Rehabilitation of MCL Knee Sprain in Football

This article discusses the rehabilitation program for MCL knee sprain in football, including exercises and recovery timeline. It explains the mechanism of injury, different grades of sprain, and the importance of rehabilitation exercises such as isometrics, ROM, proprioception, concentric/eccentric, PWB to FWB strengthening, core exercises, and flexibility training. The article concludes with recommendations for future research and emphasizes the importance of understanding the needs of football players in developing an effective rehabilitation program.

REHABILITATION-
MCL KNEE SPRAIN
INJURIES IN FOOTBALL

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................1
DISCUSSION..................................................................................................................................2
CONCLUSION................................................................................................................................5
REFERENCES................................................................................................................................6

INTRODUCTION
MCL or Medial Collateral Ligament injury is a stretch, partial tear, or complete tear of
ligament on inside of knee. It is made up of two bands (connects femur and tibia bones) (Bagwell
et al., 2018). It is one of the most common knee injuries and mostly it occurs from an outward
angulation force (when an object hit outer part of Knee with force) on the knee. These injuries
are often known as MCL sprain. It is one of the most common type of sprain injury in sports that
can be suffered by individuals by direct blow to knee. This MCL knee injury is of three types:
first is grade 1 MCL injury which is least severe in which ligament is stretched but not torn.
Second is grade 2 MCL knee injury in which ligament is partially torn and causes some
instability in knee joint. Third is grade 3 MCL knee injury is the most severe type of injury in
which ligament is completely torn. Joint instability is common in this third grade MCL knee
sprain injury (Andrews and et. al., 2017). Grade 1 and 2 can be treated non-surgically but grade 3
requires surgery.
The MCL knee sprain is extremely common in sport like Football. Football game require player
running, cutting, jumping, landing, tackling etc. that can become a reaon for this sprain injury.
This injury is graded on the basis of above specified three grades only but in form of minor to
severe. Mechanism of occurrence of this sprain injury: when sudden impact is applied to lateral
knee or a combination of valgus force is applied then occurrence of this sprain injury upon knee
can occur while playing. All the people who directly get hit on outer side of Knee while plays
one either with Football or by falling can get this injury. When a Football injures their MCL and
if they are suffering from Grade 1 and 2 MCL knee Sprain then through physical therapy,
activity modification, bracing, icing can help in reducing pain, swelling and bringing normal
movement back where player can return to play between several weeks to 2 months (Clifton and
et. al., 2017). But if player has injures their MCL and is suffering from grade 3 injury then it
might take more than 2 months for their recovery. Treatment of this grade injury can vary injury
to injury and upon its seriousness. Male footballers have greater risk of suffering from this sprain
as compared to female players and on an average time lost in recovery of this injury is 23.5 days
and if it is serious them more time is lost (Bagwell et al 2018). The main aim of this work is to
develop a rehabilitation program for footballers who got injured from MCL knee sprain injuries
in Football and to explain epidemiology of MCL injuries in football player. In this work
exercises that can be used in rehabilitation program of MCL knee sprain injury for footballers
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will be discussed with discussion of different kinds of exercises, number of dosages of exercise
and repetition will be discussed.
DISCUSSION
The discussion of different kinds of exercises used in educational package have been
discussed with justification for their inclusion. In this rehabilitation program all the exercises
have been explained in stages and ways in which it progresses from week 1 to week 10.
Isometrics
Isometrics exercises are those exercises that involve muscle engagement without
movement (Baker et al., 2018). It is first and the foremost type of exercise which is required to
be started as soon as pain allows the patient to participate (Kim, Chasse and Taylor, 2016). This
exercise is important to be included in rehabilitation program because it helps the injured person
to gain strength slowly without putting too much pressure on injured tissue.
In the rehabilitation of an MCL injury both Quadriceps and hamstring exercises should
be included (Montello et al., 2018). Quadricep isometric exercise is one of the most powerful
exercise that can be done to for knee joints. This exercise from the package is crucial for
walking, running, jumping and squatting. For Footballers this exercise is important especially for
first 3 weeks it is important to include this exercise this also important because it can herlp the
injured footballer to run faster and improve explosiveness and power while helping out posture
and preventing leg injuries. In first week, 25% contractions of 2 times to 5 repetitions are done,
in second week it is brought to 50 and in third week it is brought to 100 percent.
ROM
ROM or Range of Motion is an exercise to bring flexibility of knee back, reduce tightness
and swelling (Wannop et al 2020). It is recommended to include this exercise in rehabilitation
program for at least 6 weeks (McManimon-Myers, 2018). For first three weeks passive knee
flexion exercise can be included for increasing flexibility (Takei, 2017). For first two weeks 2
times to 5 repetition can be done and for third week 3 times to 5 repetitions. For week 3 to week
6 Single Leg extension sitting exercise can be included for slowly increasing movement of knee.
Proprioception
Proprioception exercise is required to be included within rehabilitation program because
it helps in developing balance and coordination with knee injury for increasing stability of the
leg, as opposed to mobility and strength (Ravindran, 2021). There are various kinds of
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Proprioception exercise categorising from beginners to expert and these exercises will begin
from week 2 to week 10. In week 2 Wobble Board Sitting will be done because it allows bending
of knees. In third week, ball knee control exercises will be done as this exercise will help in
