Whether a recreational competitor or the very best soccer player, athletes participating in cutting sports are vulnerable to knee injuries that are a result of ligament tears.
Within just a two-week period the NFL has witnessed one of its premier veteran running backs and one of the best young rookies both go down with knee injuries. First it was San Diego Chargers running back Ryan Mathews who went down last week and now this week Pittsburgh Steelers rookie linebacker Ryan Shazier joined him. Both players left their respective games early and did not return. Later the teams released reports that the injury sustained was a sprained MCL (medial collateral ligament).
The knee is made up of bones and ligaments that work together to support the knee and its range of motion. These bones are the thighbone (femur), the shinbone (tibia), and the kneecap (patella). These bones are joined together by ligaments. The collateral ligaments connect the femur to the tibia and fibula (which is a smaller bone in the lower leg). The MCL is the collateral ligament toward the inside of the knee, i.e., the one that is closest to your opposite knee. This ligament connects the femur to the tibia. As expected from the anatomy, the collateral ligaments act to support and control any sideways movements of the knee.
Injury to the MCL is typically sustained via direct contact to the outside of the knee. If the contact is forceful enough the MCL will stretch beyond its means and may become sprained to varying degrees. The severity of the sprain is diagnosed into three different grades. Grade I sprain is very minimal and while the MCL has been stretched abnormally, there is no structural damage to the knee. Grade II sprains are a bit more severe and involve the MCL actually becoming loose due to excessive stretching. Grade III sprains a very severe and involve a complete tear of the MCL into two separate pieces. Even a grade I sprain will cause some discomfort, pain, and swelling on the inner knee. The more severe sprains will cause feelings of instability as well.
Luckily for Ryan Mathews and Ryan Shazier, MCL injuries rarely require surgery. The only time that surgery would be required is if the MCL is so severely damaged that it cannot heal itself or if the injury is compounded by additional ligament tears in the knee. The non-surgical road to MCL recovery involves a combination of ice, immobilization, and physical therapy. Icing the knee helps to reduce the swelling associated with the injury. Preventing the knee from sideways movement via a brace and crutches prevents the ligament from enduring further stress and gives it the opportunity to completely heal. Lastly, exercises designed to strengthen supporting leg muscles should be used to regain strength and stability. Once the rehabilitation, a return to activity should be completed gradually to avoid any re-injury or aggravation. For Ryan Shazier and Ryan Mathews the timeline for their return is approximately 4-5 weeks. This is prototypical timeline for a Grade II MCL sprain and as long as they do not rush back too early, they should be good to go come mid-season.
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