A Lateral Collateral ligament injury is when the varus force (bowing) on the knee is too great for the ligament to resist. This occurs during activities like a sudden change in direction, twisting your knee while your foot is fixed, when your knee hyperextends, or if there is a direct hit to your knee. A Lateral Collateral ligament tear usually occur at speed, and if it coincides with muscle weakness or knee instability, because it increases your risk. Just like a Medial Collateral ligament sprain on the inside of the knee, the Lateral Collateral ligament on the outside needs to be strong enough & able to withstand different forces to your knee. Let’s discuss this in more detail.

Each person’s case is unique and we want to address your specific needs. If you would like us to investigate or provide some insight, we invite you to contact us by clicking the link below.

What is the Lateral Collateral Ligament made up of?

The Lateral Collateral ligament is a fibrous band on the outside of your knee. THe ligament is made up out of very strong cable-like collagen fibers. It originates from the lateral femoral epicondyle, this is the bony bump on the outside of your thigh just above the knee joint. It attaches to the head of the fibula which is the outside bone in your lower leg just below the knee joint.

It also forms part of the “posterolateral corner”. The biceps femoris tendon also anchors at this point.

What does Lateral Collateral Ligament do?

The Lateral Collateral ligament is one of the four ligaments that help stabilise your knee joint. Your Lateral Collateral ligament prevents excessive motion of your knee bowing inwards. While your knee is straight, your Lateral Collateral ligament stops our lower leg from collapsing inwards.  It also prevents excessive outward rotation of the tibial bone. The ligament takes up slack when your foot is forced inwards in relation to the knee, or when the foot is planted and the knee is twisted outwards.

For example, when you play soccer and run towards the ball, someone kicks it to your left, you have to very suddenly change direction, your foot stays on the ground while your body starts turning outwards, and your knee twists outwards over your foot.

How does a lateral collateral ligament sprain happen?

A ligament sprain is a form of overstretching of the ligament. The fibrous band is like a pulley, which prevents the joint moving into extreme ranges. But when the force is too big for the ligament to resist, the fibers will tear.  Over stretching the Lateral Collateral ligament will result in tears & a sprain of your ligament.

It is very important to know and understand the difference and implications thereof. In the case of a tear, you may hear a snap or tearing sound. For example when a rugby player is tackled on his knee from the inside when his foot is firmly planted, the weight of the tackler will be in excess of what the Lateral Collateral ligament can resist. The force directed on the player’s knee is pushing his knee outwards. The Lateral Collateral ligament is at full stretch while a uncontrollable load is being forced on it, therefore this will thrust the ligament past its boundaries and cause the ligament to tear or completely rupture.

The collagen fibers tear like a rope. On a cellular level, injury will cause inflammation along the sheath of the ligament (a membrane that gives the ligament its nutrients – normal sustenance is disrupted). In turn, the inflammation causes swelling, pain and loss of function of the ligament, leaving the knee to buckle inwards. The swelling along the sheath contributes of loss of space around the ligament that restricts the normal slide of the ligament.

Ligament tears are indicated by Mucoid degeneration and fibrinoid necrosis (a type of cell death).

Lateral Colateral Ligament injury
Lateral Collateral ligament injury, Lateral Collateral ligament sprain, Lateral Collateral ligament tear, knee LCL injury, knee meniscus tears

Causes of Lateral Collateral Ligament sprain

An Lateral Collateral ligament injury occurs mostly during sporting activities, but it doesn’t rule out the fact that it happen at work or just during a normal daily activity. For example, you are a soccer player, running towards the ball. An opponent comes from your left side, also running towards the ball, he collides with you and his knee hits you on the inside of your right knee. Your foot is planted in the ground at the time and thrusts your knee outwards. This puts the Lateral Collateral ligament at full strain. If the force exceeds the tension of the ligament the fibers start snapping & tearing, causing a Lateral Collateral ligament sprain.

When these mechanisms of injuries occur, they usually happen at speed, and if the knee stability muscles are not firing properly, the ligament will have to take up the slack, therefore it will increase your risk of an Lateral Collateral ligament sprain. If the ligament doesn’t get properly treated and rehabilitated, it could cause repetitive sprains.

A single, sudden, overload on the ligament will be classified as acute trauma, but repetitive straining of the ligament in excess of its abilities, will develop a persistent laxity of the ligament over and over again. The end result is a Chronic Lateral Collateral ligament injury. The ligament will end up in a cycle of constant damage leading from fatigue, strain and eventually tear or full rupture.