developing balance. IT has been included in this package because it because is unstable and this
gives the knee proprioceptive input. Using unstable surface is important in this sprain injury
because it helps in strengthening Quadriceps. This exercise will be done for 3 times to 8
repetitions. In week 4 Clockwise circles on a foam pad exercise will be done as this exercise will
help in reducing tightness of muscles (Weiss and Elixhauser, 2016). This exercise will be done
from 3 times to 10 repetitions. In such manner different kinds of Proprioception exercises are
included in rehabilitation programs. These exercises are important to be included to increase
knee stability of injured footballer. These exercises require a bit of strength and movement in leg
due to this these exercises are included in week 2 not in week 1 and to bring strength, mobility,
and control over movement back this exercise is included till week 10. Proprioception training
for ligament injuries are important as they are based upon high-frequency instability exercises
and can help in bringing improvements in proprioceptive and postural control and were effective
in reducing the incidence of ankle sprains, knee sprains (Pruitt, 2018).
Concentric /Eccentric
Concentric /Eccentric exercises are extremely important for footballers who had suffered
from MCL knee sprain. This exercise is important to be included because in rehabilitation
program as well there are chances of patient to get injured or chances that injury get worsen due
to some carelessness etc. inclusion of this exercise will help in ensuring that chances of getting
injured are reduced by 60 to 70 percent (Wannop and et. al., 2020). These exercises are started
when pain in the injury slowly starts to reduce. This exercise is started in week 4 of MCL knee
sprain injury because at 5th week reconstruction of MCL starts beginning. Due to this, this
exercise is included in 4th week. 5 to 6 weeks of Eccentric training is sufficient for an injured
person to increase their isometric strength and for preventing any kind of muscle damage, these
exercises are included from 4th week to 10th week. Initially these exercises are made in 3 times to
5 repetition but as the person starts to gain strength and slowly these repetitions are taken to 4
times to 15 repetitions because injured footballer start with low level of strength.
PWB To FWB Strengthening
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PWB strengthening is known as partial weight bearing strengthening exercises is
important to understand strength of injured person leg and for increasing strength of leg. In this
half of injured person weight is put on their leg to understand how much pressure affected leg
can bear for good movements. Whereas, FWB strengthening exercise are known as Full weight
bearing exercise in this a person’s body weight of a person can be transferred to their injured
limb. This helps the patient in understanding their self- limit of bearing their full body weight
(Wannop and et. al., 2020). It is extremely important to increase overall weight bearing strength
of a person so that they can bear their body weight and stand upon their own legs. Before starting
this exercise, it is important to ensure that MCL starts to be developed other than this it is
observed that there is muscle weakness for at least 4 weeks of injury. Due to this PWB and FWB
strengthening exercises are included at 4th week but it only included for 5 weeks because this
exercise affects soft tissues of injured part as well and after 7th to 8th week muscles start
developing and strengthening so due to this, these exercises are included only from 4th to 8th
week after injury.
Core
Core exercises are included in rehabilitation program because it helps in optimal
biomechanical alignment (Clifton et al 2017). These core exercise is extremely important for a
football player because it helps in improving their flexibility, helps in development of perfect
movement and further helps in reducing pain and helps in speedy recovery from MCL knee
Sprain (Stirton, Altintas and Johnson, 2021). It is also important to be included in rehabilitation
program because it helps in development of other smaller muscles near knee that are important in
preventing back pain and helps in providing support in movement (Wannop and et. al., 2020).
These exercises are important to be included after 3 weeks of injury because it requires
development of strength in leg so that injured person can do core exercises properly. It is
included from 4th week to 10th because for a football player because it helps in enhancing their
balance and stability and enable them to perform football actions more efficiently (Kara,
Dönmez and Korkusuz, 2020).
Flexibility
One of the most important exercises to be included in rehabilitation program is of
flexibility. As it has already been discussed that after 3 weeks MCL starts developing. So, from
4th week onwards it is important to include flexibility exercises within this program because it
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helps in increasing flexibility of leg muscles, helps in providing support to knee for movement
(Wannop and et. al., 2020). In MCL knee sprain injury four weeks of flexibility training is
sufficient. After complete rehabilitation program in 10th week running as a flexibility training is
included for increasing strength, mobility, flexibility so that football player can return to playing
their sport.
CONCLUSION
From the above rehabilitation program, it has been summarised that each and every kind of
exercise in rehabilitation program for any kind of injury like knee injury plays an important and
vital role. It is important to understand reason because of which MCL knee sprain injury occurs
and time period that it takes for proper recovery. It has also been summarised that before
developing a rehabilitation program for an MCL sprain injury it is important to understand things
that are important for a footballer so that they can play in an excellent manner. Those factors are
strength, flexibility, control over movement etc. keeping these factors in mind, rehabilitation
program should be developed. Recommendations for future research based on content from the
discussion are as follows: in this program exercises to increase intensity level of players should
also be included considering whole healing process so that healing process of player can speed
up. In this program muscle endurance of the uninjured limbs and joints should also be included
for complete and speedy recovery of patients. This will help in preparing patient in a better
manner for recovery at both physical and psychological level and will be helpful for them to play
football as soon as the rehabilitation program is finished.
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