Addressing Skiing-Related MCL Injuries with Physical Therapy

MCL sprains or tears are the most common ski-related knee injury, accounting for up to 20% of all ski injuries and 60% of all ski-related knee injuries. An MCL injury can occur while skiing when pressure or hard contact from a collision or fall impacts the outside of the knee, straining or tearing the ligament. Physical therapy is the preferred treatment for the majority of MCL injuries, restoring function, mobility, stability, and strength to the MCL and knee joint through a targeted therapeutic exercise program.

Knee Joint Anatomy: the MCL

The MCL, or medial collateral ligament, is located on the inside of the knee, attaching to the femur (thigh bone) and shin bone (tibia). The MCL plays a key role in providing valgus stability to the knee joint and preventing the knee from swinging to the outside against any forces placed on the knee.

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Skiing-Related MCL Injuries

Skiing is a dynamic winter sport, demanding strength, agility, and coordination while moving down slopes of packed snow and ice. Knee injuries make up one-third of the total injuries that occur during the ski season. Of the ski-related knee injuries, MCL sprains or tears are the most common injury. MCL injuries account for 15-20% of all skiing injuries and 60% of ski-related knee injuries.

Ski-related MCL injuries can occur when pressure or hard contact from a collision or fall impacts the outside of the knee, stretching or tearing the ligament. During a fall, the skier loses their balance with their center of gravity moving forward while the knee moves toward the center line of the body and the shin bone becomes externally rotated. This valgus external rotation can place intense pressure on the MCL, causing injury.

MCL injuries tend to be more common among beginner and intermediate skiers. Another way an MCL injury can occur is when the ski tips are pointed towards one another in a snowplow position when the skier is trying to slow down or stop. If the skier falls, this places pressure on the outside of the knee, which can strain or tear the MCL. MCL injuries can occur on their own or in conjunction with other knee injuries, such as an ACL ligament tear or a meniscus tear.

Symptoms of a torn MCL include:

• Pain, swelling and bruising on the inner side of the knee

• Swelling that spreads to the rest of the knee within 24-48 hours post-injury

• Knee stiffness and limited range of motion

• Difficulty and pain when trying to bend or straighten the knee

• Unstable feeling in the knee as though the knee may buckle

• Pain or difficulty walking, sitting down, rising from a chair, or climbing stairs

Physical Therapy for MCL Injuries

Physical therapy is the preferred treatment for the majority of MCL injuries, restoring function, mobility, stability, and strength to the MCL and knee joint through a targeted therapeutic exercise program. Surgery is generally not required unless there are other ligament injuries like an ACL tear along with the MCL tear. If that is the case, surgeons perform an MCL reconstruction surgery using a graft from another part of the body. Following surgery, physical therapy is essential to restore function in the knee joint.

Physical therapy treatment for a ski related MCL injury may begin with an initial period of immobilization accompanied by ice and compression to relieve pain and swelling, followed by early range of motion and isometric quadriceps strengthening exercises. Once full range of motion is achieved, the physical therapist implements a program of progressive resistance exercises, isokinetic and closed chain exercises, and functional rehabilitation to prepare the skier for a return to the slopes.

Physical therapy for an MCL injury can include:

• Pain management using ice, compression, and manual therapy

• Gentle range of motion exercises of the knee and leg

• Isometric quadricep strengthening exercises to support knee flexion early in recovery

• Targeted strengthening of the quadriceps, hamstrings, gluteal muscles, and hip adductors to support proper knee alignment and take stress off of the knee joint by strengthening surrounding muscles

• Aerobic conditioning to build endurance and mobility in the lower extremity, including rowing, stationary biking, elliptical training, or aquatic therapy

• Agility, balance, and stability training, focusing on improving joint proprioception (the body’s ability to understand where it is in space)

• Functional return-to-sport training to ensure the MCL can handle the various loads placed on it during skiing. This involves increasing the difficulty of exercise and sport-specific maneuvers gradually.

To prevent ski related MCL injuries:

• Use proper ski equipment and work with a ski instructor if you haven’t skied in a while.

• Engage in a dynamic warm up, stretching the upper and lower extremities and back and doing some dynamic movements like jogging, jumping jacks, or lunges to warm up your muscles for activity.

• Use proper skiing technique, with hands and weight forward, legs parallel, and hips, knees, and ankles flexing equally.

• Be sure to stay on marked trails for your safety and to avoid difficult terrain that could increase the risk of injury.

• Start slow, skiing half a day until your endurance improves. Ski injury rates increase towards the end of the day when skiers are fatigued.

• Prepare for ski season 3 to 4 weeks ahead of time with a pre-slope conditioning program that involves flexibility, strength, and endurance training to prevent injury and prepare your body for the demands of skiing.

If you have experienced an MCL strain or tear, working with a physical therapist can help you regain strength and function and return to sport safely without surgery!