The Lateral Collateral ligament rarely ever gets injured in isolation, therefore it is important to consult with your physiotherapist in order to assess the surrounding structures as well.

How bad is it?

The symptoms of an Lateral Collateral ligament injury depend on the degree of stretch that is put on the ligament.

Grade 1 LCL sprain (mild)

Small amount of fibers torn, some discomfort and pain. The ligament only has a slight stretch. No swelling or much pain, but you may run into trouble if this starts happening over and over again. Recurrence of micro tears in the ligament could lead to more severe tears. You will have no loss of function or range of movement of your knee, but may be painful at some point during the movement. You will be able to continue playing.

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

Medical treatment

You will need to consult with a Physio to establish the extent of damage and accurate diagnosis. Physio treatment of a Gr 1 LCL sprain is very successful.

What you should do during this time:

  • Rest from any activity that causes your pain
  • Ice your knee

Recovery Time

Grade 1 – 2 to 4 weeks. An LCL sprain heal within a few weeks (anything between 2-4 weeks). However , the collagen fibers only align after 6 weeks (maximal ligament strength), so it is advisable to not return to sport too soon.

Grade 2 LCL tear (moderate)

Partial tear with some swelling and bruising. Pain level increases quite a bit from a grade I, and moving the knee will not occur without pain. It may feel uncomfortable to bend or straighten the knee and your knee may feel unstable and like it wants to “give way”. 20% to 80% of the fibers torn. You will not be able to put weight through the leg. Even if you try to continue playing, you will have considerable amount of pain and limping. The pain will not allow you to straighten your knee or lift your leg forward (knee to chest).

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

Medical treatment

Contact us A.S.A.P. The faster we have a look at it before the swelling and bleeding sets in, the better. You have to consult with a Physio to establish the extent of damage and determine the most appropriate course of action. We can successfully restore your ligament without any surgical intervention.

  • Use of a weight-bearing brace or supportive strapping will be used during this phase. This aids in avoiding overuse of the ligament and puts some pressure on the ligament to ease the pain.
  • Physiotherapy management during this grade will be the same as with a grade I, progression will be expected to be slower.
  • Comprehensive rehabilitation program addressing all the stages of recovery
  • Expect return to activity to be no sooner than 6 weeks.

Recovery Time

Grade 2 – 6 to 8 weeks (With early treatment, we try to get you jogging at 6 weeks)

Grade 3 LCL tear (severe)

Complete tear. Swelling and discolouration (bleeding under the skin) is visible. The knee feels like it wants to give way completely. Bearing full weight is almost impossible. Bleeding and swelling will definitely be present.

The main concern with a Gr 3 tear, is the ligament’s ability to stabilize the knee joint,  if the ligament tears into two separate flaps, there is no way the ligament can ‘heal’ or re-attach without surgery. A Sonar or Diagnostic Ultrasound will show the full extent of the damage. Surgery is the best option to re-connect the separated segments of the torn muscle.

Often there will be no pain, but the disfigurement is quite obvious, since all the fibers are torn. It is important to know that there could be other structures involved with such an injury, but we will discuss this in more detail with our differential diagnosis later.

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)

Medical treatment

Contact us immediately! The faster we have a look at it before the swelling and bleeding sets in, the better.
You have to consult with a Physio to establish the extent of damage and determine the most appropriate course of action.

What you should do during this time:

  • You will be on crutches for up to 6 weeks, during which
  • You will wear a hinged brace up to 6 weeks
  • It is essential to see your physiotherapist for full rehabilitation of the knee, as it will become a very unstable joint if left untreated.

Recovery Time

Will depending on conservative or surgery treatment option. Conservative may be more than 8 weeks with intensive rehab.
If you have completely ruptured your medial collateral ligament you will need surgery and may take 4 – 6 months to full recovery.


If this position is painful going into it, the test is positive meaning you may have some degree of Lateral Collateral ligament tear.


  • Stand on one leg
  • Do a small squat (bend the knee slowly)
  • You will either feel pain on the outside of your knee, or you wouldn’t want to stand on one leg, depending on the severity of your sprain


  • Kneel with both knees on a mat or on the ground.
  • Sit back onto your heels, you may only feel the pain when all of your weight is shifted backwards.


