368 | MCL Strain Around the Knee? What You Need To Know

[00:00:05] [SPEAKER_01]: Welcome to the Optimal Body Podcast. I'm Dr. Jen.

[00:00:08] [SPEAKER_00]: And I'm Dr. Dom, and we are doctors of physical therapy bringing you the body tips and physical

[00:00:13] [SPEAKER_00]: therapy pearls of wisdom to help you begin to understand your body, relieve your pains

[00:00:17] [SPEAKER_01]: and restrictions, and answer your questions. Along with expert guests, our goal of the

[00:00:21] [SPEAKER_01]: Optimal Body Podcast is really to help you discover what optimal means within your

[00:00:26] [SPEAKER_01]: own body. Let's dive in!

[00:00:29] [SPEAKER_00]: So as somebody who has had knee problems myself my whole life I've put so much

[00:00:33] [SPEAKER_00]: pressure on my knees through the way that I used to lift, work out, play my

[00:00:38] [SPEAKER_00]: sports. I need to talk about how important our foot health is and our foot

[00:00:42] [SPEAKER_00]: mobility is as the foundation to which those knees move on top of. That is why

[00:00:47] [SPEAKER_00]: wearing Vivo Barefoot shoes has been so foundational in my journey. It has

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[00:01:47] [SPEAKER_00]: naturally just by wearing your barefoot shoes. Today we're talking

[00:01:51] [SPEAKER_02]: about MCL ligament strains. That was kind of redundant I guess. Your

[00:01:57] [SPEAKER_02]: medioclateral ligament that provides the stability around the knee. This was

[00:02:01] [SPEAKER_02]: actually a request that has come in and we listened to you so if you have more

[00:02:07] [SPEAKER_02]: requests please send them in because this though common isn't super

[00:02:14] [SPEAKER_00]: prevalent especially in like the general population. I feel like more

[00:02:18] [SPEAKER_00]: people are familiar with the ACL. That's the one who gets all the

[00:02:22] [SPEAKER_00]: glory and all the hate because it is probably more commonly talked

[00:02:26] [SPEAKER_00]: about more commonly injured especially when we talk about major knee injuries.

[00:02:31] [SPEAKER_00]: I think in one of the studies we looked at the MCL accounts for 8% of

[00:02:36] [SPEAKER_00]: all knee injuries so I mean decent amount and that doesn't just

[00:02:41] [SPEAKER_00]: include ligament injuries so something we should definitely talk about what is

[00:02:46] [SPEAKER_00]: the MCL? We have the four major ligaments that are always talked

[00:02:50] [SPEAKER_00]: about in the knee like I mentioned the ACL and the PCL those two prevent

[00:02:54] [SPEAKER_00]: the knee the tibia from shifting back and forth which is the lower bone in our

[00:02:59] [SPEAKER_00]: leg and the MCL and the LCL which are the medial and lateral collateral

[00:03:03] [SPEAKER_00]: ligaments and those inside and the outside and those give our knee kind of

[00:03:09] [SPEAKER_00]: that inside outside stability the medial lateral stability. So when we're

[00:03:14] [SPEAKER_02]: looking at you know mechanism of injury this is when it's going to be

[00:03:18] [SPEAKER_02]: common traditionally more so in sports like when you're like playing

[00:03:22] [SPEAKER_02]: running going for something but can also happen as an adult you're

[00:03:27] [SPEAKER_02]: chasing child you're playing around with a child you're running cutting.

