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/addn 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