LATERAL COLLATERAL LIGAMENT (LCL) SPRAIN
The lateral collateral ligaments are located on the outside part of the knee between the femur (thigh bone) and the tibia (shin bone).
The LCL resists various stresses (forces pushing the inside of the knee outwards or forces pushing the lower end of the shin bone and foot inwards). It’s especially vulnerable when the knee is flexed (bent). A good example of this can be seen when a footballer gets kicked on the outside of the foot or leg. The LCL also restricts internal rotation of the lower leg (actions which turn the foot inwards). This why this ligament is vulnerable during skiing; when the ski rotates towards the other foot it creates a significant torsion (twisting) force at the knee. The LCL, unlike the medial collateral ligament, is not attached to the knee meniscus (pad of cartilage between the thigh and shin bone).
Although relatively rare, the LCL can also be injured by repetitive lower irritation. This is often more difficult for the patient to realise and can be as subtle as sitting in a certain position or running on sloped or soft surfaces, such as beaches. A very important job of any manual therapist is to first prevent this mechanism of injury in order to allow the ligament to repair.
DIAGNOSIS
At Bodymotion, we take a thorough history from the patient, which often gives a good indication as to which knee structures may be damaged. This will dictate the specific orthopaedic test performed during the initial assessment. They will also examine the knee to see if there is any tenderness or swelling around the ligaments.
Ligament sprains are graded as follows:
Grade I
• Able to fully bear weight through the knee with negative instability on the varus stress test.
• No/mild swelling on the inside of the knee.
• Mild/moderate tenderness over ligament.
• Mild pain.
Grade II
• Able to bear weight through the knee with positive instability on the varus stress test and slightly increased movement.
• Mild to moderate swelling on the inside of the knee.
• Moderate/marked tenderness over ligament.
• Moderate/severe to marked pain.
Grade III
• May be able to bear weight through the knee, but aware of significant instability (feeling of giving way) with positive instability on the varus stress test.
• Mild to moderate swelling on the inside of the knee.
• Moderate/marked tenderness over ligaments.
• Moderate/severe pain.
Ligaments cannot be seen on x-ray and, due to their close proximity to bone, ultrasound imaging is often of little use in this region. Therefore, MRI scans tend to be utilised when assessing suspected severe ligamentous injuries.
If there is any sign of instability on testing (giving way of the knee), this may suggest the ligament is not sprained but ruptured and would require referral for further assessment – and possible surgical opinion.
(The list of conditions given above and subsequent explanations are intended as a general guide and should not be considered a replacement for a full medical examination. Furthermore, we do not purport to treat all the conditions listed. Should you wish to discuss any of these conditions with our chiropractors, please do not hesitate to phone the clinic on 020 7374 2272 or email enquiries@body-motion.co.uk).
Our team of chiropractors and massage therapists are on hand to answer any questions you may have, so get in touch today via enquiries@body-motion.co.uk or on +44 (0)20 7374 2272.