cast before, but that was easy. I knew I couldn’t go til the cast was off. Now I have to judge for myself. I don’t mind surfing through a bit of pain, but this worries me. If I go and re-injure it. Depression will set in. OB has been really good too😭

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Steve
11/6/2020 09:19:44 am

Hey Greg,

Sorry to hear about that. Most of my significant injuries have been on small surf.

This is the toughest injury I've ever had. It's hard, but be patient. Reinjury is worse as I described. Be rigorous about gaining range of motion, but don't push the strengthening. Go at it slowly. Believe me, it will be worth it. And, after a full recovery, don't stop the exercises, especially the band exercises and the plyometrics. Make them part of your regular stretching routine and you'll avoid reinjury. Good luck, and again (sorry) Patience is the key with this one.

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Victoria Monahan
11/19/2020 07:10:33 am

Hi..I just came across this blog. Thank you! Im 12 weeks into a right lead leg MCL tear. Grade 2 almost 3. I went back to gym a month ago and Mtn biking just shortly after gym. Ended up getting mild plantar fasciitis on left foot because of the favoring going on with the right leg. Arghhh. Im so disgusted with this injury. So debilitating to my lifestyle. Its awful. Its hard to stay down..its deceiving still at times. Feel great...then hurts like heck next. Its the worst injury ive ever had. Thanks for your encouragement. Over it in Arizona.

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steve
11/19/2020 08:22:55 am

Sorry to hear about the injury. For me, I couldn't believe that it would take as long as it did or how much work was required, but not too much. Yes. It was very frustrating.

As you saw, I reinjured a year and a half later because I assumed everything was okay. If you can, add your stretches and exercises to your regular routine. Reinjury is worse so do everything you can to prevent it. It's been two and a half years since that last one and I've had no problems. As I keep saying (probably too often) the hardest part is being patient and accepting that it's going to take time to fully heal. Hang in there!

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K C
11/21/2020 10:58:39 am

Steve,

Thanks for writing this blog and being responsive on the comments section. It’s incredibly helpful during a demoralizing time. I’m currently 2 weeks in walking around the house gingerly (noticeable swelling on both sides of the knee still). Urgent care doctor thought it was maybe a Grade 2 but I’m still scheduling an MRI since my knee cap has locked up with sharp pains during heel slides. Started formal PT a few days ago and they think it might be Grade 2+ so they’re very interested in looking at the resulting images from the MRI in case there’s something with the meniscus.

What upper body exercises could you keep up during your first few weeks of injury? I’m going a little stir crazy not being able to swim, bike, run, windsurf, hike, etc. every day. Trying to stay positive and patient, following your example!

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Steven Jackowski
11/21/2020 03:55:45 pm

K C, Sorry to say I couldn't do much - some bar dips, some weights, but I couldn't even sit in a kayak comfortably (I do whitewater). Maybe a sit-on-top would have worked. Also at some point, I did some swimming with a float between my knees/feet. But I remember that that was too painful the first few weeks - just the body rotation.

Sorry I don't have much more to offer other than to keep the faith and stay patient. Fingers crossed that you don't have a meniscus tear.

Steve

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K C
12/9/2020 03:03:50 pm

After many weeks in the MRI and specialist scheduling maze, the ortho I saw finally read my MRI today and the good news is the meniscus looks great! But because the MCL is a grade 3 (worse than expected), the MPFL is also sprained, and I still have a bunch of tibial plateau bone bruising (amazing what an X-ray misses) - the hinged Mueller brace I thought I weaned off of 2 weeks ago is back in my treatment plan. I’ll need to wear it through weeks 5 & 6 just to help out the MCL. So glad I found this blog though since everything I did right (e.g., heel slides and light cycling) came from this (everything I did that wasn’t clinically recommended was just due to a lack of patience). When in doubt, imaging can help illuminate what’s really going on!