  • Stand on a step
  • Step down with the affected leg staying on the step
  • Your knee will feel like it wants to give way outwards or you’d have pain if there is a sprain
  • Gently repeat trying to hold your knee inwards, and then repeat holding it outwards. Any difference?


  • Stand on your affected leg
  • Bend it slightly
  • Twist your body towards your knee
  • Then twist your body away from the knee
  • Either direction of twisting may cause pain
  • Pain and/or instability will indicate a possible sprain


Our Physiotherapists diagnose a ligament tear and sprain by placing stress on each individual ligament during our testing. Our physiotherapists are experts at detecting a Lateral Collateral ligament tear because we develop a fine dexterity for this type of injury. We test it by doing a few specific stretch and stress tests, after which we test the knee’s ability to bear Weight, Balance, Range of movement, Stability and Endurance of your knee. Other diagnostic tests:


In this case, it is unnecessary to perform an x-ray, as the ligament will not show up on an x-ray and pathology will go undetected.


An MRI may be useful to rule out other injuries to the knee, for example, a meniscus injury, bursitis, ACL, Tendonitis’. But when a pure Lateral Collateral ligament injury is suspected, it is an unnecessary and expensive thing to do an MRI.

Sonar (Diagnostic Ultrasound)

This is the most cost effective diagnostic tool to determine an LCL sprain. The width of the ligament can be compared to that of the opposite side, and the degree of the tear is determined through a diagnostic ultrasound. We refer mostly for this type of diagnostic tool when it comes to ligament sprains, however, we can usually tell through our clinical tests whether we suspect a ligament injury or not.

Why is my knee pain not going away?

Maximal ligament strength will only return after about 6 weeks, when the collagen fibers have rearranged and matured.

Before this, the ligament can be prone to re-occurring injury or progression of the injury from a grade I to II or III. For example, if you sustained a grade I injury this past weekend during a soccer match, you have rested and iced it well. It feels better this week, and now, a few days later, you run onto the field. A player from your team kicks the ball to you, but just a few meters too wide, and at speed. You have to suddenly change direction. Your knee twists outwards while your foot stays in the ground for that second. The ligament is not ready to handle the load at this stage. At this point, you may have overloaded and overstretched the ligament to worsen your condition from a sprain to a tear.

It is always better to allow the full time for a ligament to heal until it is back to its normal state before getting back onto the sports field. Your physiotherapist will be able to assess and tell you exactly when this moment of readiness is.

A big problem we see with a Lateral Collateral ligament injury these days:

If you are asking yourself ‘why is it taking so long for the pain to go away’ then you might want to consider the following.

When a ligament tears, the body reacts similar to repairing an open wound. Let’s say for example, you have a cut on your thumb, but you keep writing with that hand. At this rate you are shearing away the cells that are closing the wound. The same principle applies. The more you put strain on the ligament, the longer it takes to heal.

Patients generally start running again because the pain “feels better” within 3 days. However, within these three days, you are disrupting the most vital part of the healing when participating too soon again, because you are “ripping the wound right open again”. This causes even more damage and will take even longer to heal. This is also the most common reason why patients consult us.

What makes Lateral Collateral ligament injury worse

  • Straightening the knee through the pain
  • Bending or ‘forcing ‘ the knee to bend
  • Running – especially trail running (uneven surfaces)
  • Climbing stairs (up and down)
  • Jumping – especially on the landing
  • Kneeling to fix the sink or getting something from the bottom drawer
  • In the gym: leg press, knee extensions, side leg raises, squats, lunges.
Lateral Collateral ligament injury, Lateral Collateral ligament sprain, Lateral Collateral ligament tear, knee LCL injury

Anti-inflammatories: to take them or not to take them?

If you are taking anti-inflammatory medication for your ligament tear, STOP taking them. Inflammation is the body’s natural way of healing the injured collagen fibers. The medication is preventing this process from taking place, not to mention, masking the effect of the trauma on the tissue if you return to running while still taking anti-inflammatory medications.

This is a bit of a “catch-22” situation. During healing, inflammation is necessary for the healing process to take place. But inflammation causes swelling, pain and discomfort in the joint. If your goal is to just have less pain, take the anti-inflammatories. If the goal is to heal the ligament quicker, leave the anti-inflammatories and allow the natural process of healing to take place.

