Baffling 8 month Grade 2 MCL sprain

[physiobob]

Hi Sam, just read your post. MCL's are painful and they remain painful for a long time. It was funny but reading it I was thinking all this guys needs is some frictions to the ligament and low and behold that was a treatment that worked. From you recent observations the knee gets into trouble when sitting for long periods. This is in around the 90 degree flexion mark which is also specific to the medial meniscus at that range. The ligament itself communicated with the meniscus and different fibers of the MCL are under different amounts of tension depending on the position of the knee. This is a way that the brain helps us to understand joint position without having to look at where our limbs are all the time. Anyway the point being that the position of the knee is different in sitting to that when walking.

Yes I agree with pronation contributing to issues here but you were OK prior to your injury so let's not over analyze that. Orthotics are always useful in part. Connective tissue, especially degenerate tissue, does not like being help in the one place for a long period of time. Doing so leads to pain e.g. bend the finger back and hold it for a few seconds and it doesn't hurt. Hold it there for 5-10mins and it become really painful. I would get someone to assess the medial joint line to see if in fact the meniscus is irritated and if so it can be frictioned as well. They I would friction the MCL in the position in which you get the pain.

It's unlikely you'll need an op as I see dozens of presentations like yours every year and less than 1% need investigative surgery. Best of luck

[roycar]

agree with the above. friction in painful position. medial ligament also has a role in checking lateral rotation at the knee in 90 degrees knee flexion. I'd try some specific soft tissue mobilisation a la glenn hunter into lateral rotation at the knee in a flexed position, see what the response from this is, ie is it pain provocative, does it respond to some grade 3's into same.

[sammo440]

Thanks again for the replies to my problem. Posting the thread in the first place was such a stab in the dark - I thought the main benefit of it would be some sort of release from writing it down. Not sure where I really am now as things are different depending on what I do each day, but I still think there is a gradual gradual improvement. I am focussing for the time being on developing my left quad, although any suggestions for new excercises that can be done on my own (I do have one of those blue elastic strap things) would be greatly appreciated. The most frustrating thing is just not being able to see a decent physio. I`ve been to see different people in Chile and Brazil, but no one seems to have a clue about frictioning. Anyone fluent Spanish speakers out there who might be able to give a description? They all just want to do the electrotherapies that I`ve been warned against and ultrasound, which I was told back in England also wasn`t effective. I`ll be in Lima in a week or so though so might have another crack then. When I get back I think I`ll make our like I`ve been travelling the world for a cure.

Oh yeah, just in reply to one of the things mentioned so far, I did get some orthotics before I went away and I`ve been wearing them all the time. Not sure if they really help or not, as I think I need a higher arch. As I understand it, most people who need orthotics have flat feet, but my feet aren`t flat, they just roll in. When I walk around now I tend to lift up the big toe on my left foot as I bring my foot down as I know from looking in the mirror that this stops it rolling in, but I don`t know if this might somehow be giving myself different problems.

I had no idea knees could be this complicated. Thanks again anyway, I really mean it.