Lateral Collateral Ligament
Your lateral collateral ligament (LCL) is a cord-like ligament on the lateral (outer) side of your knee that forms part of the posterolateral corner. It originates from the lateral femoral epicondyle, joins the bicep femoris tendon before attaching to the head of the fibula. It is one of four major ligaments that help you to stabilise the knee joint. LCL sprain is the most common form of LCL injury. In isolation, a lateral collateral ligament injuries only account for 2% of all knee ligament injuries. Most LCL injuries occur in combination with, damage to other knee ligaments and structures: e.g. ACL, meniscus and posterolateral corner.
What Causes an LCL Injury?
The primary function of your lateral collateral ligament is to resist varus force and external tibial (shin bone) rotation. This force occurs if your tibia/foot is forced inwards to the knee or when your foot is grounded, and your knee twists medially.
The LCL is injured when the varus force is too high for the ligament to resist. The ligament overstretches. This overstretch can occur through a sharp change in direction, twisting the knee on a planted foot. Othe causes include incorrect landing technique, hyperextension of the knee or a blunt force hit to the knee, such as in football tackle or a motor vehicle accident. The incident usually needs to happen at speed, but muscle weakness or incoordination predispose you to a ligament sprain or tear.
LCL Injury Severity?
The severity and symptoms of a knee ligament sprain depend on the degree of stretching or tearing of the knee ligament. You may notice an audible snap or tearing sound at the time of your ligament injury.
In a mild, Grade I, LCL sprain, the knee ligament has a slight stretch, but they don’t tear. Although the knee joint may not hurt or swell very much, a mild ligament sprain can increase the risk of a repeat injury.
With a moderate Grade II LCL sprain, the knee ligament tears partially. Knee swelling and bruising are common, and the use of the knee joint is usually painful and challenging. You may have some complaints of instability or a feeling of the knee giving way.
With a severe Grade III sprain, the ligament tears completely, causing swelling and sometimes bleeding under the skin. As a result, the joint is unstable and can be difficult to bear weight. You may have a feeling of the knee giving way. Often there will be no pain or severe pain that subsides quickly following a grade 3 tear as all of the pain fibres are torn at the time of injury. With these more severe tears, other structures are at risk of injury, including the meniscus or ACL.
How is an LCL Injury Diagnosed?
On examination, your physiotherapist will look for signs of ligament injury. There will be tenderness over the ligament site, possible swelling and pain with stress tests. MRI may also be used to diagnose a knee ligament injury and look at other surrounding structures for combination injuries.
How Long does it take for an LCL Injury to Heal?
Treatment of an LCL injury varies depending on its severity and whether there are other combination injuries.
Grade I sprains usually heal within a few weeks. Maximal ligament strength will occur after six weeks when the collagen fibres have matured. Resting from painful activity, icing the injury, and some anti-inflammatory medications are useful. Physiotherapy will help to hasten the healing process via electrical modalities, massage, strengthening and joint exercises to guide the direction that the ligament fibres heal. This plus exercises to strengthen your knees helps to prevent a future tear.
When a Grade II sprain occurs, use of a weight-bearing brace or some supportive taping is commonplace in early treatment. This support helps to ease the pain and avoid stretching of the healing knee ligament. After a grade II injury, you can usually return to activity once the joint is stable, and you are no longer having pain. The ligament healing may take a minimum of six weeks. Physiotherapy helps to hasten the healing process via electrical modalities, massage, strengthening, and joint exercises to guide the direction that the knee ligament fibres heal. This healing helps to prevent a future tear and quickly return you to your pre-injury status.