[00:03:30] [SPEAKER_00]: Dogs are awful for knee injuries too. I feel like you see videos all the

[00:03:35] [SPEAKER_00]: time of a dog just sprinting and running into the side of someone's

[00:03:38] [SPEAKER_02]: leg. Yeah exactly so that is how the mechanism of injury typically for an

[00:03:43] [SPEAKER_02]: MCL is that you get this valgus strain which means that the knee is

[00:03:48] [SPEAKER_02]: someone's kind of hitting on the outside of the knee and the knee is

[00:03:52] [SPEAKER_02]: falling in making like an owl shape that's kind of how you can think of

[00:03:56] [SPEAKER_02]: valgus it's that owl that the lower leg is coming out to the side not

[00:04:02] [SPEAKER_02]: necessarily being hit by the side but you're rotating you're turning

[00:04:06] [SPEAKER_02]: your foot is getting stuck in the knees going a different way right and

[00:04:10] [SPEAKER_02]: so we're getting that force on the inside of the knee to really kind

[00:04:16] [SPEAKER_00]: of injure that MCL. And I think when we talk about valgus like you might

[00:04:22] [SPEAKER_00]: hear people in fitness or in movement talk about valgus a lot and hate on it

[00:04:27] [SPEAKER_00]: honestly and say oh valgus movement of the knee is bad and we're people who

[00:04:32] [SPEAKER_00]: don't really like demonizing the knee going in itself. Yeah the

[00:04:37] [SPEAKER_00]: mechanism of injury has more so to do with uncontrolled and

[00:04:43] [SPEAKER_00]: unstabilized pressure put into that valgus position on the knee so it's

[00:04:49] [SPEAKER_00]: really like a force or a pressure that our knee can't control that ends up

[00:04:54] [SPEAKER_00]: causing the injury which can happen to our knee in any position really

[00:04:58] [SPEAKER_00]: because we like to point out how we see people all the time doing very

[00:05:03] [SPEAKER_00]: high level movements cutting running and their knee goes into valgus and

[00:05:07] [SPEAKER_00]: it's fine and they have no knee problems and they don't ever have

[00:05:11] [SPEAKER_00]: knee injuries like that but it's really when we have that uncontrolled

[00:05:16] [SPEAKER_00]: unstable eyes you know movement that our knee just isn't ready to support

[00:05:20] [SPEAKER_00]: that our body isn't ready to support that we might have an injury.

[00:05:23] [SPEAKER_02]: I think what's cool and hopefully what people are seeing is that it's

[00:05:26] [SPEAKER_02]: becoming more popular to see that it's okay for that knee to fall in.

[00:05:30] [SPEAKER_02]: We can even look at I know there's lots of videos that go around

[00:05:32] [SPEAKER_02]: about like power lifters or professional athletes who are lifting

[00:05:37] [SPEAKER_02]: super heavy in a back squat and as they're coming up particularly out of

[00:05:42] [SPEAKER_02]: that bottom of the squat you see their knees come in together almost touching

[00:05:45] [SPEAKER_02]: before they're coming up right and that actually gives them more force gives

[00:05:50] [SPEAKER_02]: them more power it's something their body is naturally doing and it's not bad

[00:05:54] [SPEAKER_02]: and just like you said with we see that so much in like football or

[00:05:58] [SPEAKER_02]: tennis or other sports that knee is literally coming so far on the

[00:06:04] [SPEAKER_02]: inside of the foot and to be told you can never train that is only going to set

[00:06:08] [SPEAKER_02]: you up more for injury if we avoid it all the time.

[00:06:12] [SPEAKER_00]: Made it through that back bar back ball back squat thing.

[00:06:15] [SPEAKER_02]: Stop just keep going.

[00:06:18] [SPEAKER_00]: I mean does that a little itchy?

[00:06:21] No we're not keeping that in.

[00:06:23] [SPEAKER_00]: I love bringing up the power lifter example because they're literally

[00:06:27] [SPEAKER_00]: lifting the heaviest weights people will put on their back in the world

[00:06:30] [SPEAKER_00]: and they're going into this valgus and so it just goes to show that

[00:06:35] [SPEAKER_00]: you know if we train it if we make it strong we can prepare the body better

[00:06:39] [SPEAKER_00]: and I think that's the point and I love seeing more movement experts movement

[00:06:43] [SPEAKER_00]: professionals training into valgus and training the body to control in that area

[00:06:49] [SPEAKER_00]: and I think this would be very helpful for the average person but also for elite athletes

[00:06:53] [SPEAKER_00]: because then you prepare your body for the unknown you prepare your body for the variable

