What is a collateral ligament sprain?
The two collateral ligaments are located on the sides of the knee joint and connect the thighbone (femur) to the lower leg. The MCL (medial collateral ligament), on the inside of the knee, connects the femur with the tibia, and the LCL (lateral collateral ligament) connects the femur to the fibula. A collateral ligament sprain is an injury that causes these ligaments to stretch or tear. The MCL is closely connected to the medial meniscus, so an MCL injury can sometimes also affect this important structure inside the knee.
How can it occur?
The collateral ligaments might be injured by a twisting motion or by a direct push from the side. Muscle dysfunction can seriously affect leg alignment and stabilization and is an important contributing factor to knee injury and overuse issues concerning the lower extremities. Muscle overuse often occurs when the body fails to compensate for existing muscle dysbalance. Muscle dysbalances are very common and naturally occur as the body adapts to specific training demands over time. . As long as compensation is effective – or, in other words, as long as the dysbalance is well managed by the body – this need not cause any problems. However, with high training loads, insufficient rest or after a minor injury, the body may struggle to compensate, leading to muscle dysfunction in the various muscle groups involved in the compensation. This is why symptoms may simultaneously occur in different parts of the body in an overuse situation.
The psoas muscle is probably the most important muscle involved with dance injuries. Psoas dysfunction leads to tightness of the rectus femoris muscle (a part of the quadriceps) and deactivation of the piriformis (one of the smaller pelvic muscles inserting on the sacrum). This causes pelvic torsion and functional leg length discrepancy. Active knee stabilization thus will be seriously affected and the risk of a collateral ligament injury will rise.
What are the typical symptoms of a collateral ligament sprain?
Symptoms include swelling and pain at the outside (LCL sprain) or inside (MCL sprain) of the knee. This pain can be located above or underneath the knee joint line. In severe cases a giving way of the knee to one side is possible. Sometimes you can hear or feel a pop or snap at the time of the injury.
How can a collateral ligament sprain be diagnosed?
Your doctor will examine your knee and may find tenderness and swelling on one side of the knee. He will check for stability of the joint and evaluate the grade of the sprain. In a severe lesion of a collateral ligament, the knee will open to the injured side. An MRI scan is sometimes needed to find out if the meniscus or other structures inside the knee have been injured as well. Correct diagnosis of this issue demands an exact analysis of the accident and a thorough functional clinical examination, including specific tests to identify joint and muscle dysfunction. Finding out the exact causes and contributing factors of an injury is often challenging and your doctor may ask a specialist in manual medicine for his opinion.
This MRI scan of the knee shows a sprained medial collateral ligament (MCL). The ligament itself is not torn, but you can see quite a big hematoma (bleeding) around it that is depicted in white in this image.
What treatment options are there?
If you had a knee injury, you should take a break from your ballet training immediately. Ignoring the pain can have serious consequences, as the situation will become increasingly complicated the longer you train with pain. The RICE concept (rest, ice, compression and elevation) is an easy guideline that can be used to initially treat acute knee injuries. Please read my “First Aid” post to obtain some background information that you will need to adapt this concept successfully and learn about the use of painkillers.
Some sprains will need a stabilizing brace for 6 to 8 weeks but only few will need surgery to stabilize the knee. If you have been prescribed a stabilizing knee brace, it is extremely important to wear it round-the-clock. Moreover, please ensure that your brace fits properly during treatment time. Be note that due to muscle loss, braces may become loose and cannot fulfill their function properly.
Almost all ligament sprains will heal within 8 weeks, but if a ligament heals in a loose position you might end up having an instable knee. Stabilizing knee braces are aimed to guide the knee properly through its whole range of motion and let an injured collateral ligament heel with proper tension.
Sensomotoric training – namely rehabilitation of active leg stabilization – is mandatory after a knee accident and should be started as soon as possible.
In order to handle a given overuse situation in the course of rehabilitation, its underlying causes – namely muscle dysfunction and muscle dysbalance – have to be addressed specifically. Muscle dysfunction can appear as muscle tightness (contraction) or weakness (inhibition) and the muscles affected have to be treated accordingly in the rehabilitation process. Some muscles will have to be stretched whereas others will rather have to be strengthened. A well-suited training program including corrective exercises as well as a general strengthening and endurance routine is the most effective way to deal with most overuse situations.
You had a knee accident and suspect a problem with your collateral ligaments? These are the next steps:
- See a doctor
Dancers seek help from various different kinds of therapists, many of whom may employ treatments that are outside of mainstream medicine. Before considering the use of such alternative medicine, you should see a doctor for an evaluation and diagnosis. Finding a doctor who is familiar with dancers’ knees is sometimes challenging and you may want to see different specialists. A good place to start is to ask your friends and fellow dancers for the names of their favorite doctors.
- Start working on the underlying problems
As far as rehabilitation allows, there is a lot that you can do to work on the problems that may have contributed to the accident. Ultimately, it often comes down to addressing the same fundamental issues. Here are some useful exercises that I recommend to my patients (most of them can be performed wearing a brace):
Please refer to your doctor to confirm that the exercises you choose to do are suited to your individual problem, and obtain supervision from a professional trainer to ensure that you are performing them correctly.
- Talk to your ballet master or dance teacher
Technical issues and faulty dance technique are important predisposing factors of overuse and injury in dancers. Amending dance techniques often plays a crucial role in the treatment and prevention of overuse and injury and you should not hesitate to address any issues, if necessary.