Here we present an example of a rehabilitation programme for a professional
footballer with a grade II medial collateral knee ligament sprain.
Days 1 to 3
Rest from activity.
Protect the injury site from further damage by using crutches to avoid
putting any weight through the injured leg.
Apply ice packs or a 'cryo-cuff' device for 20 minutes every 2 hours (never
apply ice directly to the skin). This will have
pain-relieving effect and also help to control the swelling. Apply a
compression bandage to limit the joint swelling. The injured knee should
be elevated in order to control and reduce swelling. Oral anti-inflammatory
medication may be prescribed by a doctor.
Days 4 to 14
Continue to rest the injured part completely.
Continue to protect the injured knee from further damage by using crutches.
If it is not too painful it may be possible to begin partial weight-bearing
on the affected leg whilst continuing to use the crutches. To further
protect the knee a hinged knee brace should be used to prevent stress
on the medial ligament. This should be locked between minus 10 degrees
of extension and 90 degrees of flexion.
Once the inflammatory response from the damaged tissue has settled (after
3-5 days) the ligament begins to lay down scar tissue to repair itself.
It is thought that this process can be encouraged with the use of
such as ultrasound and
Begin ankle and hip range-of-movement exercises.
Weeks 2 to 4
The hinged knee brace should be worn at all times during the early active
rehabilitation phase, and should be set between minus 5 degrees of extension
and 110 degrees of flexion. Provided it is not too painful, full weight-bearing
should be encouraged and the crutches should be abandoned.
A normal gait pattern should be present, with the heel striking the
ground first and the toes pushing off for the next step.
Isometric quadriceps should be performed in the pain-free range of movement.
Straight leg raising should be performed to reinforce quads contractions.
Gentle range-of-movement exercises should be encouraged between 90 to
30 degrees of knee flexion.
Early proprioception exercises should be initiated.
Weeks 4 to 6
The hinged knee brace should be worn at all times during the active
rehabilitation phase. There should be no restriction of knee extension
Range-of-movement exercises should be continued.
When range of movement allows, static cycling should be initiated.
Isotonic muscle strengthening exercises should be initiated and resistance
gradually increased (leg press/squats/ham curls/quads extensions).
Continue proprioceptive training.
Weeks 6 to 10
The hinged knee brace should continue to be worn, without restriction
of knee extension or flexion.
Range-of-movement exercises should be continued, until full range of
extension and flexion is pain free.
Isotonic muscle strengthening should continue, so that the affected
knee's quads and hamstrings have 90% strength of the unaffected knee.
Continue static cycling and increase resistance.
Initiate straight line running, gradually increasing the pace. Initiate
'figure-of-eight' running, gradually increasing turns.
Begin 'fitter' exercises.
The hinged knee brace should be discarded.
Isotonic muscle strengthening should continue.
Continue to progress static cycling.
Increase speed of running and increase turning angle to 180 degrees.
Begin cliniband lateral agility/running exercises and star jumps. Hop
distance should be 100% of opposite knee. Kicking the ball/block tackling.