[00:06:58] [SPEAKER_00]: world that is our performance whether that's on the football field basketball court

[00:07:03] [SPEAKER_00]: or walking your dog so it really helps prepare us and when we talk about mcl injuries

[00:07:10] [SPEAKER_00]: they tend to be graded one through three like most ligament or tendon injuries

[00:07:16] [SPEAKER_00]: grade one is seen as more minor or a minor strain there isn't a lot of involvement of

[00:07:23] [SPEAKER_00]: actually like tearing or disrupting of fibers or if there is it's minimal so it tends to be just an

[00:07:29] [SPEAKER_00]: over stretching of the ligament itself which can cause some laxity some pain you're not going to

[00:07:36] [SPEAKER_00]: see as much you know bruising or and then this will reflect in the rehab then we have grade two

[00:07:43] [SPEAKER_00]: which is kind of the most variable because this can extend from just you know minor tearing

[00:07:49] [SPEAKER_00]: of the ligament itself all the way to almost a full thickness tear of the ligament and then

[00:07:54] [SPEAKER_02]: grade three is full thickness tear yeah and so when we're looking at really the rehab process if

[00:08:00] [SPEAKER_02]: you know non-surgically speaking we're going to be looking at grade one and two

[00:08:05] [SPEAKER_02]: you will need surgery traditionally for a grade three especially in if depending on what your

[00:08:13] [SPEAKER_00]: goals are right you know if you're a person who doesn't do a lot of high intensity impact activities

[00:08:21] [SPEAKER_00]: things that require cutting turning spinning your dog is not going to go crazy when you're

[00:08:26] [SPEAKER_00]: you have a very well trained dog on walks on like ours who is like a sled dog i've heard of people

[00:08:33] [SPEAKER_00]: who have full thickness mcl injuries and they rehab because they're not trying to get back to

[00:08:37] [SPEAKER_00]: playing basketball or running on trails or things like that you know but in most cases

[00:08:42] [SPEAKER_00]: full thickness tears you know surgery is going to be the better route for full rehab back to

[00:08:48] [SPEAKER_02]: whatever participation you want and there was a you know an article that was cited

[00:08:54] [SPEAKER_02]: medial collateral ligament healing and multi-disciplinary assessment in rabbits

[00:08:58] [SPEAKER_02]: now obviously again we always want to preface rabbits are not humans but we saw that an injured

[00:09:05] [SPEAKER_02]: mcl can heal without treatment but the healing process does plateau at a certain part and then you

[00:09:12] [SPEAKER_02]: have you know just scar formation on that area causing some different mechanical and chemical changes

[00:09:19] [SPEAKER_02]: which yes is going to happen but again you can live with that like dom said especially if you get

[00:09:24] [SPEAKER_02]: muscles around the area to be extremely strong to help support that stability of the knee

[00:09:30] [SPEAKER_02]: now you do have to be careful what are you going back into are you going back to playing

[00:09:34] [SPEAKER_02]: football going back to playing sports or are you just kind of every day kind of rehab and

[00:09:41] [SPEAKER_00]: i think it's important to talk a little bit about you know just the healing of ligaments

[00:09:45] [SPEAKER_00]: themselves because again this is why with a grade three like you said the goal is to have a well

[00:09:53] [SPEAKER_00]: organized ligament with the tissues reforming and connecting in a way that provides that

[00:09:59] [SPEAKER_00]: stability back to the knee right and kind of the three stages of the tissue healing

[00:10:03] [SPEAKER_00]: is we get that inflammation stage which is right after injury we get a little bit more of the

[00:10:11] [SPEAKER_00]: local heat swelling pain and severe cases are you know we might have some loss of mobility

[00:10:16] [SPEAKER_00]: and then the proliferative phase which starts fairly quickly after injury but then can last

[00:10:22] [SPEAKER_00]: depending on the severity of injury a significant amount of time you know three to six weeks it

[00:10:27] [SPEAKER_00]: says here but could be even longer depending on the type of injury you have this is where

