Symptoms of a 1st degree LCL sprain

• Light stretch, no tear
• About 5/10 pain on the VAS scale
• Could get slightly swollen on the outside of the knee
• Mild tenderness over the area
• No instability/giving way of the knee
• No discolouration

Symptoms of a 2nd degree LCL tear

• Partial tear of the ligament
• Swelling common
• Bruising (discolouration)
• High pain level
• Difficulty bending or straightening (flexing and extending) the knee
• Feeling of instability (giving way) when full weight bearing on injured side
• Fearful of putting full weight on affected side

Symptoms of a 3rd degree LCL tear

• Complete ligament rupture
• Swelling
• Bleeding under skin (red and blue discolouration)
• Unstable joint
• Can’t bear full weight on affected side
• Feeling of knee wanting to give way
• Either no pain, or severe pain that subsides quickly
• This injury usually increase the risk of other structures being injured as well (ACL, meniscus)

The Lateral Collateral Ligament (LCL)

Imagine a strong, slender bundle of ropes on the outer side of your knee. his is the Lateral Collateral Ligament, or LCL for short. This bundle connects your thigh bone to a smaller leg bone. This small bone is called the Fibula, and it sits on the outside of your lower leg. The LCL acts like a stabilizer, preventing your knee from moving too much side-to-side, especially from bending outwards.

Muscles Around the Knee

Around your knee, there are many incredibly important muscles. The most well-known are the quadriceps at the front of your thigh and the hamstrings at the back. The hamstrings especially are responsible for controlling the knee as it rotates. These muscles are like the engine and brakes for your knee, helping you to move, bend, and straighten your leg. They work together to keep your knee stable and strong, especially when you’re walking, running, or jumping.

Other Ligaments in the Knee

Besides the LCL, your knee has three more main ligaments. On the inside, there’s the Medial Collateral Ligament (MCL), which works with the LCL to stop your knee from moving too far in or out. Deep in the center, the Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL) cross each other, controlling the forward and backward movements of your knee. These ligaments are like ropes sitting on the inside, holding the knee joint together and anchoring the bones to each other.

Menisci: The Knee’s Shock Absorbers

Within your knee there exist two C shaped pads known as menisci. They serve as cushions or shock absorbers between your thigh bone and shinbone. Their role is to distribute force during activities like walking or running safeguarding your knee from strain. Additionally they ensure knee movement acting like gel pads that facilitate gliding.

The Complete Picture: Your Knee Joint

All these parts — the LCL, muscles, other ligaments, and menisci — work together in the knee, one of your body’s most complex joints. It’s where your thigh bone meets your shinbone, with the kneecap in front as a shield and that acts like a pulley when you are straightening the knee.

The Knees Side Protector

Imagine the Lateral Collateral Ligament (LCL) as a guardian positioned on the outside part of your knee. Its role is to prevent sideways movement of your knee . It’s similar, to having a friend who prevents you from veering off course while walking along a trail.

The Team Player

The LCL doesn’t operate solo; it’s part of a team. Alongside companions like the Medial Collateral Ligament (MCL) on the inside and the Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL) located within the knee, they collaborate effectively as a team. This teamwork is what maintains the strength and stability of your knee whether you’re engaging in activities, like running, jumping or simply strolling around.

The Knee’s Safety Belt

When you’re playing sports or running around, the LCL is like a safety belt for your knee. It holds everything in place, especially on the outer side, making sure your knee doesn’t bend in ways it shouldn’t. It’s always there, working quietly to keep you safe while you’re having going about your day.

The Knee’s Feedback Friend

The LCL is also kind of like a messenger. It helps your knee sense where it is and what it’s doing, which is super important for moving smoothly. It’s like having a sixth sense for your knee, so you can move without having to think about every step. Ligaments, such as these, are responsible for proprioception.

The Balance Keeper

When you’re doing things like dancing, playing sports, or even just turning quickly, the LCL is like the balance keeper in your knee. It works with other parts of your knee to make sure everything stays aligned and balanced, helping you move confidently and gracefully.

The Side Swipe

Imagine you’re playing a sport or simply walking, and suddenly you bump your knee’s outer side hard against something, or someone hits it from the inside. This kind of hit is what usually causes an LCL injury. It’s like someone pushing you sideways when you’re not expecting it, and your knee takes the brunt of it.

Twist and Shout

Another way the LCL can get hurt is if your knee gets twisted while your foot is planted firmly on the ground. It’s like trying to turn quickly while your foot is stuck, and your knee feels the twist. This sudden twist can stretch the LCL too much or even tear it.