Chris Brosseau
11/29/2020 06:47:39 pm

Hello Steve,
Inspiring story! I had a high grade 2 MCL tear with a a slight stretching of ACL (hit a stump back country snowboarding in Colorado in February 2020) Tried to snowboard Saint Mary's Glacier in May and felt some discomfort. I've been dirt biking, running and skateboarding this summer mostly pain free but still get some weird sensations from time to as of November 2020. Going snowboarding December 3rd and hope to be be pain free!
Thanks!
Chris

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Steve
11/29/2020 10:48:08 pm

Hi Chris,

If you've been doing rehab exercises, I'd keep them up. By now you shouldn't be feeing any discomfort - at least in my experience. If you're not doing the exercises, I'd highly recommend starting/restarting. I guarantee - a reinjury is worse. Plyometric and extension are the most important.

With a La Nina, it's not looking like a great season out here. I'm certainly hoping for more. We had a promising start and then it stopped. Current forecasts have us at least two weeks without any precipitation. Hope it's better where you are!

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Meaghan
1/29/2021 03:40:03 am

Hello all:

This blog is excellent; I'm a full-time ski instructor. I had an MCL/ACL incident two weeks ago; MRI showed a full tear on both. My doctor can't believe the range of motion I have - I blame it on my indomitable spirit. 😉

I’ve rehabbed several race horses 🏇 and got them running when no one thought they would. Here is what I have done so far:
I started the next day w the basic active rest exercises, focusing on squeezing the quad and pushing the knee down. Next, I hit the pool twice a day. It’s been hard with so much powder here in Vermont (we usually don’t get), even harder getting into my car with so much snow. I then went to Tractor Supply and purchased all my medical needs: poultice, vet-wrap, polo wraps, and standing wraps. You can order human poultice online; I just went w what I know. After each pool session, I would walk laps around the pool and use my hands to simulate my ankles. I’m sure you have all seen ski racers do this. My goal was to let each joint flex loosely and comfortably. Goal accomplished!!!

Music is the most important, in my opinion! I would have given up several times without those songs that move me. Hold On by Wilson Phillips has been my go-to song 🎶.

Pool: start by walking, then add small movements (tiny) think of just the ankle to begin. I made little circles in both directions, then added figure 8’s in both directions and w both legs. This is also how I train horses 😉. As you get more comfortable, take longer strides in the pool. By day 4, I was running laps in the pool. Yesterday I swam overhand for the first time, wahoo! Stick w flutter kicks only; my frog legs won’t work yet. I know I can ski when my frog leg is back. Next, those crazy exercises the doctor wants me doing on land I do in the pool first. I use the lane divider as my hurdle, it was hard the first time, but it gets easier each time. I focus w all my mental strength, and I remember to squeeze all those muscles. Mental strength is so vital while getting through physical strength.

I'm very holistic. I go to the slopes every day between pool sessions and practice what I did in the pool on the snow. I made sure I went when it wasn't icy or busy. I needed some uneven ground to train on. LISTEN to your BODY, don't push it too far. I found a small hill to start and walked some figure-8’s, then moved to on the snow, the same process. Each day gets more comfortable, follow the prescribed exercises, and keep your mental strength healthy. I have kidney disease, which means no pills at all for me; I don't even use Tylenol; this is a mental challenge you are going through; the physical recovery is a product of Your mental focus. Yesterday I put my ski boots on and walked around w my skis and poles; I couldn't clock in w my bad leg yet, I stopped and didn't push anymore. This is where ill be guiding my strength now that I have a benchmark.

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Steven Jackowski
1/29/2021 08:00:31 am

Excellent! You're on your way and with out a doubt, you'll be skiing soon. I was lucky. The timing on mine was such that I was back in the water a couple of month before ski season. The good news was that skiing puts a lot less lateral stress on the MCL than surfing, so I knew I was good to go. I love the idea of the pool exercises in the snow. This is great! Let us know how you progress towards full recovery. And, as I noted, don't stop the exercises (particularly the stabilization exercises) after you're 100%. They will help prevent future injuries, which have a longer recovery time).

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Mary
3/20/2021 08:08:29 pm

Did you get a surgery?

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Steve
3/20/2021 09:33:27 pm

Hi Mary,

Not sure if you're asking me or Meaghan, but no. I didn't have surgery. In general with an MCL tear, even a grade 3 (complete tear), they can be healed with proper rehabilitation per my blog and the comments of others. I note that this is unique for the MCL, ACL, Meniscus, and PCL tears often require surgery.