When a Grade III injury occurs, you usually wear a hinged knee brace for up to six weeks, with a small amount of movement, and use crutches for 1-2 weeks to protect the knee ligament from weight-bearing stresses. As your pain resolves and knee ligament repairing occurs, the knee brace can be gradually unlocked to allow additional knee movement as tolerated. The aim is to allow for full knee ligament healing and slowly return to normal activities. Severe LCL injury treatment via physiotherapy is a primary choice. However, we recommend the advice of a knee surgeon. Patients may not return to their full level of activity for 3 to 4 months. We highly recommend that you seek professional advice from a healthcare practitioner who specialises in knee ligament injuries to avoid long-term knee instability.
What is the Treatment for an LCL Injury?
Depending on the grade of knee ligament injury, you can start to feel better within days to just a few weeks of the damage. Your physiotherapy treatment will aim to:
- Reduce pain and inflammation.
- Normalise joint range of motion.
- Strengthen your knee: especially quadriceps (esp VMO) and hamstrings.
- Strengthen your lower limb: calves, hip and pelvis muscles.
- Improve patellofemoral (knee cap) alignment
- Normalise your muscle lengths
- Improve your proprioception, agility and balance
- Improve your technique and function, e.g. walking, running, squatting, hopping and landing.
- Guide your return to sport, activities and exercises.
- Minimise your chance of re-injury.
We strongly suggest that you discuss your specific knee rehabilitation plan with your trusted healthcare practitioner, after a thorough examination by a knee injury clinician such as a sports physiotherapist, sports physician or knee surgeon.
Most LCL injuries resolve well with conservative management. However, surgery may occur if there is significant ligament disruption, e.g. Grade III. Knee surgery may also be required if there is a considerable combination of injuries involving the ACL, posterolateral corner or meniscus. In these cases, the opinions of your knee surgeon, physiotherapist and doctor will guide the need for knee surgery.
Risks of knee surgery include infection, persistent instability and pain, stiffness, and difficulty returning to your previous level of activity. The good news is that better than 90% of patients have no complications post-surgery.
Post-operative knee rehabilitation is one of the most important aspects of knee surgery. The most successful and quickest outcomes result from the guidance and supervision of an experienced sports physiotherapist.
Your physiotherapy rehabilitation following knee surgery focuses on restoring full knee motion, strength, power and endurance. You’ll also require balance, proprioception and agility retraining individualised towards your specific sporting or functional needs.
As mentioned earlier, your sports physiotherapist is an expert in this field. We suggest you contact them for the best advice in your circumstance ces.
Your physiotherapist will guide your return to sport. It is highly variable and depends upon on your specific knee ligament injury and the demands of your competition.
How to Prevent Recurrence of LCL Injury?
A knee strengthening, agility and proprioceptive training program is the best way to reduce your chance of a knee ligament sprain. Premature return to high-risk activities such as sport carries risk. Please discuss with your physiotherapist or surgeon.
Common Causes - Knee Pain
Knee pain can have many origins from local injury, referred pain, biomechanical issues and systemic issues. While knee pain can appear simple to the untrained eye, a thorough assessment is often required to ascertain the origin of your symptoms. The good news is that once a definitive diagnosis is determined, most knee pain quickly resolves with the correct treatment and rehabilitation.
Knee Ligament Injuries
- Knee Ligament Injuries
- ACL Injury
- PCL Injury
- MCL Sprain
- LCL Sprain
- Posterolateral Corner Injury
- Superior Tibiofibular Joint Sprain
Knee Meniscus Injuries
- Chondromalacia Patella
- Fat Pad Syndrome
- Patella Dislocation
- Patellofemoral Pain Syndrome
- Osgood Schlatter’s Disease
- Sinding Larsen Johansson Syndrome
Knee Tendon Injuries
- Corked Thigh
- Thigh Muscle Strain
- Hamstring Strain
- ITB Syndrome
- Popliteus Syndrome
- Muscle Strain (Muscle Pain)
- DOMS – Delayed Onset Muscle Soreness
Children’s Knee Conditions
Other Knee-Related Conditions
- Runner’s Knee
- Plica Syndrome
- Stress Fracture
- Overuse Injuries
- Restless Legs Syndrome
For specific information regarding your knee pain, please seek the assistance of a healthcare professional with a particular interest in knee condition, such as your physiotherapist.