Physio treatment for a LCL tear

Grade 1 Lateral Collateral Ligament sprain

Phase 1 (Week1)


  • To reduce swelling
  • To get the knee to fully extend (straighten)
  • To get the knee flexed (bent) more than 90 degrees
  • Start pain free strengthening exercises


  • Pain free Passive stretches of the quads and hamstring muscles
  • Static quad and hamstring strengthening exercises
  • Isometric quad, hamstring, glute and calf exercises.
  • Examples: calf raises, quads contractions on pillow, theraband resistance exercises- but come see us for a more specific exercise protocol and put us to the test!

Phase 2 (Week 1-2)


  • Get rid of swelling completely
  • Restore full range of motion (ROM)
  • Start jogging


  • Dynamic strengthening exercises introduced here
  • Examples: knee flexions, extensions, step ups, half squats, single leg calf raises, bridging exercises

Phase 3 (Week 2-4)


  • Regain full strength
  • Maintain Full ROM
  • Introduce sport specific exercises/ exercises that allow you to get back to your daily activities completely like driving, climbing stairs and running


  • Adding more load/weight to activities
  • Increasing the speed and agility of movements
  • Examples: weighted squats, leg presses, plyometrics, sideways running drills

Phase 4 (week 3-6)


  • Maintaining full ROM, strength, agility, speed
  • Adding endurance
  • Performance based when dealing with a sports person (full time training and competition based)


  • Finally hopping, bouncing or jumping activities can be included here

Grade 2 or 3 Medial Collateral Ligament tear

Phase 1 (Week 1-4)


  • Control swelling
  • Maintain full extension of knee
  • Gain range to more than 90 degrees flexion
  • Introduce strengthening exercises
  • Maintain fitness (best suggestion would be a stationary bike).


  • Non weight bearing week 1-2 (use crutches)
  • Partial weight bearing week 3-4
  • Full weight bearing week 4 onwards
  • Wear a brace that is set at 30 degrees
  • Stretching, strengthening and mobility exercises will be done in the brace (knee extension should not be more than 30 degrees)
  • Examples of exercises: static quads, hamstrings, calf raises, hip abductions

Phase 2 (Week 4-6)


  • Completely eliminate swelling
  • Full weight bearing
  • Full ROM
  • Injured leg as strong as uninjured leg


  • Week 5: Knee brace set to 60 degrees
  • Week 6: Remove knee brace (other knee support can be used at this time for compression, for example a knee guard, only to support knee during this transition phase for a week, no longer than that because we don’t want the knee to become dependent on external support)
  • Examples of exercises: Quads and hamstring stretches, along with static and isometric quad exercises: leg presses, hamstring curls, step ups, calf raises. Upper body strength and endurance should be maintained, and general fitness kept by swimming or stationary bike. No breastroke though!

Phase 3 (Week 6-10)


  • Full ROM
  • Strength
  • Return to light jogging
  • Return to sport specific exercises at week 10
  • Return to full activities of daily living (walking, driving, getting in and out of bed without pain)


  • Light jogging after week 6
  • Sideways running after week 8

Phase 4 (Week 10+)


  • Performance based when dealing with a sports person (full time training and competition based)


  • Plyometrics, hopping, jumping, agility, speed by week 10

What else could the condition be?

  • ITB syndrome – Its a sharper pain that only comes on during running, and subsides.
  • Pesa serines Bursitis – Pain on the insertion site of the Bicep Femoris muscle
  • Lateral meniscus tear – This involves the disc on the outside of the knee joint.
  • Peroneal nerve entrapment – nerve type pain radiating down the outside of the lower leg.
  • Tibial plateau fracture – Fractures or avution may happen with a direct impact to your knee
  • Head of fibula immobility – Superior Tibiofibular joint that helps turning the lower leg outwards.
  • Popliteal muscle strain – A muscle controlling the knee to lock and unlock at the back of your knee.
  • Peroneal sprain or tendinitis – A muscle in the lower leg that controls the foot movement anchors on the outside of your knee.

Lateral Collateral ligament injury, Lateral Collateral ligament sprain, Lateral Collateral ligament tear, knee LCL injury

Anatomy of your knee

The lateral collateral ligament (LCL)

Imagine a strong, slender bundle of ropes on the outer side of your knee. This is the structure of your lateral collateral ligament, or LCL for short. This bundle of fibres connect your thigh bone (femur) to your lower leg bone (fibula). The LCL acts like a stabilizer, protecting your knee joint from moving too much side-to-side.