Overstretching

Sometimes, if you move your leg too far outward, the LCL can get overstretched. Think of it like pulling a rubber band too far – it can strain or even snap. This happens to the LCL when the knee is forced to bend in a way it’s not meant to.

The Breakdown

When the LCL gets hurt, it might just stretch too much, get partially torn, or in severe cases, completely tear apart. The severity depends on how much force your knee faced. It’s like a rope that’s frayed or snapped depending on how much pressure it’s under.

The Consequences

When the lateral collateral ligament (LCL) is hurt you may experience a sense of instability in your knee particularly when attempting sideways movements or engaging in activities requiring movement of your knee. Without care and adequate rest, this injury can stop your tasks such as walking or climbing stairs, and it will end up causing discomfort and difficulty. It is crucial to provide the attention it needs to facilitate your knee’s return to its role – as a robust and dependable part of your leg.

• Direct Blow to the Inner Knee

  : A strong impact, to the inside of the knee can tear the LCL, which is situated on the outside. In football, a common reason for LCL injuries is a hit to the knee during tackles leading to a notable number of knee ligament injuries in the sport.

• Twisting Movements: Rotating your leg outward while your foot remains stationary can harm the LCL. This frequently occurs in sports when athletes pivot or turn swiftly. For example, basketball players often sustain LCL injuries due to twisting movements during changes in direction contributing to the occurrence of such injuries in the sport.
• Hyperextension: Over-straightening your leg more than its normal range, or hyperextension, can also injure the LCL. This is like bending a ruler backward until it starts to strain. An example of this is in gymnastics, where hyperextension-related LCL injuries can occur during landings or acrobatic movements, although these injuries are less common compared to other mechanisms.

Mild LCL Injury (Grade I)

A mild LCL injury, classified as Grade I, may cause pain and tenderness on the outer part of your knee. The swelling is usually minimal. When you bend your knee sideways (such as during a Varus stress test), you may experience some discomfort. However, your knee should not feel unstable or loose. This type of LCL injury typically indicates that your ligament is strained rather than torn.

Moderate LCL Injury (Grade II)

On the other hand, a moderate LCL injury, categorized as Grade II, can be more painful. You are likely to experience increased soreness and pain on the outer part of your knee along with swelling. During the Varus stress test, there will be more discomfort. Your knee may feel slightly unstable. This suggests that your ligament is partially torn, which is greater than just a strain.

Severe LCL Injury (Grade III)

In a severe LCL injury, the ligament is fully torn. Surprisingly, there are instances where the pain may not be as intense, as a grade II injury. However, the issues are more severe. You may still experience pain and sensitivity on the part of your knee along with swelling. When you check your knee by bending it you will notice a looseness indicating that the ligament is not providing the necessary support. This kind of injury can lead to a greater sense of instability in your knee.

Other Injuries that come with LCL Injuries

When your LCL is injured it’s not unusual for other parts of your knee to suffer damage well. Additional ligaments, in your knee, such as the Anterior Cruciate Ligament (ACL) or Posterior Cruciate Ligament (PCL), or the Posterolateral Compartment (PLC) a group of tissue structures at the back of your knee may also be affected. In some cases the injury might be severe enough to cause a dislocation where the bones are displaced. Occasionally there could also be damage to the menisci, which act as shock absorbers inside your knee. Keep an eye out for injuries to the back or side of your thigh, like hamstring or Iliotibial Band Syndrome.

We are confident enough to diagnose your Lateral Collateral Ligament (LCL) Sprain in the knee at an inclusive and accurate dimension as skilled physiotherapists. We make our objective locating the exact reason for your knee pain thus we formulate a treatment approach that will suit you lifestyle.

To start off with the diagnostic procedure of LCL sprain, first we take a complete history of your symptoms emphasizing time of onset, intensity and any aggravating or relieving factors. After that, we do a thorough physical examination of the knee which includes:

• Palpation: With careful examination of the area around your knee, particularly at the lateral side, we try to palpate for any tenderness, swelling or increased warmth. This will help differentiate the kind of pain that you have as one related to ligament muscle, tendon and joint pathologies.
• Range of Motion: In LCL sprain, it is relevant to assess the range of motion present in the muscles and tendons around your knee joint.
• Muscle Strength Testing: It is very significant to access muscle imbalance, especially the knee muscles including the hamstrings and quadriceps which are responsible for providing support to the stability of the knees.
• Special Tests: We employ some clinical tests that aim to provoke signs of an LCL sprain. These tests assist in confirming an affected LCL when traditionally diagnosed, but most importantly, they also help differentiate an LCL injury from other knee pathologies.
• Further Imaging: If our initial assessments point towards an LCL sprain, further imaging such as an MRI may be required. This helps us discern the exact extent of your injury in order to better manage it if it is necessary.