[00:10:32] [SPEAKER_00]: our body gets back to work trying to start and remodel that tissue it sends we have angiogenesis

[00:10:38] [SPEAKER_00]: which is a formation of new blood cells our little cells in there go to work trying to

[00:10:43] [SPEAKER_00]: take away the dead tissue of the ligament and lay down new ligamentous tissue

[00:10:49] [SPEAKER_00]: and the wound contraction where when we have that stretch or that tear the

[00:10:55] [SPEAKER_00]: the ligament tends to be lax it'll start to tighten down or contract back to where it was

[00:11:01] [SPEAKER_00]: and then maturation which stage three stage three it says it can start anywhere from two to three weeks

[00:11:07] [SPEAKER_00]: after injury but last up to a year and I would argue that's important to know yeah I think that's

[00:11:12] [SPEAKER_00]: important to know and I would argue even beyond that because our tissues are always

[00:11:16] [SPEAKER_00]: maturing and remodeling and turning over so if we get to a year and we're just like okay great

[00:11:22] [SPEAKER_00]: this is finally done never have to worry about it again it's not really the reality because

[00:11:26] [SPEAKER_00]: all of our muscles and ligaments and tissues are and tendons are remodeling so that's where

[00:11:31] [SPEAKER_00]: based on the stresses and loads we put on the body we're going to continue to train

[00:11:37] [SPEAKER_00]: that ligament in a sense to be ready for whatever activities we want to do and this is

[00:11:41] [SPEAKER_02]: again where we're looking at the rehabilitation process so when when it is just that minor

[00:11:47] [SPEAKER_02]: MCL sprain or strain and we're looking more at the superficial portion of that ligament

[00:11:53] [SPEAKER_02]: meaning that we can handle it non-operatively right it's when it goes into that major MCL

[00:11:59] [SPEAKER_02]: and becomes the superficial in the deep layers within the ligament that we then have to look

[00:12:04] [SPEAKER_02]: at okay is surgery going to be necessary for me for my quality of life and what I want to do

[00:12:10] [SPEAKER_02]: but when we're looking really in that acute stage so you just got injured you just got an MCL

[00:12:16] [SPEAKER_02]: injury you can technically go to a physical therapist and and they can do some testing and

[00:12:23] [SPEAKER_02]: and kind of feel around the area and different tests can lead us to identify that you've had

[00:12:29] [SPEAKER_02]: an MCL strain we cannot say necessarily the degree without getting imaging so that's where

[00:12:37] [SPEAKER_02]: but seeing a physical therapist first can tell you if they believe it's necessary to get in

[00:12:43] [SPEAKER_02]: imaging so and this can save you a lot of money and I think that's important to note too it doesn't

[00:12:48] [SPEAKER_02]: you don't always have to go and get the MRI right away especially if you didn't have a huge accident

[00:12:54] [SPEAKER_02]: or you just noticed like you you landed weird you turned weird and you felt something in your

[00:13:00] [SPEAKER_02]: knee but you're still able to walk your you know maybe you notice some swelling and some pain

[00:13:04] [SPEAKER_02]: but you can still move okay go see a physical therapist first they'll do some testing

[00:13:09] [SPEAKER_02]: and they'll refer you if necessary to see to get an MRI or to get further imaging or to go see a

[00:13:16] [SPEAKER_02]: physician otherwise they can actually start the rehab process right away and I think that is

[00:13:23] [SPEAKER_02]: you know something to note and something that's great no matter what injury you have going on in

[00:13:28] [SPEAKER_02]: the body if it's not super severe you didn't have a really you know traumatic accident

[00:13:32] [SPEAKER_02]: you can go to a physical therapist first I think that's important too just because

[00:13:36] [SPEAKER_00]: like you said getting that initial eyes or more trained eyes and hands on your knee to give you

[00:13:43] [SPEAKER_00]: that initial guidance with swelling management with pain management with what exercises you can

[00:13:49] [SPEAKER_00]: safely do or things you can do because especially with these injuries our knee gets pretty confused