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 side-to-side. Deep in the center of the knee joint, you can find two cruciate (cross) ligaments, called the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL). They help to control forward and backward movements of your knee and anchoring the knee joint.

Muscles Around the Knee

Around your knee, there are many incredibly strong and important muscles. The most well-known are the quadriceps at the front of your thigh and the hamstrings at the back. The hamstrings split into two, with one part connecting to the inside of the knee and one part connecting to the outside. Together with a smaller muscle called the popliteus, they help to control the rotation and forward movement of your knee. You can think of them as the engine and brakes for your knee. The LCL attachment intertwines with the attachments of these muslcles. So, often when one of them gets injured, the others will be injured as well.

Menisci: The Knee’s Shock Absorbers

Within your knee there are two C-shaped cartilage-type pads known as menisci. They serve as cushions or shock absorbers within the knee joint especially with a twisting movement. They also make the gliding action within the knee easier.

The Complete Picture: Your Knee Joint

All these parts — the LCL, muscles and menisci — work together. Unfortunately, they can also get injured together as well. It’s important to look at the bigger picture with a knee ligament injury.

What does the lateral collateral ligament do?

The knee’s side protector

Imagine the lateral collateral ligament (LCL) as a guardian positioned on the outside part of your knee. Its role is to prevent the knee from buckling sideways.

The team player

The LCL doesn’t operate solo; it’s part of a team. Alongside companions like the kedial collateral ligament (MCL) on the inside and the cruciate ligaments (ACL and PCL), they collaborate effectively as a team. This teamwork is what gives your knee the best stability. Ultimately giving you the ability to squat, run, jump or hike up a mountain.

A feedback friend

The LCL also acts like a messenger. By keeping the knee stable, it helps your body to sense your knee’s position in space. This is called proprioception and it’s like having a sixth sense for your knee, so you can move without having to think about every step.

The Balance Keeper

Doing things like dancing, leaping, turning or taking part in sport requires a lot of balance and coordination. The LCL, together with the other ligaments in your knee give you the ability to maintain your balance and stability on one leg. This helps you to move confidently and gracefully.

I have a lateral collateral ligament injury – How did it happen?

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.


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.

Causes of a lateral collateral ligament injury

  • Direct Blow to the Inner Knee

    : A strong impact, to the inside of the knee leads to an increased stretch of the outside of the knee. 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: Twisting your knee, with your foot planted in one place can easily injure the lateral side of the knee and LCL. This frequently occurs in sports when athletes pivot, turn or change direction quickly.
  • Hyperextension: Over-straightening your leg into an extreme range can also injure the LCL (as well as other ligaments). This is like bending a ruler backward until it starts to strain. An example of this when a gymnast or acrobat needs to land with a hyperextended knee. 
  • Landing after a jump: Landing on an unstable surface or even falling over after you land, can easily put too much strain on the outside of your knee. This leads to a strain injury of the lateral knee.

Symptoms of a lateral collateral ligament injury

Tests that you can do to see if you have a lateral collateral ligament injury

  • Choose a step or a sturdy box that’s about the height of a standard stair.

  • Stand in front of the step with your feet hip-width apart.
  • Place the foot of your suspected injured leg onto the step. Keep your other foot on the ground.
  • Shift your weight onto the foot on the step and straighten your knee to lift your body up onto the step. Try to use mainly the leg on the step, not pushing off too much with the other leg.
  • Lower yourself back down to the starting position.
  • Do this several times, paying attention to any pain or instability.

If performing this action causes pain on the outer side of the knee or if you feel unstable, it could be a sign of an LCL injury.

  • Lie on your back on a flat surface. Keep your legs straight.

  • Bend the knee of your injured leg by slowly sliding the heel towards your buttocks.
  • Try to bring your heel as close to your buttocks as possible without causing pain.
  • Slide your heel back to the starting position.
  • Do this several times, noticing any restrictions or pain.

If you feel pain or cannot bend the knee completely during the heel slide, it might suggest an LCL injury

  • Stand up straight with your feet hip-width apart.

  • Cross your injured leg behind your other leg. Your legs should be crossed at the thighs.
  • Lower your body down in a curtsy-like motion. Bend both knees, keeping your back straight.
  • Straighten your legs and uncross them, returning to the starting position.
  • Do this several times, observing any pain or discomfort.