And that all the findings should be well communicated to you by your physiotherapist all through the assessment procedure whereby there will be negotiations as according to the best form of treatment to help control your LCL Sprain as required. However, here at Well Health Pro, we stay focused in guaranteeing your rehab process is well taken care of with an objective for full recovery and return to your routine activities free from pain.

Ligaments cannot be seen on X-Ray. X-rays can only show the bony parts of your knee, and since the LCL is a soft tissue, you will not be able to see the injury. However, if we suspect a fracture such as Segond fracture, an X-ray will show this injury.

Your physiotherapist can refer you to get x-rays taken if necessary.

Diagnostic ultrasound can be used to show the presence of a tear in the ligament. It will also be used to assess the surrounding soft tissues around the injured area. The ultrasound will be able to tell us how bad the injury is as well.

If you need an ultrasound, your physio will refer you.

An MRI is the gold standard for seeing the full extent of a knee injury. It will be able to show us both the bony and soft components of the knee in great detail. However, it is an expensive option as compared to ultrasound and X-ray.

If your physiotherapist suspects anything more than just a muscle spasm, you will be referred to the right specialist.

Improper healing and Chronic Inflammation:

The affected area may not have fully healed, leading to continued discomfort. Because your injury does not heal properly and can keep getting injured, this may lead to chronic inflammation. This inflammation will result in the formation of scar tissue can limit movement and cause discomfort.

Complications and Muscle Imbalances:

Other injuries or conditions, like Baker’s Cyst or Arthritis, might have developed. This may develop because the supporting muscles of your shoulder were not strong enough to stabilize the knee, which will put you at risk of developing other painful conditions of the knee.

Improper Treatment and Underlying Conditions:

The initial treatment might not have addressed the root cause or severity of the injury. Not only may improper treatment affect the recovery of your shoulder, there may also be factors that you may have not considered such as Diabetes, Osteoporosis or Rheumatoid Arthritis.

Waiting too long

With time, the inflammation and pain can become more severe, leading to a more challenging recovery process. It has a chain reaction and leads to other areas becoming sore and overworked.

Not using protective gear properly

It is not uncommon for people to place themselves in a sling for either too short or too long of a time. This may lead to inadequate healing or cause the shoulder to become weak and dependent on the sling for their pain.

Treating the wrong problem or not completing treatment at all

Not getting a proper diagnosis from the start is another issue. It wastes valuable time and delays appropriate treatment. Failure to identify the root cause of your heel pain leads to ineffective treatment. Patients often try out various forms of treatment but fail to complete them. Committing to a consistent and comprehensive treatment plan under professional guidance is essential for effective recovery.

Rest and pain medication alone won’t solve the problem

Relying on medication can mask the pain without addressing the root cause of the problem. Finding the balance between resting and safe movements is key to recovery. People tend to think that they can stretch the pain away, but usually it makes the problem worse. It’s important to follow a guided exercise program with a combination of different types of exercises for different muscle groups. Resting too much or too little can be detrimental. Too much rest leads to weakness and stiffness and deconditioning. Too little rest simply prolongs the inflammation.

As experienced physiotherapists, we understand that a Lateral Collateral Ligament Injury is painful and frustrating to recover from. We want to assure you that together, we can create a treatment plan to guide you through recovery. It will include a combination of techniques designed to reduce your pain and inflammation, and to improve your shoulder mobility and strength.

• Manual therapy: Hands-on techniques, like soft tissue mobilization and joint mobilization, to decrease your pain and increase your range of motion of your knee.
• Therapeutic exercises: We’ll work together on targeted exercises to strengthen and stretch the muscles around your knee. This usually includes working on the muscles of the front and the back of your knee.
• Activity modification: Initially, we guide you to modify your daily activities and exercise to minimize stress on your knee.
• Pain management and Education: Giving you the information you need to understand your pain, helps with long-term pain relief. We can advise you on different pain-relief strategies that are both safe and effective.
• Other effective modalities: We will also use pain management techniques such as Dry Needling and Electrotherapy that has been proven to manage pain. Strapping can also be used to protect the injured area so that the joint may heal properly.

