Non-Operative — MCL Rehabilitation

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

Crutches WBAT immediate post-injury Phase I; crutches discontinued Phase II if able to walk without limp

Key Restrictions

Increase in pain/swelling or loss of ROM signals overly rapid progression at any phase; hinged knee brace/immobilizer as needed Phase I; return to competition criteria include physician approval, full ROM, no MCL tenderness, no instability, no effusion, muscle strength >=85% contralateral

Timeline & Phases

Phase I, Maximal Protection Phase (day 1 through day 7): early protected ROM, prevent quad atrophy, decrease effusion/pain; day 1: ice/compression/elevation, hinged knee brace/immobilizer if needed, crutches WBAT, PROM/AAROM to maintain ROM, isometric quad sets, flexion SLRs; day 2: continue above, SLRs (flexion/abduction), hamstring sets, whirlpool for ROM (cold first 3-4 days then warm); days 3-7: continue as above, brace worn at night (daytime as needed), crutches WBAT, ROM as tolerated, eccentric quad work, bicycle for ROM stimulus, multi-angle isometrics, mini-squats and light leg press; Phase II, Moderate Protection Phase (days 8-14, criteria: no increased instability/swelling, minimal tenderness, PROM 10-100 deg): full painless ROM, restore strength, ambulation without crutches; days 8-10: discontinue crutches if no limp, progress to full ROM exercises, PRE strengthening (quads/medial hamstrings/hip abduction), multi-angle isometrics, closed-chain strengthening (shuttle, leg press, mini-squats, step-ups), stationary cycling, water exercises/running forward-backward, flexibility (hamstring, quad, ITB, gastrocnemius); days 11-14: continue as week 2, initiate isokinetics (sub-maximal to maximal, fast contractile velocities), begin running program if full painless extension/flexion present; Phase III, Minimal Protection Phase (week 3, criteria: no instability, no swelling/tenderness, full painless ROM): increase strength/power, strengthening emphasis on fast-speed isokinetics/eccentric quads/hip abduction/medial hamstrings, isokinetic test, proprioception training, endurance exercises, cross training (cycling, Nordic Track, Stairmaster, swimming), initiate agility program/sport-specific activities (do not progress if pain/limp/undue fatigue); Phase IV, Maintenance Phase (weeks 4-8): continue isotonic/isokinetic strengthening, flexibility, proprioceptive activities, sport-specific/agility/running drills; return to competition when physician-approved with full ROM, no MCL tenderness, no instability, no effusion, muscle strength >=85% contralateral, satisfactory proprioception, lateral knee brace if necessary

Notes

OSMS Rehabilitation Guidelines; timeline may be accelerated for first-degree MCL sprains or extended for more severe injuries — schedules are guidelines only, adjusted per pain/swelling/ROM response