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Physical Therapist's Guide to Lateral Collateral Ligament Sprain

Lateral collateral ligament (LCL) sprain occurs when the ligament on the outer side of the knee is overstretched. Collateral ligament knee injuries make up about 25% of severe knee injuries in the United States. They most often occur in adults aged 20-34 years and 55-65 years. LCL sprains mainly happen during sporting activities, including contact and noncontact sports, and affect women and men equally. A physical therapist treats LCL sprains to reduce pain, swelling, stiffness, and any associated weakness in the knee or lower extremity.

Lateral Collateral Ligament Injuries (LCL)?

The lateral collateral ligament is a thick, strong band of tissue that connects the thighbone to the shinbone. It is located on the outer side of the knee. It helps keep the knee joint stable. It is one of several collateral ligaments that support the knee. The LCL can be injured if the knee is hit on the inner side, which pushes the knee outward, or if the knee straightens too quickly or forcefully (hyperextends), which causes stress on the outer side of the knee. The LCL may be stretched, partially torn, or completely torn.

How Does it Feel?

With an injured LCL, you may feel:

  • Swelling on the outside of the knee
  • Pain on the outside of the knee
  • Tenderness on the outside of the knee
  • A feeling that the knee is locking, catching, buckling or giving way during movement

The pain of an LCL injury may cause you to limp.

How Is It Diagnosed?

If you see your physical therapist first, your therapist will conduct a thorough evaluation that includes taking your health history. Your physical therapist will also ask you detailed questions about your injury, such as:

  • How and when did you notice the pain?
  • Did you feel pain or hear a "pop" when you injured your leg?
  • Did you turn your leg with your foot planted on the ground?
  • Did you change direction quickly while running?
  • Did your knee straighten out very quickly?
  • Did you receive a direct hit to the leg while your foot was planted on the ground?
  • Did you see swelling around the knee in the first 2 to 3 hours following the injury?
  • Does your knee feel like it is locking, catching, buckling, or giving way when you try to use it?

Your physical therapist also will perform special tests to help determine the likelihood that you have an LCL sprain. Your physical therapist will gently press on the outer side of your knee to see if it is painful to the touch, and push on the inner side of the knee to see if that causes pain on the outer side. Your physical therapist may use additional tests to determine if other parts of your knee are injured, and will also observe how you are walking.

To provide a definitive diagnosis, your physical therapist may collaborate with an orthopedic physician or other health care provider. They may order further tests, such as an x-ray to confirm the diagnosis and to rule out other damage to the knee, including fracture.

How Can a Physical Therapist Help?

Your physical therapist will work with you to design a specific treatment program that will speed your recovery, including exercises you can do at home. Physical therapy will help you return to your normal lifestyle and activities. The time it takes to heal the condition varies, but improvement is generally noted in 4 to 6 weeks.

During the first 24 to 48 hours following your injury, your physical therapist may advise you to:

  • Rest the area by using crutches or a brace, or by avoiding walking or any activity that causes pain.
  • Apply ice packs to the area for 15–20 minutes every 2 hours.
  • Consult with a physician for further services, such as medication or diagnostic tests.

Your physical therapist will work with you over time to:

Reduce Pain and Swelling

Your physical therapist may use different types of treatments and technologies to control and reduce your pain and swelling, including ice, heat, ultrasound, electrical stimulation, taping, exercises, and hands-on therapy, such as massage.

Improve Motion

Your physical therapist will choose specific activities and treatments to help restore normal movement in the knee and leg. These might begin with "passive" motions that your physical therapist performs for you to gently move your leg and knee joint, and progress to active exercises and stretches that you do yourself.

Improve Flexibility

Your physical therapist will determine if any of your leg muscles are tight, and teach you how to stretch them.

Improve Strength

Certain exercises will aid healing at each stage of recovery. Your physical therapist will choose the exercises and equipment that are right for your specific condition to steadily restore your strength and agility. These may include cuff weights, stretch bands, weight-lifting equipment, and cardio-exercise equipment, such as treadmills or stationary bicycles.

Improve Balance and Agility

Regaining your sense of balance is important after an injury. For athletes, restoring agility is important, also. Your physical therapist will teach you exercises to improve your balance and agility skills.

Speed Recovery Time

Your physical therapist is trained and experienced in choosing the best treatments and exercises to help you heal, return to your normal lifestyle, and reach your goals faster than you are likely to do on your own.

Return to Activities

Your physical therapist will discuss your goals with you and use them to set your work, sport, and home-life recovery goals. Your treatment program will help you reach those goals in the safest, fastest, and most effective way possible. Your physical therapist will teach you exercises, work retraining activities, and sport-specific techniques and drills to help you achieve your goals.

