Baffling 8 month Grade 2 MCL sprain

[sammo440]

About 8 months ago I suffered a grade 2 sprain of my MCL in my left knee, which has since been confirmed with an MRI scan, along with some minor fissuring of the patella. On the night of the injury, although in some pain, I was still able to play football, and it wasn´t until I was on the train home and then in bed that night that it really started to get painful. It didn´t swell up massively, but I became virtually unable to move it and could not sleep that night because of the pain.

At that point I got it x-rayed, but nothing showed up and over the coming 6 weeks or so I could feel improvement on it every day. After about 2 months I started playing the odd game of 5 a side football again as it was my weak leg which was injured so I could avoid using it and I only got a few twinges in it when I jogged about which weren´t too painful and when I had sprained my ankle ligaments I had been able to do this and it had not really affected it´s recovery. Over the next 3 months though, progress slowed to a stop, so about 5 months after the injury I eventually went to see a physio to see what was wrong.

At this point, in addition to playing football once a week I was walking about 45 minutes to work and back each day, which would be fine, but would make it ache a bit by the end. I was also still feeling twinges of pain whenever I went out at weekends and danced as drinking alcohol meant that I stopped being careful with it. For the rest of the time it didn´t really affect my daily life too much, but I could feel it almost all the time with a very mild pain. The physio told me that the lack of recovery was probably because when I walked my feet rolled in, putting extra strain on that ligament. This was also apparently associated with having a poor posture, with over developed hip flexors and very tight quads, which possibly had something to do with weight distribution.

I started doing exercises to correct this, along with stopping playing football, and a week later on my next visit to the physio she performed cross friction massage to the ligament as well. The following day after the massage I felt some improvement, and as I also became able to be careful with the knee when I went out, this improvement continued for another 6 weeks or so until I wasn´t really feeling it at all for hours at a time. I even played football again, in a tournament, and although I felt a bit of pain in it between games I was passing the ball with my left foot with no pain and the next day it didn´t feel any worse.

A week later though I left to go traveling around South America for 9 months and on my first weekend in Chile, I guess as I had grown complacent, I made it worse again. I am not sure how I did this as I couldn´t remember feeling twinges in it how I used to do, but on the Sunday morning I felt like it had been put back about a month or so. Now, after another 2 months it is still not back to how it was. I have been very careful at all points and haven´t played any football or done any running so I am really confused.

In addition to this it feels different to how it did before, in that now I feel it mostly when I am sat down for more than 10 minutes or so, when it begins to ache. If I keep my feet up then it feels better, but obviously this is not always possible, and I have had a few days where I barely walk on it at all and it still didn´t feel any better afterwards. I also saw a physio in Santiago Chile a few times who gave it ultrasound and electotherapy (possibly called something different – pads were attached to my knee and electricity pulsed through it), but it didn´t really have any effect. To make things even more confusing, 2 weeks ago I went on a 5 day trek on uneven ground up and down mountains with a heavy back pack on, walking for about 8 hours a day, and my knee felt absolutely fine! Even when we did stop to sit down it felt fine and I basically felt almost nothing from it the whole 5 days, but when I got back, within about 5 days it had gotten back to almost as bad as it had been before.

Athough there was some small improvement this was mostly been wiped out a few days ago either through having an overnight bus ride (so was unable to fully recline – lying down in bed is the only time that I can never feel it) or through trying for a couple of minutes to massage the ligament myself as this was the only thing that seems to have worked so far. I really don´t know what I should be doing anyway and can´t discuss it with anyone out here as it is fairly complicated and my Spanish is not that strong.

I am also a bit reluctant as performing assessments on it in the past has often made it feel worse. So to sum up, at the moment I can walk around and only feel it a little bit after a while (on the first day of my long walk I felt this same mild pain after a while and then it went sometime later), but when I sit down it starts to ache after about 10 minutes. This can sometimes be alleviated by extending my leg, but not always.

If anyone has any advice on what might be wrong and what I should be doing to help it or what I may be doing already to stop it getting better, or any thoughts on whether it may need an operation and if so whether I might be able to get on a waiting list while I am out here, I would massively appreciate it.

I don´t mind paying for this time either, or calling someone up from out here, I am just desperate to have it sorted as worrying about it is seriously affecting my trip.