[00:13:55] [SPEAKER_00]: right our quad muscles our big thigh muscles have more difficulty contracting because of pain

[00:14:01] [SPEAKER_00]: or because they feel less stability in the area so especially in the acute phase that's one

[00:14:05] [SPEAKER_00]: thing that a physical therapist might say right away like hey just sit there on your couch or in

[00:14:11] [SPEAKER_00]: your bed with your legs straight and start trying to activate that quad they call them quad sets or

[00:14:16] [SPEAKER_00]: you know quad activations um and it's basically just contracting your quad to try and really

[00:14:21] [SPEAKER_00]: straighten that knee out and then relax contract hold and then relax and that might just be what

[00:14:28] [SPEAKER_00]: the what the physical therapist gives you and says okay do this for a few days come back

[00:14:32] [SPEAKER_00]: let me know how it feels and that can give us even more information on how irritable the knee is

[00:14:37] [SPEAKER_00]: how ready it is to move into the next phase which would be subacute which again depending on

[00:14:43] [SPEAKER_00]: grade of injury it's hard for us to say exactly when each of these rehab phases would start

[00:14:47] [SPEAKER_02]: exactly that's why seeing a physical therapist in person is key yeah so exercises we might do

[00:14:53] [SPEAKER_00]: in the subacute phase is a straight leg raise that's the next set of step of the quad set where

[00:14:58] [SPEAKER_00]: you're contracting that quad lifting the leg straight hamstring quadricep hip flexor stretches

[00:15:06] [SPEAKER_00]: different non-weight bearing light resistance exercises so that's where even just sitting in a

[00:15:10] [SPEAKER_00]: chair and doing what we call a long arc quad um I haven't thought of these phrases in a long time

[00:15:16] [SPEAKER_00]: not being in the clinic but long arc quad where you're kicking your leg straight from a bent

[00:15:22] [SPEAKER_00]: position and increased endurance activities they have the example of a stationary bike which

[00:15:28] [SPEAKER_00]: it's not really weight bearing so it's good for just that range of motion getting the tissues pumping

[00:15:33] [SPEAKER_02]: and moving through then we go into more progressive within that subacute phase so we're

[00:15:39] [SPEAKER_02]: still kind of like in those early stages we continue with that same kind of exercise program

[00:15:44] [SPEAKER_02]: but maybe we might put a little bit more resistance so say I'm still doing non-weight

[00:15:49] [SPEAKER_02]: bearing but I'll put an ankle weight on my on my ankle as I'm doing those those quad kicks

[00:15:56] [SPEAKER_02]: before moving into more of like the functional phase that's when we can start to do

[00:16:00] [SPEAKER_02]: more of like okay let's do some more a little bit more mobility stability balance we're going to

[00:16:07] [SPEAKER_02]: integrate a little bit of core with some exercises and see how the entire body's kind of working

[00:16:13] [SPEAKER_02]: together proprioceptively and how that knee is responding um then then that's when we'll move

[00:16:19] [SPEAKER_02]: into more of like sport specific what what is really like your goal what are you trying to get back

[00:16:25] [SPEAKER_02]: to and how do we strengthen um around from the whole foot to hip comp core complex really

[00:16:32] [SPEAKER_02]: of how that's really working together with your knee to get you back prepared for what you

[00:16:37] [SPEAKER_02]: really want to do so that's where we might you know we still might not do complete total strength

[00:16:44] [SPEAKER_02]: and and get you all the way fully back but we might start things like lunges and skipping and jumping

[00:16:49] [SPEAKER_02]: sport specific movements dynamic functional drills before really going into the maintenance phase

[00:16:55] [SPEAKER_02]: that can go up to a year with a physical therapist where you're working more on strengthening

[00:16:59] [SPEAKER_02]: more on proprioception more on dynamic movement um and really taking that recovery to its fullest

[00:17:06] [SPEAKER_00]: capacity and in those two phases the functional and sport specific phase you said one word that I