Celia
2/25/2021 03:34:30 pm

Hi Steve,
Thanks for all your great advice and candid feedback! I have a somewhat crazy question to ask... I just damaged my MCL (MRI tomorrow) and I have been completely off my feet for 7 days. After reading your blog and comments, I realize I need to start (slowly) with stretching and exercises. My question is, what advice to you have for someone who hates repetition and gym workouts?? I don’t keep up (no matter how hard I try) with them and I hate doing the same thing every day. I am very active with my kids (biking, walking/hiking) and we LOVE to alpine ski - and my goal is to be back 100% for next season. Is there an alternative rehab that you might suggest? Told you it was a crazy question but had to ask.... :)

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Steven
2/25/2021 10:23:12 pm

Hmm. Difficult question. I've been lucky. I've always been able to do whatever workouts were required for rehab and conditioning without a coach. My wife is the opposite. She needs structured classes for yoga (I can do it on my own), and consistent physical therapy for rehab. Recently, she asked if I could be her personal trainer and so far that's working well. If you're married, perhaps you could arrange to have your spouse walk you through the exercises every day. Without daily work, your recovery will be long.

If that doesn't work and you have the financial capabilities, perhaps you could hire a personal trainer for an hour a day. Otherwise, I think physical therapy would be best. It would likely be only a couple of times a week, but hopefully you can motivate yourself on at least some of the off-days.

But again, you don't need a gym workout. Really, if you can just dedicate 15-20 minutes a day to those exercises, you'll succeed. 15-20 minutes? I'm sure you can do it. Set aside a particular time every day. Maybe your kids could help - hey Mom, show me your exercises... Good luck! Sorry I didn't have more suggestions.

Steve

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Meaghan
2/26/2021 03:50:51 am

Hi Celia,

I'm a full-time ski Instructor in Vermont; I had two grade 3 tears in January, both my ACL & MCL. My doctor gave me a return to snow three weeks after, and I've been skiing for the past three weeks. I went to the pool twice a day. There is magic in the water. Active rest is very important, keep it moving. I would wake up and just start dancing. Make a fun playlist and dance through the storm.

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Kim link
3/8/2021 12:04:09 am

Thanks for sharing such a detailed article. I'm nearly 4 weeks into my MCL injury and getting annoyed that it's not healing quicker! I want to get back out and start hiking again - which is likely where the injury occurred. But I know it's a long healing process; my GP advised the RICE method, gave me a course of anti inflammatory medication, and referred me to physio. I've been doing very light stretches so far but it just feels like it's pulling all the time. Painful too. I tried driving yesterday for the first time and it hurt - especially using the clutch - but was doable. It swelled up by the time I got home though.

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Steve
3/8/2021 06:43:35 am

Hi Kim,

I strongly recommend the exercises in the my post. They do work but it will take time and patience. The heel slides and associated stretches will be difficult, but range of motion is essential. Don't give up!

Steve

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Milk
3/18/2021 01:09:34 pm

Hello Steve and Everyone,

Thank you very much for sharing the experience.
I wish I saw this blog on the first day I got injured.

I did my MCL on 10th Feb, by simply slip on the surface while landing from not so high jump (tennis practice).
Confirm with the doctor 3 weeks later. He didn't mention the grade, but said it would heal on it own ... Would take 2-6 weeks... So I think it is probably somewhere between Grade 2. Now, I am on the end of 5th week. Nowhere from healing, but it is getting better.

This post has helped conforting me and allow me to adjust my time-frame with the rehab schedule.
I have overdid a few times with light exercises or rehap due to
>> [3rd day] Underestimating the severity as I feel a lot better after talking the medicine (anti-inflame + muscle relaxant)
>> [8th day] feel good with no pain, even without the medicine and thought it was only Grade 1.
>> [15th day] feel a lot better, hence did too much of the rehab.
After these these mistakes, I have been more careful with whatever new activities I would put into my routine and try not to over do it.

