Medial Collateral Ligament (MCL) Tears: Common Causes and How to Treat It

Unlike some knee injuries that develop over time, ligament sprains, which account for about 40% of all knee injuries, tend to be acute injuries that occur at a specific moment. “Most of the time, people are able to tell me the moment that an MCL injury happened,” says Vanessa Matos, PT, DPT, a physical therapist at Hinge Health. “They’ll say, ‘I stepped off the curb awkwardly, and my knee started hurting,’ for example.”

Medial collateral ligament (MCL) injuries, like tears, can result in pain on the inside of the knee and instability. But don’t panic. While an MCL tear may sound scary, this injury is more often successfully treated with non-surgical options, like physical and exercise therapy, than other ligament injuries.

Read on to learn more about MCL tears — their symptoms, causes, and treatment options — including exercises recommended by Hinge Health physical therapists.

What Is the Medial Collateral Ligament?

The medial collateral ligament is one of four primary ligaments that support the knee joint. Ligaments are strong fibrous bands of tissue that connect one bone to another. Like the ACL at the front of the knee, the MCL also connects the femur (thighbone) to the tibia (shinbone), but its connection point is on the inner side of the knee. 

The MCL plays a pivotal role in maintaining knee function and stability by preventing the knee from moving too far inward.

What Is an MCL Tear?

MCL injuries, in which the ligament is sprained or torn, often occur from a direct hit to the outside of the knee that forces it inward, like when playing football or soccer. MCL injuries can also occur during other sports with frequent starts, stops, twisting, changes in direction, and lateral movements, like tennis, basketball, pickleball, or downhill skiing. In fact, roughly 60 percent of skiing injuries involve the MCL. MCL injuries also happen outside of sports like, for example, in a car accident. They even occur in everyday life, most often when you twist or turn while your foot is firmly planted. For example, you might be playing with your kids or dog, moving quickly to catch or avoid something, or bending and picking up or moving something heavy. But that doesn’t mean you should avoid these activities. Staying active and strengthening muscles that support your knees can help to prevent an MCL injury or reinjury.

MCL injuries are divided into three levels of severity: 

• Grade 1 is a sprain, in which the MCL has been overstretched, not torn. The ligament still provides stability, and you haven’t lost any knee function. You may have some knee pain and swelling, but you can walk on it and perform most everyday activities.

• Grade 2 is a partial tear, in which the MCL has been overstretched to the point that it is loose and can’t provide full stability, making walking and stair climbing difficult. You may feel like your knee is going to give out as you do these activities, especially when changing directions. 

• Grade 3 is a full tear, sometimes referred to as a rupture. When this happens, you’ll feel less stable putting weight on your injured leg, and walking will be more difficult.

“MCL injuries can happen in isolation, but, in more severe cases, other structures in the knee are typically injured at the same time,” says Dr. Matos. “The MCL and ACL are often injured together. And there's something called the ‘unhappy triad’ that's an injury to the ACL, MCL, and medial meniscus. It’s a common combination due to how the knee is designed.”

MCL Tear Symptoms

No matter how you injure your MCL, the symptoms are generally the same, though they can vary in intensity depending on the severity of the injury. They include: 

• Sharp pain on the inside of the knee at the moment of injury

• Feeling or hearing a popping sound when the injury occurs

• Swelling in the first few hours

• Loss of range of motion

• Difficulty walking or bearing weight on the injured knee

• Sense of instability

• Feeling like the knee is going to give out or having the knee give out

• Pain on the inside of the knee when using the foot to move something, like a doorstop

• Soreness or tenderness on the inside of the knee

MCL Tears: A Hinge Perspective

Anytime you hear that you’ve torn something in your body, it’s perfectly natural to be a little alarmed. And the more severe your MCL injury is, the more hesitant you may be to get back on your feet, which is entirely understandable. You may feel unstable putting weight on the injured leg or worry about moving your knee. Your concerns are valid, but take heart: Ligaments, including the MCL, are resilient bands of connective tissue. They’re designed to recover and heal.

One of the most important components of recovery — whether you need surgery or not — is movement. As our Hinge Health care team likes to say, movement is medicine. It helps to maintain range of motion, brings nutrients to the knee joint for healing, and strengthens supporting muscles.

A physical therapist can help you overcome any hesitations you have about moving with a torn MCL. They can design an exercise program tailored to your symptoms and abilities. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

Causes of an MCL Tear 

MCL injuries and tears occur when the ligament absorbs too much force. Here are some common ways that can happen:

• Rapid change in direction

• Sudden twisting

• Direct impact to the outside of the knee, such as a car accident, fall, or collision while playing sports

• Abrupt stop

• Pivoting when your foot is firmly planted

• Landing awkwardly, perhaps after a fall or jump

Treatment Options for MCL Tears

Most MCL injuries and tears can be treated without surgery. “The MCL does really well with conservative management,” says Dr. Matos. “It can actually heal on its own because it has better blood supply than other ligaments.” Here are some of the conservative treatment options for an MCL tear or injury:

• P.E.A.C.E and L.O.V.E. protocol. You may be familiar with the advice to rest, ice, compress, and elevate an injury (the R.I.C.E. approach), but the latest thinking is to focus on P.E.A.C.E. (protect, elevate, adjust anti-inflammatories, compression, and educate) and L.O.V.E. (load, optimism, vascularization, and exercise). This new, more comprehensive approach prioritizes movement and exercise as a vital component to your healing.