[00:17:12] [SPEAKER_00]: think is super important which is proprioception which we talk about a lot and it's our body's

[00:17:18] [SPEAKER_00]: sense of what our joints are doing right and when we have ligament disruption or tissue

[00:17:24] [SPEAKER_00]: disruption in general we have a lot of these proprioceptive nerve endings in these tissues

[00:17:29] [SPEAKER_00]: and so when we tear a ligament like that it kind like I said it kind of throws our knee

[00:17:34] [SPEAKER_00]: in a whack it makes it confused the knee might not have as good of an understanding of what it's

[00:17:40] [SPEAKER_00]: doing in space so we might start to see more of that valgus when we're doing squats if we're not

[00:17:45] [SPEAKER_00]: paying attention to it and retraining it and that's where during these functional and sport

[00:17:49] [SPEAKER_00]: specific phases different balance activities um focusing more on that form we're not going

[00:17:55] [SPEAKER_00]: to go straight into strengthening into that valgus position like we were talking about earlier

[00:17:59] [SPEAKER_00]: you know so so we do want the knee to regain stability a lot more yeah stability but understanding

[00:18:07] [SPEAKER_00]: because you can have a really strong stable knee and still not have great proprioception

[00:18:11] [SPEAKER_00]: and the knee will track all over the place um so one thing that we often will do is like we

[00:18:17] [SPEAKER_00]: call it a six-way heel tap where you're standing on one leg and you tap the opposite foot in

[00:18:23] [SPEAKER_00]: front to the side to the other side behind and then kind of rotate around on your knee

[00:18:28] [SPEAKER_00]: and back on your knee and just focus on what that stance leg knee is doing does the knee track

[00:18:34] [SPEAKER_00]: forward kind of right over the middle of the foot towards the second and third toe

[00:18:38] [SPEAKER_00]: each time or does it like to wobble back and forth and as you do exercises like that more

[00:18:44] [SPEAKER_00]: consistently you'll probably notice okay i'm getting the knee to track a little bit better

[00:18:48] [SPEAKER_00]: and I think that's one thing that throughout all the phases we really need to focus on do I have

[00:18:54] [SPEAKER_00]: control of that knee and if it is going into a valgus position is that intentional and is that

[00:19:00] [SPEAKER_00]: supported right in a way that I can handle if I get back on a running trail or on the court field

[00:19:06] [SPEAKER_02]: or wherever exactly and that's where I would say you know this is where there's so many people

[00:19:13] [SPEAKER_02]: will hammer in will biomechanics and biomechanics and how your body is moving and it's true

[00:19:17] [SPEAKER_02]: we want to understand you know are we keeping our knee in line and are we moving

[00:19:22] [SPEAKER_02]: quote on quote with good form and all this stuff so in early rehab this is where I would say biomechanics

[00:19:29] [SPEAKER_02]: does matter can you do a single leg step down without having your knee wobble in and out

[00:19:35] [SPEAKER_02]: you know can we control from the hip down to the foot keeping that knee in the stable line

[00:19:40] [SPEAKER_02]: and that's where we want to find that stability and strength what you know even now like say

[00:19:47] [SPEAKER_02]: you don't have an mcl injury if you've had one like try that lateral step down so you're

[00:19:51] [SPEAKER_02]: gonna stand on the side of like a step stool just start low and then you're going to

[00:19:57] [SPEAKER_02]: trying to keep your hips pretty even you're gonna try to just slowly lower that opposite heel

[00:20:03] [SPEAKER_02]: down to the floor without letting that knee come on the inside or outside of you know of your foot

[00:20:10] [SPEAKER_02]: and seeing if you can keep those hips stable too like you don't want the leg that's dropping

[00:20:14] [SPEAKER_02]: that hip to drop so like how can we use biomechanics in the beginning to create more of that stable

[00:20:22] [SPEAKER_02]: environment prior to then moving into okay how do we allow those tissues to adapt in different

[00:20:28] [SPEAKER_02]: planes of motion now and that's where Dom was talking about that six way reach we start to