If Surgery is Necessary

Surgery is extremely rare in cases of LCL injury. However, if other parts of the knee are injured at the same time as the LCL, you may need additional treatment for those injuries that might include surgery. If surgery is needed, you will follow a recovery program over several weeks guided by your physical therapist, who will help you minimize pain, regain motion, strength and agility, and return to normal activities in the speediest manner possible.

Can this Injury or Condition be Prevented?

Your physical therapist can recommend a home exercise program to strengthen and stretch the muscles around your knee, upper leg, and abdomen to help prevent future injury. These may include strength and flexibility exercises for the leg, knee, and core (midsection) muscles.

To help prevent a recurrence of the injury, your physical therapist may advise you to:

  • Learn correct knee positioning when participating in athletic activities.
  • Follow a consistent flexibility and strength exercise program, especially for the hamstrings (back of the thigh) and quadriceps (front of the thigh) muscles, to maintain good physical conditioning, even in a sport's off-season.
  • Practice balance and agility exercises and drills.
  • Always warm up before starting a sport or heavy physical activity.
  • Wear shoes that are in good condition and fit well.
  • Maintain a healthy weight.

Real Life Experiences

Darlene is a 23-year-old dancer studying at a prominent performing arts school. During a rehearsal class, she is practicing choreography that involves high jumps and leaps. After 1 leap, she lands on her right knee when it is too straight, and feels a sharp pain on the outer side of the knee. She tries to keep going, but the pain in her knee becomes worse. She limps home. After a few hours, her knee does not feel better. She calls her physical therapist.

Darlene’s physical therapist is able to see her immediately, and thoroughly examines the knee. She touches all around the joint, and finds that it is very tender on the outer side. She can see there is some swelling in that area. She tests the ligaments of the knee and finds that the LCL is slightly looser than the LCL on the other leg. Darlene reported pain during this test. The physical therapist determines that the LCL is mildly sprained, meaning that it is overstretched but not torn. The physical therapist applies an ice pack and electrical stimulation to help reduce the pain and swelling. She then applies a brace that keeps the knee straight, and teaches Darlene how to use crutches. She advises Darlene to rest her leg for 48 hours.

When Darlene returns for her next session, her physical therapist determines that she is ready for gentle motion and strength exercises, and begins to teach them to her. Within a few weeks, Darlene doesn’t need the crutches or the brace, and she has much less pain when walking. Her physical therapist progresses Darlene through a rehabilitation program that includes strengthening, stretching, balance exercises, and even some modified dance movements. After about 6 weeks, Darlene is able to start a basic ballet class and begin working on her dance skills again.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat LCL sprains. However, you may want to consider:

  • A physical therapist who is experienced in treating people with orthopedic injuries. Some physical therapists have a practice with an orthopedic focus.
  • A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic or sports physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists that have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist (or any other health care provider):

  • Get recommendations from family and friends or from other health care providers.
  • When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have your type of injury.
  • During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

Further Reading

The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.

The following articles provide some of the best scientific evidence related to physical therapy treatment of your injury. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.

Thaunat M, Pioger C, Chatellard R, et al. The arcuate ligament revisited: role of the posterolateral structures in providing static stability in the knee joint.

Knee Surg Sports Traumatol Arthrosc. 2013 August 31 [E-pub ahead of print]. Article Summary on PubMed.

Kim YH, Purevsuren T, Kim K, Oh KJ. Contribution of posterolateral corner structures to knee joint translational and rotational stabilities: a computational study. Proc Inst Mech Eng H. 2013;227(9):968-975. Article Summary on PubMed.

DeCarlo M, Armstrong B. Rehabilitation of the knee following sports injury. Clin Sports Med. 2010;29:81-106. Article Summary on PubMed.

Schorfhaar AJ, Mair JJ, Fetzer GB, et al. Knee: lateral and postereolateral injuries of the knee. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee & Drez's Orthopaedic Sports Medicine: Principles and Practice. 3rd ed. Philadelphia, PA: Saunders Elsevier; 2009: chap 23; sec F. Article Summary Not Available.

Irrgang JJ, Fitzgerald GK. Rehabilitation of the multiple-ligament-injured knee. Clin Sports Med. 2000;19(3):545-571. Article Summary on PubMed.

Meislin RJ. Managing collateral ligament tears of the knee. Phys Sportsmed. 1996;24(3):67-80. Article Summary on PubMed.

Paletta GA, Warren RF. Knee injuries and Alpine skiing: treatment and rehabilitation. Sports Med. 1994;17(6):411-423. Article Summary on PubMed.

* PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.

Authored by Andrea Avruskin, PT, DPTReviewed by the editorial board.

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