Thanks a lot. Sam

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[alophysio]

thanks for the update sammo440

An arthroscopy isn't what i would recommend. Persist with physio although i think 6 months is a bit long - however, i haven't seen you personally.

All the best - and keep us informed!

Cheers

[sammo440]

Thanks for that. Yes, I'll keep trying with the physio. It should do me good anyway to get my posture sorted even if it's not having a direct effect on my knee. I don't think it's a meniscal thing as it doesn't get inflamed and the pain i get generally is now in the medial part of my knee. Do you think from what I've described though (and not that I'm taking this as a direct diagnosis, as I know it's impossible to do that without seeing it yourself) that it could be a partial entrapment of the saphenous nerve in the scar tissue or would I be experiencing other symptoms if that was the case?

[Laura Jayne Physiotherapy]

I have a patient who is going through similar recovery Sammo. Without seeing you it is hard to advise but i'd agree with Alophysio and persist.

Wishing you a speedy recovery

Laura Jayne Physiotherapy

[sammo440]

I've been meaning to come back to this for months, as I wanted to say thank you for everyone who read and replied to my thread. After almost 10,000 words on here, 15 different physios, about £1000, and 2 years, I am now back playing football, have no pain whatsoever in my knee, and although I think there will always be a bit of weakness in that ligament, I am so unbelievably happy and grateful to get where I am now.

The advice on here was really useful, especially when I was away travelling and couldn't speak to anyone about it properly, and it made such a difference just to feel that I was being listened to and to be reassured that my worst fears weren't accurate. I'm sure if I'd been able to see any of you you would have helped me recover, but in the end it was the 15th physio I came across (I got passed around a few different physios when I went to different practices, saw private and NHS physios in Manchester and London and saw a few different ones when I was travelling in Brazil, Chile and Colombia) who saw what it was that was stopping me recover and helped me through it.

Basically, my problem was in my posture. I may struggle to remember everything now, but I had over-active hip flexors and very shortened quads (I'm 6'3" and so the growth of my muscles probably didn't catch up properly with that of my bones) which meant that my hip was significantly tipped forwards, I gripped and held through my hip flexors and lower back rather than stomach and those muscles near my glut, and as I walked, rather than the pressure going through the centre of my leg, it went through the inner side and my feet rolled in, suggesting that I had flat feet, even though this wasn't the case.

The process of becoming aware of what muscles I used when I stood and walked was absolutely torturous, and changing it virtually impossible. I'm still very much in the process of changing these in-grained habits and becoming comfortable with them, but I'm at a point now where I've given my MCL enough of a break for it to recover. It wasn't without some pretty serious set-backs though, as I was trying so hard to change things that I didn't understand that I made the wrong changes, forcing movements with the wrong muscles, so that for about a month at the end of last year I suffered serious back-pain and developed a nerve problem in my left leg whereby I had pins and needles in it constantly. I nearly lost it at that point as my physio was telling me it was just because I was getting older and these things happen and I knew that wasn't the case, but thankfully my persistence, her patience and my eventually gaining the awareness I needed, paid off.

So again, thank you. A lot of your posts show that you were on the right lines, and I just wish one of the 14 other physios I saw beforehand had looked at the bigger picture of my whole posture etc rather than focussing purely on the knee.

[alophysio]

Hey Sammo440 - that is great news!!

i think the lesson from this is that you should ALWAYS consider the big picture.

Those posture corrections shouldn't be painful - a useful test to see if you are doing it right is to ask the physio to do an "isometric muscle test" for your anterior deltoid or any other muscles you want to test - if the posture correction is good, you will be strong, if it is bad, you will be weaker than just standing there comfortably. This is the most simple test of whether something is effective or not and so many Physios don't use it or understand it!

All the best - remember to trust your instincts - so many of my patients tell me through their story what is wrong with them so if you feel like you aren't being listened to, tell them to listen to you!

Cheers and thanks so much for the update!

[sowmya14]

Hi.. Sammo440 i am from India .. after reading about ur ligament tear story i feel its a very similar one to mine .. i ad a ligament tear a year ago and still i have pain .. i cant stand continuously for more than 15 min and cant walk more. So i felt if u tel me hw u got the recovery it may help me . i know it is a very long back story of ures but hoping i may get some replies I am posting this. Thank you.