Dr. Howard Liss treats disorders that cause pain and disability by providing consultative services and soft tissue and joint injections when needed. When medically appropriate, he makes specific referrals for diagnostic testing (lab work, imaging, electrodiagnosis), physical and occupational therapy, interventional procedures (epidurals and facet joint injections), and surgery.
Commonly reported in contact sports such as football, basketball, rugby and martial arts, a medial ligament sprain, or MCL injury, describes a tearing of the ligament on the inside of the knee. Injuries range in severity, and they are graded as a 1, 2 or 3.
With mild symptoms including tenderness in the area of the medial ligament, a grade 1 MCL injury occurs in less than 10% of cases. While pain can be felt when pressure is applied to the lower leg (adding stress to the medial ligament), there is generally no swelling, and the knee joint remains stable. In turn, a grade 2 MCL injury results in significant discomfort, with mild to moderate swelling over the medial ligament. The knee joint may present some signs of instability. Yet, a complete tear of the ligament is classified as a grade 3 MCL injury. While there is severe joint dysfunction, pain could remain mild.
The positioning of the medial ligament is such that it prevents the knee from moving sideways, specifically from forces from the other side of the knee (the outside). Having two parts, the deep inner section and the superficial ligament band, injury often occurs in the deepest fibers of the ligament initially. This depends on the force of impact and the amount of stress placed on the ligament. If it is great enough, some (or all) of the fibers may tear. In effect, a number of other injuries may result including medial cartilage meniscus injury, MCL sprain or ACL tear. For instance, if a basketball player attempts to turn quickly while their foot is planted, the joint will essentially open, and the ligament may tear.
While numerous other sports injuries and conditions are related or similar to MCL injuries, common symptoms include sudden, acute knee pain, rapid swelling and pain on the inside of the knee.
Treatment and Rehabilitation for MCL Injuries
Perhaps the greatest approaches to the treatment and rehabilitation of MCL injuries is a comprehensive one in which multiple body systems, muscle groups and conditions are considered. A number of knee injuries manifest similarly to a medial ligament sprain. Physiatrists are in a unique position to classify an MCL injury with expertise regarding the complex network of nerves, bones, joints, ligaments, muscles and tendons. They are aware of how they affect the medial ligament.
Early treatment of an MCL injury will likely involve active rest, ice therapy, compression bandage (a hinged knee brace is beneficial for grade 2 or 3 MCL injuries), elevation or even steroid injections, as physiatrists work to manage pain and inflammation. Ultrasound therapy and interferential TENS treatments also work to reduce pain and inflammation in tissues surrounding the ligament. Though part of treatment, these modalities provide important diagnostic information to the physiatrist that is then used to tailor the patient’s rehabilitation program.
When pain and inflammation become managed, patients can tolerate mobility and strengthening exercises, as determined by the physiatrist. For instance, isometric strengthening exercises using static muscle contractions are effective at maintaining muscle strength while ligaments are healing. As the ligament strengthens, more advanced rehabilitation exercises are prescribed. Some are explained below:
- Closed kinetic chain exercises – similar to daily activities, these exercises utilize multiple joints and patients use their own body weight
- Balance enhancement exercises – aimed at assessing and restoring core stability and hip and leg muscle control while including the vestibular and visual systems
- Proprioception exercises – aimed at helping patients generate an awareness of the brain, motor and sensory connection in relation to sports and daily activities
- Sports-specific exercises – aimed at improving agility and response time and will emphasize warm-up, flexibility, posture and positioning
- Strength and stretching exercises
- Yoga and mind-body connection
- Patient education and biomechanics training
While a large part of rehabilitation for an MCL injury will involve physical conditioning and training, physiatrists realize the connection between physiological and psychological wellness. Simply put, when individuals feel better physically, they also feel better mentally and vice versa. Thus, there is great value in patient education and awareness of sports-specific techniques, posture and positioning and modifications to daily activities. While this helps patients avoid re-injury, it also empowers patients to take control of their health.
At the Howard Liss, M.D. Rehabilitation Institute in Tenafly, patients can rely on Dr. Liss to put together the right treatment, therapy and rehabilitation plan to ensure the most optimal outcome. Dr. Liss works closely with other specialists required to rehabilitate patients suffering from chronic pain or serious injuries, and Dr. Liss will refer patients as needed to ensure appropriate treatment. With extensive education and exposure to a variety of conditions that affect the cervical and lumbar spine, bones, nerves, joints, ligaments, tendons, muscles, brain, and spinal cord, Dr. Liss is uniquely positioned to help patients manage their pain and maximize their functioning.
To schedule an appointment, contact the Howard Liss, M.D. Rehabilitation Institute today.