Conservative MCL Rehabilitation Protocol [PDF]

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tConservative MCL Rehabilitation Protocol Maximum Protection Phase Goals: Reduce pain and swelling Improve muscle control Protect the healing process General conditioning Achieve pain-free ROM as tolerated Methods:  Brace locked in 20 degrees to 70 degrees for second and third degree injuries  Exercises should be pain free with ROM increased as able  Exercises to be done without a brace and a pillow under the knee to protect ROM as required  Iontophoresis/TENS/pulsed US  Crutches if necessary  Weight bearing as tolerated and gait re-education  RICE  Leg raises 10x3 in 20deg knee flex  Heel slides in a non-painful ROM 10x3  Isometric Quadriceps in 20, 40 & 60 degrees of flexion 10x3x6s  Isometric hamstring in 20, 40 & 60 degrees 10x3x6s  Hip extension with thera-band above knee 10x3  Hip abduction with thera-band above knee 10x3  Isometric squeeze with pillow between thighs, 10x3x6s  Isometric VMO +/- muscle stim/biofeedback  Ankle ROM and isometric  Proprioception: AP direction only within weight-bearing limits  Finish with ice, compression, elevation and ankle pumps  General conditioning



Criteria to advance to next phase: Minimum swelling Good quadriceps control / No quadriceps lag Normal and pain-free gait without crutches Brace not required Full pain free knee extension Moderate Protection Phase Goals: Full pain-free ROM Improve Strength Improve Proprioception Methods:             



Ice massage + US ROM without restriction Supine heel wall slides 10x3 Prone ROM 10x3 Sitting ROM (hip/kn flex)10x3 Isotonic quadriceps with resistance. Performed in pain free range and progress range as able (PRE) Quadriceps strengthening with theraband 10x3 Hamstring strengthening with theraband 10x3 Isometric on quadriceps bench in (20 degrees,40 degrees,60 degrees) 10x3 Isometric hamstring on leg curl machine (20 degrees,40 degrees,60 degrees)10x3 Total hip for hip flexion 10x3 with resistance above the knee Total hip for hip abduction 10x3 with resistance above the knee Total hip for hip extension 10x3 resistance above the knee



 Total hip for hip adduction with resistance above the knee and ensuring good muscle control throughout movement  Proprioception exercises. Progress through double leg stance with eyes open/eyes closed, standing on mini-tramp EO/EC, balance board bilateral AP, single leg stance EO/EC, single leg stance mini-tramp EO/EC, single leg stance balance board AP  Isometric on leg press machine 10x2x6s at 20, 40 and 60 degrees then progress to below.  Isotonic on leg press machine, short arc initially 20-60degrees (15x3). Gradually progress extension ROM as pain and muscle control allows.  Seated CKC on pro-fitter (15x3) Unilateral 20-60 degrees and gradually increase ROM.  Bilateral isometric mini-squat (10x3) 6 sec each. Initially using 2 tables/ llel bars as support, progress to un-supported  Bilateral isotonic mini-squat (10x3) progress to 0-60deg  Unilateral squat (10x3) progress to 0-60deg  BIODEX proprioception machine: start with level 8 and progress  Pool program. Progress as muscle control allows. Ensure good control before commencing ab/add’n exercises  Cycling: commence with high seat and low resistance and progress  Soft tissue therapy e.g. frictions



Criteria to advance to next phase: Full pain free ROM Isometric hamstring/quads test >70% compared to contrataleral at 20, 40 and 60 degrees Biodex proprioception test >70% compared to contralateral (level 6) Minimum pain and laxity in valgus stress test. (Note: some residual laxity will remain present even post extensive rehabilitation after grade 2&3 injuries)



Minimum Protection Phase Goals: Normal strength



Improve proprioception Commence running Introduce functional and sports specific programs Methods:        



Multi hip for adduction 10x3 (below the knee) Multi hip for abduction 10x3 (below the knee) Isotonic hamstring PRE Isotonic quadriceps PRE Isokinetic program (con/ecc) Unilateral squats with sport cord 10x3 Wall squatting 10x3x6s Proprioception exercises: bilateral medial/ lateral direction and progress  Nordic track (ski) 5 min  Step up and down 20x3 and progress to lateral  Start running when isokinetic test > 70% in 60 degrees per second and no limp and no pain during running



When Isokinetic test > 80% No pain on running, no limp Good stability on valgus stress testing (dynamic x-ray if necessary) Add: Aerobic/functional exercises    



Lateral slides on pro-fitter (20x3) Lateral running: cutting/figure of 8 Unilateral balance board in 2 directions Jumping/hopping



Return to sport if: Sport specific program accomplished without pain or instability Isokinetic test > 90%



Functional test> 90% Proprioception test shows no difference in both sides Valgus stress test is negative