The goal is to help you get back to your daily life and exercise routine as soon as possible, while minimizing the chances of hurting your ligament, or other important structures in and around your knee.

Acute Phase (Days 1-7):

• Pain and Swelling: Right after the injury, you’ll probably feel quite a bit of pain on the outer side of your knee, and it might swell up too.
• Relative Rest and Protection: It’s important to give your knee a break during this time. You might need to use a brace to keep your knee stable and take the pressure off the LCL. This will protect the ligament while preventing the rest of your muscles from getting weaker.
• Ice and Elevation: Applying ice and keeping your knee raised can help reduce swelling and pain. This will provide a safe way to reduce your pain without any unwanted side effects such as impaired healing.

Subacute Phase (Weeks 1-6):

• Reduced Pain: As time goes on, the pain should start to get better, and the swelling will go down too.
• Gentle Movement: You can start doing some gentle exercises to get your knee moving again, but it’s important not to push it too hard. We can guide you on what’s safe to do.
• Strength and Stability: As your knee starts to feel better, you’ll work on building up the strength in your leg muscles and improving the stability of your knee.

Remodeling Phase (Weeks 6-12+):

• Continued Improvement: By now, your knee should be feeling a lot better, but you might still be working on getting back to 100%.
• Advanced Exercises: You’ll be doing more advanced exercises to make sure your knee is strong and stable enough to handle your usual activities. This can include sports or getting through your work day without feelings of instability or pain.
• Gradual Return to Activity: Depending on how severe your injury was, you might be able to start getting back to sports or other activities around this time. It’s important to listen to your body and not rush things.

• Pain medications

  : This can give relief to your symptoms, but can mask the severity of the injury if you did not get an appropriate diagnosis. Medication is a handy tool in your recovery process, but it should be used with

  guidance

  .

• Corticosteroid injections: Cortisone can improve inflammation, swelling and pain, but often the effects are temporary. Repeated use can weaken the joint and ligament integrity which will increase the risk of re-injury later on. The use of corticosteroid injections for Lateral Collateral Ligament injury is not recommended.
• Ice and Heat Therapy: These home remedies can be used with lots of success to relieve pain and swelling. Unfortunately, the effect is temporary. So, it should be used in conjunction with a proper treatment plan.
• Biokineticist: Rehabilitation can also be guided by a biokineticist, especially when you need help to return to your exercise routine or sport.
• Chiropractor: Trying to ‘click’ your knee, or hip, joint back into place after a injury is a bad idea. You still have no idea if anything else was sprained or damaged.
• Brace: Using a brace in the initial phases of your injury can be very helpful to give your knee the rest it needs. However, there should be a management plan in place, to make sure that you move and use your knee independently again.

Surgery may be necessary for an LCL injury if the ligament is completely torn, the knee is highly unstable or if other knee structures are also affected. Before opting for surgery, we will assess the extent of the injury to the knee’s functionality, as well as your activity level and objectives.

It’s important to understand that surgery marks the beginning of your knee’s healing process. The real work starts after the surgery as the body needs time to heal and regain the strength it needs to adapt to the new changes. Rehabilitation after surgery plays a role in reducing swelling and pain, restoring knee movement, improving muscle strength and getting you back to your previous activities.

There are different surgical techniques that may be chosen. The first involves a reconstruction using a graft to replace the torn ligament while another technique such as repair entails stitching together the torn ends. Regardless of the approach taken, post-operative rehabilitation is integral for a full recovery, by aiding you in regaining the stability and function of your knee.

• Iliotibial Band Syndrome: Pain from overuse, felt above the knee where the band rubs over the bone, not from a specific injury like LCL pain.
• Meniscus Tear (Lateral Meniscus): Causes joint locking or clicking. Pain more inside the joint, not localized like LCL injury pain.
• Posterolateral Corner (PLC) Injury: Involves multiple structures, causing more severe instability and rotational pain, not just the lateral instability seen with LCL injuries.
• Segond Fracture: High-impact trauma with bone tenderness and inability to bear weight, which is different from the soft tissue tenderness of an LCL injury.
• Anterior Cruciate Ligament (ACL) or Posterior Cruciate Ligament (PCL) Injury: Instability during forward or backward movements, unlike the lateral instability of LCL injuries.

• LCL sprain
• LCL strain
• Lateral Ligament Tear
• Lateral Collateral Ligament Tear
• Lateral Knee Ligament Injury