If crossing over and bending your knees causes pain on the outside of the injured leg’s knee, it may indicate an LCL injury.

How severe is my lateral collateral ligament injury?

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.


Physiotherapy diagnosis

We are confident to diagnose your lateral collateral ligament (LCL) sprain as skilled physiotherapists. We make our priority to locate the exact reason for your knee pain and from there formulate a treatment plan that will suit you lifestyle. With the right knowledge about the anatomy of your knee, we can look at the bigger picture and see if you have injured any surrounding muscles or joints.

To start off with the diagnostic procedure of a LCL sprain, we get a complete history of your injury and symptoms. After that, we do a thorough physical examination of your knee:

  • Palpation: We feel for tenderness, swelling, increased warmth, pain response or muscle spasm.
  • Range of Motion: It is important to measure how far you can bend and straighten your knee before you feel stiffness or pain.
  • Muscle Strength Testing: With any ligament injury, you’ll always have accompanying muscle pain or injury. By testing the strength of muscles like your quadriceps and hamstrings, we’ll be able to identify any muscle dysfunction and measure your knee stability.
  • Special Tests: Stretching and stressing the ligaments around your knee help to identify which ligaments were injured.


Ligaments cannot be seen on an x-ray, so it won’t be the first choice of investigation to use. However, x-rays can show the bone structure of your knee joint and can help to rule out any fractures.

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

Diagnostic ultrasound

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 and amount of swelling and fluid.

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 bones, ligaments, nerves, tendons, cartilage and swelling. However, it is an expensive option and you need to be referred by a specialist doctor to get this test.

Your physiotherapist can refer you to the appropriate specialist if you need to get a scan like this.

Why is the pain not going away?

Delayed healing and chronic inflammation:

Your LCL 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.

What NOT to do

  • Manage the pain through medication alone. You could supress the symptoms of something more serious.

  • Stretch, push or exercise through uncontrollable pain

  • Try to ‘click’ your knee back into place if it feels unstable.

  • Leave it untreated, if you are uncertain of the diagnosis, rather call us and be safe.

What you SHOULD do

  • Rest as needed after your initial injury to help your body get the healing process going.

  • Use ice to relieve some of the swelling and pain.

  • Do safe movements and exercise with the guidance from a physiotherapist.

  • Finish your treatment and rehabilitation programme for better long-term results.

Making it worse

  • Crouching down

  • Kicking a ball

  • Climbing stairs

  • Walking uphill or downhill

  • Running

  • Squats or lunges

  • Jumping

  • Suddenly turning to change direction

  • Climbing in and out of the car

Problems we see when patients come to us with a LCL injury

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.

Physiotherapy treatment

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.

Healing time

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.

Other forms of treatment

  • Doctor

    : Your doctor can assist you with a diagnosis and a prescription for pain medication if necessary. Medication is a handy tool in your recovery process, but it should be used with guidance and in combination with rehabilitation. The use of cortisone is not recommended.

  • 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 joint ‘back into place’ after an injury like this is not recommended. It can flare-up the inflammation process or worsen the ligament tear.
  • Orthotist: An orthotist can recommend and prescribe a knee brace and crutches according to the severity of your injury. A brace can help with healing, especially in the acute phase of your injury. However, there should be a management plan in place, to make sure that you move and use your knee independently again.

Is surgery an option?

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.

What else could it be?

  • Iliotibial band syndrome: Pain at the outside of your knee, thigh or even hip. Typically caused by overuse and very common in runners. 
  • Meniscus tear (lateral meniscus): This is an injury of the extra cartilage layer inside the knee joint. It often causes a clicking or locking sensation in your knee. Caused by a twist injury of your knee. .
  • Cruciate ligament injury (ACL or PCL): These ligaments are found inside the knee joint. It protects the tibia from sliding forward or backward on the femur. Very common to injure it when you have to change direction or stop suddenly.
  • Lateral hamstring tendinopathy: The outside part of the hamstring tendon attaches onto the knee. Close to the LCL. Tendon pain often feels worse when you exercise and afterwards as you cool down. Severe stiffness of your knee the next morning.

Also known as

  • LCL sprain
  • Lateral ligament tear
  • Tear of the lateral collateral ligament
  • Injury of the lateral knee ligament