Steve (or anyone), if you still see this post, I have a few questions.
1.) Is muscle stiffness/tightness (near the MCL) in the morning is common thing even on the later week (5th week)? Do you have the explaination why it is happening and how do you cope with it?
2.) Even in the 5th week, if I overdid the rehap/exercise, I would be a bit in pain the next day. So, I usually ICE it just after the rehab to avoid inflammation. Not sure whether this is a good idea, or better off do less with the rehab without any ICE?

Lastly, I would like to share a few trick I used to overcome the stiffness/tightness in the morning or anytime during the day. As I mention that I used ICE to avoid inflammation after the rehab, on the contrary, I also use HOT-PACK to looseni up the muscle near the MCL. So since the 4th week, I have been switching between HOT-PACK and ICE-PACK though out the day. I heard that HOT-PACK would encourage blood flow; hence heal faster. Not really sure it would, but at least it is my current remedy on the tightness/stiffness in the morning.

P.S. Would be interesting to see how long this blog would go... At some points, I think Steve could be more knowledgeable than some doctors that haven't experienced the MCL sprain themselves. At least, at this point in time, it is the most informative than most website/youtube I read/watched.

Reply
Steve
3/18/2021 04:19:28 pm

Hi Milk,

To answer your questions:

1) Yes. There us definitely stiffness/tightness and it will last well beyond your recovery. Continuing your stretches will make it slowly go away. It takes time for the fibers to reestablish themselves. When they do, it's important to prevent them from getting too tight which seems to be their tendency. Thus, keep up gentle stretching with regular movement to help them grow in the right way.

2) Ice is important each time you reinjure. That said, I'd back off. You have to be patient. For stretching, take it to the point of pain then back off. For exercises, if it starts to hurt, it's time to back off. If you're having increased pain the next day, you did too much. Note that in general, in the morning, you will have stiffness/pain for a while. Warm up gently, then do the stretches, then the strengthening.

As for the heat, it's a great idea. Hot-packs, hot tubs, massages, etc. are all good for increasing the blood flow after the initial swelling has been reduced through ice/RICE.. Ligaments and tendons don't get as much blood as muscles, though to my understanding the MCL has a bit more access to blood. Hence the reason it can usually heal itself without surgery.

Bottom line is to be patient. That's the hardest part of rehabbing the MCL. I guarantee that if you take it slowly but are rigorous about the stretching and gentle strengthening, you'll get to full recovery faster.
If you overdo it, you steadily lose ground.

Good luck!.

Reply
Milk
3/18/2021 09:17:02 pm

Hello Steve,

Thank you very much for a very informative reply.
Now, I knew how to handle the stiffness/pain in the morning properly.

I will try to be more patient!

Really appreciate the work you are doing here!
This probably helps a lot of people, including me.

Cheers!

Sarah Aviles
3/22/2021 05:49:30 pm

I agree just reading this info on here, is so helpful during my mcl recovery.

Reply
Sarah Aviles
3/22/2021 05:42:17 pm

MCL tear skiing Aspen Feb 9th. What a crazy injury to heal. I work on my feet so that doesn't help. Given a hinged brace at ER and once home seen orthopedic. Doing PT and still doing very modified yoga 🧡
But yeah one day feels strong,yet another feels like never gonna heal.
Had some glitchy knee stuff recently that would give severe pain just moments. Like knee catches with ow. Scheduled now for MRI,the glitchy stuff stopped so that is good. Might still get MRI just to know how knee looking I think. So almost six weeks out. 🙈

Reply
Steve
3/22/2021 05:50:31 pm

Hi Sarah,

In general a good PT or Osteopath can determine the degree of the injury and whether meniscus or other ligaments are involved. If it's just the MCL, you can rehab even a grade 3 (complete rupture) without surgery. You should be seeing steady progress if you have a good rehab plan. There's no reason to push, it will just take longer to fully recover. Definitely look at the rehab exercises/programs I recommended. They worked for me and now, for countless others.

Good luck!