• Physical therapy. Physical therapy is a research-backed treatment for MCL tears that increases strength, stability, flexibility, power, coordination, and function. In addition to recommending exercises, a physical therapist (PT) may use neuromuscular stimulation (low-level electrical impulses that cause muscles to contract) to enhance strength and function in surrounding knee and leg muscles. Physical therapy also helps you regain confidence in movement, helping you get back to the activities and sports you enjoy. 

• Ice and heat. Icing can help reduce swelling and pain immediately following an MCL injury. Heating increases blood flow and can reduce stiffness. You can apply ice or heat as needed for 10 to 20 minutes at a time, but avoid using heat to treat a new injury, which may delay healing. 

• Knee bracing. If knee instability is keeping you from being active, a brace may help, but it’s not a replacement for exercise therapy. You also want to avoid wearing a brace for long periods since movement promotes healing. A brace may be helpful immediately following surgery, but overall evidence for its effectiveness after an MCL tear is inconclusive, so you should follow the advice of your doctor or physical therapist. 

• Patience. You may be able to avoid surgery and make a full recovery, even after a full MCL tear, but it’s going to take time. If you only sprained your MCL (grade 1), you should be able to return to normal activities within a few weeks. However, more serious MCL tears can take longer to heal, so give yourself grace and don’t rush your recovery. “One of the greatest predictors of reinjury is returning to sports too quickly,” says Dr. Matos. That said, you should be able to return to everyday activities sooner.

MCL Surgery: What to Know

Surgery isn't necessary for most people to recover from an MCL tear, and conservative measures should be prioritized. Research shows that 98% of athletes with grade 1 or 2 MCL injuries fully recover without surgical interventions.

Even grade 3 MCL tears can heal with conservative management. However full MCL tears often occur with other injuries like ACL and meniscus tears. When accompanying injuries require surgery, doctors will often repair the MCL, too, with good outcomes. According to a review in the journal Arthroscopy, Sports Medicine, and Rehabilitation, about 90% of people, many of them athletes, were able to return to their previous activity or sport after surgery.

If you need surgery for your MCL injury, physical therapy will still be a vital part of your recovery.

Hinge Health physical therapists recommend these exercises to strengthen the muscles that support the knee and promote healing from an MCL injury or tear. These moves are particularly beneficial because they focus on stabilization of the core, hips, and pelvis, which contributes to better movement that protects the knees.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Prevention of an MCL Injury

Injuries happen, but here are some strategies that can help reduce your risk and minimize the severity if an MCL injury does occur.

• Ease into activity. A five to 10-minute dynamic warm-up prepares your body for activity and has been shown to reduce injury. Try butt kicks, side shuffles, high knees, and squats to warm up your lower body and knees.

• Exercise regularly. You’re more likely to get injured if you’re inactive during the week and then go out and play hard on the weekend. “Our bodies are the healthiest when we’re moving,” says Dr. Matos. Regular exercise, and even small movement breaks throughout the day, will keep you strong, agile, powerful, and flexible, reducing your risk of an MCL injury. 

• Check your technique. If you’re starting a new activity, lessons can be helpful to ensure good technique during high-risk activities like downhill skiing, soccer, or pickleball. A physical therapist can also provide sport-specific recommendations.

• Get the right gear. Running shoes aren’t appropriate for soccer, tennis, or pickleball because they don’t have the lateral support needed for activities with a lot of side-to-side movement and quick changes in direction. If you’re a skier, make sure your bindings are properly adjusted. Properly fitted, sports-specific footwear can help protect against injury.

PT Tip: Start With a Warm-Up

Before doing any physical activity, consider doing a dynamic warm-up for five to 10 minutes. This transition from being inactive prepares your body for activity by sending more blood flow to working muscles, ligaments, and tendons, decreasing joint stiffness, and warming up the body. When you’re colder and stiffer, you’re more likely to sprain or strain something, according to research from BMC Medicine.

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. MCL Tear. (2021, October 18). Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/21979-mcl-tear 

2. Naqvi, U. and Sherman, A.I. (2023, July 17). Medial Collateral Ligament Knee Injury. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK431095/ 

3. Herman, K., Barton, C., Malliaras, P., and Morrissey, D. (2012). The effectiveness of neuromuscular warm-up strategies, that require no additional equipment, for preventing lower limb injuries during sports participation: a systematic review. BMC Medicine, 10(1). doi:10.1186/1741-7015-10-75

4. Filbay, S.R., Ackerman, I.N., Russell, T.G., and Crossley, K.M. (2017, May). Return to sport matters-longer-term quality of life after ACL reconstruction in people with knee difficulties. Scandinavian Journal of Medicine & Science in Sports, 27(5), 514-524. doi:10.1111/sms.12698

5. Wright, M.L., Coladonato, C., Ciccotti, M.G., Tjoumakaris, F.P., and Freedman, K.B. (2023, May 5). Combined Anterior Cruciate Ligament and Medial Collateral Ligament Reconstruction Shows High Rates of Return to Activity and Low Rates of Recurrent Valgus Instability: An Updated Systematic Review. Arthroscopy, Sports Medicine, and Rehabilitation, 5(3), e867-e879. doi:10.1016/j.asmr.2023.03.006