What is Physiotherapy Treatment?
Physiotherapists help people affected by illness, injury or disability through exercise, manual joint therapy, soft tissue techniques education and advice. Physiotherapists maintain physical health, help patients to manage pain and prevent disease for people of all ages. Physiotherapists help to encourage pain-relief, injury recovery, enabling people to stay playing a sport, working or performing activities of daily living while assisting them to remain functionally independent.
There is a multitude of different physiotherapy treatment approaches.
Acute & Sub-Acute Injury Management
Hands-On Physiotherapy Techniques
Your physiotherapist's training includes hands-on physiotherapy techniques such as:
- Joint Mobilisation (gentle joint gliding techniques)
- Joint Manipulation
- Physiotherapy Instrument Mobilisation (PIM)
- Minimal Energy Techniques (METs)
- Soft Tissue Techniques
Your physiotherapist has skilled training. Physiotherapy techniques have expanded over the past few decades. They have researched, upskilled and educated themselves in a spectrum of allied health skills. These skills include techniques shared with other healthcare practitioners. Professions include exercise physiologists, remedial massage therapists, osteopaths, acupuncturists, kinesiologists, chiropractors and occupational therapists, just to name a few.
Your physiotherapist is a highly skilled professional who utilises strapping and taping techniques to prevent and assist injuries or pain relief and function.
Alternatively, your physiotherapist may recommend a supportive brace.
Acupuncture and Dry Needling
Many physiotherapists have acquired additional training in the field of acupuncture and dry needling to assist pain relief and muscle function.
Physiotherapists have been trained in the use of exercise therapy to strengthen your muscles and improve your function. Physiotherapy exercises use evidence-based protocols where possible as an effective way that you can solve or prevent pain and injury. Your physiotherapist is highly-skilled in the prescription of the "best exercises" for you and the most appropriate "exercise dose" for you depending on your rehabilitation status. Your physiotherapist will incorporate essential components of pilates, yoga and exercise physiology to provide you with the best result. They may even use Real-Time Ultrasound Physiotherapy so that you can watch your muscles contract on a screen as you correctly retrain them.
- Muscle Stretching
- Core Exercises
- Strengthening Exercises
- Balance Exercises
- Proprioception Exercises
- Real-Time Ultrasound Physiotherapy
- Swiss Ball Exercises
Biomechanical assessment, observation and diagnostic skills are paramount to the best treatment. Your physiotherapist is a highly skilled health professional. They possess superb diagnostic skills to detect and ultimately avoid musculoskeletal and sports injuries. Poor technique or posture is one of the most common sources of a repeat injury.
Aquatic water exercises are an effective method to provide low bodyweight exercises.
Sports physio requires an extra level of knowledge and physiotherapy skill to assist injury recovery, prevent injury and improve performance. For the best advice, consult a Sports Physiotherapist.
Women's Health Physiotherapy is a particular interest group of therapies.
Not only can your physiotherapist assist you in sport, but they can also help you at work. Ergonomics looks at the best postures and workstation set up for your body at work or home. Whether it be lifting technique improvement, education programs or workstation setups, your physiotherapist can help you.
Plus Much More
Your physiotherapist is a highly skilled body mechanic. A physiotherapist has particular interests in certain injuries or specific conditions. For advice regarding your individual problem, please contact your PhysioWorks team.
ACL TearAn ACL (Anterior Cruciate Ligament) tear most often occurs during sporting activities when an athlete suddenly pivots, causing excessive rotational forces on the ligament. Individuals who experience ACL tears describe a feeling of the joint giving out, or buckling. You'll commonly hear a "pop."
Signs You May Have Sustained an ACL Tear:
- Sudden giving way of the knee
- Hearing a 'pop' at the time of injury
- Sudden swelling of the knee joint
- Pain in the knee when walking