Steve

Reply
Sarah Aviles
3/23/2021 04:58:59 pm

Thanks Steve, yep been doing PT and the stretches you suggested whole time now. 😉
MRI tomorrow, hoping to just find it is only mcl. I believe they diagnosed correct...but want MRI since so much pain yet, just if anything peace of mind that only mcl. My work makes this tough as on feet job. (Drs didn't have me restricted from work at all, which did surprise me) but trying to listen to body.

Sarah Aviles
3/24/2021 09:47:26 pm

Oh boy MRI finally of this injury...yep mcl sprain listed but along with some other concerning things.
From report: Moderate marrow edema in the anterior and posterior aspects of the medial tibial plateau with findings suggestive of a subtle subchondral fracture in the posterior aspect of the medial tibial plateau. Significant marrow edema in the posterior aspect of the lateral tibial plateau. Mild apparent downsloping of the posterior most aspect of the lateral tibial plateau may represent a developmental finding. A subtle subchondral fracture in this region is difficult to exclude.

Steve
3/24/2021 10:37:12 pm

Yikes! I don't know much about this possible fracture, but from what I understand, if it's not displaced, and it seems like displacement would have been clear in the MRI, non-surgical treatment over 3-4 months can resolve it. Since that is what's required for a bad MCL tear, conservative rehab may do the job. Hopefully you can avoid surgery. I'd suggest getting a second opinion from a sports-med doc (MD or DO (osteopath)) and hopefully they can recommend a good physical therapist who has experience with these specific injuries.

Above all, be patient. From the case studies I've read you can get there if you work consistently, but gradually.

Again, good luck!

Steve

K C
3/23/2021 03:01:45 pm

I’m back again since I originally read through comments trying to understand how long everyone need to get to full recovery! With the Grade 3 MCL and grade 2 MPFL, it took me about 4 months to feel really good about jogging, swimming at 95% sprint speed (tried out a 100IM), and doing plyometrics/agility drills on an empty gridiron at lunchtime hours. Felt really confident!!! Then a 5-mile hike with too many hills and uneven terrain threw some swelling back my way and I’m back to feeling like month 3; nagging pains and minor swelling throughout the knee. As you’ve said, patience is key! During the whole day after the hike I felt great and had no idea I overdid it. It was the next AM where I woke up with swelling (oops!) Trying to tell everyone out there that this might take some time, but the stabilization exercises will bring me back.

Reply
Steve
3/23/2021 04:55:50 pm

Hi K C,

Glad to hear you mostly recovered. I think the most frustrating thing with this injury is that even when you think you're back to 100% (or 95%), you need to ramp up slowly on every activity, even those you used to do without thinking. I certainly made the mistake(s) of thinking I could do what I did before.

Hopefully, it's not a reinjury, which as I experienced, took even longer to recover from than the original.

And, keep up those stabilization exercises even after you're fully recovered. They will help prevent future injuries. I have the same thing with some major back injuries - now I have those and the knee exercises added to my daily routine too.

Good luck!

Steve

Reply
Sarah Aviles
3/23/2021 05:01:03 pm

Good info, helps to not feel alone in how long these take to recover. Ortho had mentioned when six week out I will be able to not use brace at work anymore. And here we are ...pain and 🙃
Patience and stabilize/relaxation yoga 🧡

Reply
K C
3/25/2021 10:20:37 pm

Sarah - glad your yoga practice is going well! Definitely not alone: I saw the same interpretation in my MRI findings (I had a grade 3, yikes!) and my orthopedic specialist said to not worry too much about it because it’s essentially bone bruising that should take ~6 weeks total to “resolve.” My PT read through the MRI findings too and she said A. sitting more (I was still avidly standing while cooking nightly, trying to ignore the aches), B. avoiding stairs/jumping and C. using the hinged brace except sleeping and while doing daily PT exercises was helpful for the tibial plateau bone bruising issue at least in that first round of healing. Started plyometrics around week 12...it was a slower process than I expected in spite of all the infrared light I was using on my knee.

Jill
4/2/2021 06:29:02 pm

Hi Steve! I'm so glad I stumbled upon this blog! I am having a very hard time being seen in person right now and have been forced to wait due to a backup from people putting off in-person appointments (pandemic). I'm desperate for some answers though I know you can't tell much from a description - any advice from a fellow athlete is greatly appreciated!! Sorry for the long-windedness of this but I care deeply about having a solid, quick as possible recovery and I can't seem to get a lot of help!

I'm an always-active 38 year old. I won't say that I am some disciplined, hardcore athlete but I'm just a generally always active person, never sitting down for longer than a few minutes at a time. I grew up playing very competitive soccer and figure skated from about 5-18, right up until I decided I'd had enough of it and quit right before college. Anyways, I've always hiked, biked, run, played any sport I can, and I'm literally always on my feet all day long at work. I'm not in ridiculous shape but I am really healthy and active and don't have much by way of aches and pains ever. I feel very blessed.

Well last Wednesday night in a soccer game I jumped up to trap a ball and came down funny on my right leg, and felt that quirky feeling that I guess may be described as a "pop" though I felt more like everything went out and then came back in again all in one split second, and I went down. This is the same knee that 21 years ago I tore my MCL on, and opted not to have surgery. I've since been very active on it with zero problems. I'm afraid now my luck has changed.

After laying there for a moment I was able to limp off the field and limp around the house that night and the next day at work by utilizing the ball of my foot to bear weight. Weight bearing was never really all that painful. My biggest issue has been range of motion and joint stiffness. If I very slowly and very carefully go about it, I can get my leg now to straighten when seated on the floor with my legs outstretched. Not really at the leg lifts point just yet, I've tried to do them but I can't get my leg to go up much more than an inch off the floor. But when standing up, I can only really get it to fully straighten when I take the weight off of that leg and onto the other, otherwise it always wants to stay a little bit bent. I can also fully straighten it pretty easily if I bend over to touch my toes, but not so much if I'm standing upright. I don't really know because I'm totally afraid to push it where I haven't been seen yet. Maybe it could straighten if I pushed it. I can't imagine doing squats right now, but I can imagine lightly jogging. It's weird. Pain doing regular activities isn't really an issue anymore, it's really more of a crazy stiffness especially in the morning, and a feeling of my leg being really tired after walking around on it for a bit. Almost like my injured leg feels like it's been walking around in sand for a long time while my other leg's been on a flat surface. I can't explain it but it makes my whole leg tired, especially my quad and calf, probably from compensating for the knee a little bit. Due to lots of people now feeling comfortable going in to orthopedists and doctors as they get vaccinated, I was unable to get in to be seen by a doctor until next Thursday (that's 14 days from my injury). I'm really afraid I'm setting myself back not being seen by someone earlier but I literally can't get in for an appointment. I'd go to the ER but my insurance is awful. The only thing my doctor's office could do for me in the meantime is send me in for an x-ray, which noted "no acute fracture or subluxation," "mild narrowing of the medial joint compartment," a "small suprapatellar joint effusion" and said on there "no abnormality of the visualized soft tissues" but I know that an x-ray won't tell me anything about my ligaments really.

I do believe in keeping moving, not overly "resting" it though many people say to keep off of it. In the last 7 days I've done less, movement-wise than I have in many years and it's killing me, and I know it's only just the beginning. I've been doing light walking around my neighborhood, just about a mile or so at a very slow pace. I do have stairs in my house, they're a bit inevitable and to be honest don't cause me pain, especially going upstairs. Going downstairs is a little scary but I've yet to have an issue on them, I just take them very slowly. It's more of the idea that if it is something like my ACL, I'll feel that instability so I try to avoid it.

I've definitely improved in some ways since day 2-3 (I'm on day 8 right now), I can sleep comfortably at night, I'm able to walk a bit more normally, pain only really happens when pushing the ROM, but in terms of stiffness it's worst in the morning and takes a bit of tiptoeing around to get myself moving before I can start walking heel to toe again. It's improving but at a snails pace. I kind of feel like I'm plateauing in terms of improvement

Reply
Steve
4/2/2021 08:49:07 pm

Hi Jill,

The standard test for an MCL tear is the Valgus test. Basically a doctor, physical therapist, etc., moves your foot outward to see if there is looseness on the inside of the knee or pain with that movement. In my case, after my injury, my foot moved outward more than 45 degrees. That is a grade 2 MCL tear meaning the ligament is torn but not completely.

From what you describe, your injury is likely an MCL tear. To my understanding, soccer players injure the MCL more than most, and it's injured exactly as you describe.

Assuming you didn't tear anything else (e.g. the meniscus), you can rehab this yourself. Even a grade 3 MCL tear can be healed without surgery. But, it's definitely worth consulting an orthopedist or neuromuscular medicine specialist to ensure only the MCL is affected.

In the meantime, I strongly suggest following the links to the rehab programs I described. You need to be conservative and go slowly. You should do heel slides twice a day and work on extension and range of motion before you do anything strenuous or attempt any kind of strengthening. It would also be worthwhile investing in a hinged brace to take the load off as much as possible when walking or standing.

Again, check out those links and be conservative. Fingers crossed that your doc confirms it's just the MCL.

Good luck!

Steve

Reply
Steven Jackowski
4/2/2021 08:52:44 pm

Jill,

One more thing. Plateauing - This injury takes time. Lots more time than you want it to. Be patient. Keep working on ROM and once you can achieve the goals indicated in those posts, advance to gentle strengthening. But, the key here is patience. And, being an active person, it's incredibly hard not to try to push through the rehab. This one definitely doesn't work that way. If you aggravate it, it will set you back and your overall recovery time will be longer.

Steve

Reply
Jill
4/3/2021 11:29:45 am

Thanks so much for the advice, Steve, are you talking about the sportsinjuryclinic.net link? If not could you post the specific link(s) you're referencing? Very much appreciated.

Also, I have an old brace from my previous MCL tear - it's a bit tight esp in the calf as I was 17 when fitted for it, but I remember my parents paying a fortune for it and telling me to wear it every time I play - that was 21 years ago now and my mom is no longer with us. I still have it and it's in great shape because my soccer career coincided with the injury so I never really felt a need to wear it much again. Now I'm back playing again as an adult after almost 20 year hiatus and grateful to have it if I need it. It's a "Bauerfeind SofTec Genu" according to the inner tag. It's pretty restrictive and I can't really tell at this point whether I feel better or worse when I put it on and walk around. I'm wondering if I'm doing more harm wearing it now prior to having someone look over my knee, or whether I should wear it as much as possible when walking around - just trying not to set myself back further guessing on something like this. Anyway, thanks again!!!

Steve
4/3/2021 02:18:01 pm

Hi Jill,

The main site I used was the Sports Injury Clinic: http://www.sportsinjuryclinic.net/sport-injuries/knee-pain/mcl-sprain

I'm not sure if the brace will work, You need to try it out. If it makes things worse, don't use it. Also, don't be tempted to think the brace will let you resume activities. I'd suggest focusing on ROM and easy strengthening until you see the doc.

Steve

Reply
Sarah Aviles
4/2/2021 07:14:35 pm

Hi KC,
Yeah no Dr limited my work except for few days. So I've been on feel working at fast food restaurant I manage. I can sit and do lots of business but also have to help team. So when see orthopedic about MRI results finally on the 6th. If he suggests more rest, brace and PT, gonna have to ask limit to work. It's hurting a lot worse. So we will see. Thx for your info

Reply
Sarah Aviles
4/8/2021 05:58:20 am

Update on my MCL, orthopedic checked out MRI and has me off work. Very limited weight bearing. So only PT stuff pedaling, and movement exercises for whole leg strengthening on floor. No stairs, no walks, no weight bearing. See him again 23rd. For evaluation. Also given a steroid injection, due to cyst and inflammation in knee abundance yet. MCL could see the tear spot, and thickening. Square one, but better than saying surgery, so reboot, rest, and recovery.

Reply
Steve
4/8/2021 07:28:32 am

Great news. Now comes that hard part: patience.

Hang in there!

Steve

Reply
Sarah Aviles
4/10/2021 06:28:10 am

Hanging! Restorative, restful, meditation yoga 🧡 the leg strengthening exercises on floor only, while no weight bearing. I'll get there. Very helpful not to be working on feet, but from home when can support work on laptop. 🧡


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