[00:20:33] [SPEAKER_02]: rotate around that knee we're starting to move that knee in and out we're starting to get that

[00:20:38] [SPEAKER_02]: knee used to you know going side to side going in and out we have to we we can't just do squats

[00:20:45] [SPEAKER_02]: and lunges going forward and backward we have to get our body used to going more side to side

[00:20:52] [SPEAKER_02]: single leg stability and balance we have to rotate and go different directions plyometrics

[00:20:57] [SPEAKER_02]: in different directions that's why all of this is so important and then starting to

[00:21:02] [SPEAKER_02]: you know go at different speeds and different rates of movement and all that kind of stuff but

[00:21:08] [SPEAKER_02]: ultimately knowing that I think it's really important that it's not bad for your knee to

[00:21:15] [SPEAKER_02]: go outside of your ankle right it's not bad we've said this in the beginning for your knee

[00:21:21] [SPEAKER_02]: to fall on the inside and go into valgus it's just how are we working into that control

[00:21:26] [SPEAKER_00]: yeah yeah and kind of like we mentioned this is a continual process like that maintenance phase

[00:21:34] [SPEAKER_00]: it says lasting up to one year and that doesn't necessarily mean that by one year you won't

[00:21:39] [SPEAKER_00]: yet be back to your activities generally the return for an isolated mcl injury is a lot faster

[00:21:45] [SPEAKER_00]: than a year it could even be even in the you know grade three instance much shorter than that

[00:21:52] [SPEAKER_00]: like six months five months depending on how quickly you rehab back but the point being we always

[00:21:59] [SPEAKER_00]: want to continue to be training and aware that like hey I had this injury I have to keep preparing

[00:22:04] [SPEAKER_00]: my body and my knee well beyond one year in my in my opinion if I have knee injury history

[00:22:09] [SPEAKER_00]: which I do having meniscal injuries um I'm constantly training my knees you know when I

[00:22:16] [SPEAKER_00]: throw different things in so um I think that's important there's a lot of other things here

[00:22:22] [SPEAKER_00]: that we could talk about that I don't think are as important but again that that general process of

[00:22:28] [SPEAKER_00]: what do we do initially get the knee back comfortable again so that we can start doing movement

[00:22:35] [SPEAKER_00]: working into more range of motion around the hip ankle and knee then we start the strength

[00:22:40] [SPEAKER_00]: then we get weight bearing and working on balance and proprioceptive stuff

[00:22:45] [SPEAKER_00]: strength in weight bearing moving into more sport specific or plyometric activities

[00:22:50] [SPEAKER_00]: and then adding in variables like Jen said we tend to have these injuries when there are a lot of

[00:22:56] [SPEAKER_00]: variables going on and our body isn't prepared to handle that so the more times we can train with a

[00:23:02] [SPEAKER_00]: lot of variables in a relatively controlled environment where we're controlling those variables

[00:23:07] [SPEAKER_00]: the more our body will be prepared out you know in the unknown world when it's throwing all

[00:23:14] [SPEAKER_00]: sorts of things like unstable surfaces a dog pulling on my leash you know um somebody tackling me on a

[00:23:21] [SPEAKER_00]: football field uh that's what we should train for in our own controlled environments if you're looking

[00:23:26] [SPEAKER_00]: for somewhere to have a little more guidance on stuff like this in our gen health platform we

[00:23:32] [SPEAKER_00]: have all sorts of plans that could foreseeably help with somebody who's had a past mcl injury

[00:23:37] [SPEAKER_00]: we have a knee plan that helps work on all sorts of restrictions from the ankle to the hip

[00:23:43] [SPEAKER_00]: as well as starting to load the knee and then working into things like our full body low impact plan

[00:23:48] [SPEAKER_00]: high intensity plan you know those are going to help build the strength and full body mobility

[00:23:54] [SPEAKER_00]: as well as the high intensity plan which starts working into the jumping lateral movements more

[00:23:58] [SPEAKER_00]: dynamic movement um so we have that free trial link that will be down in the show notes so you

[00:24:05] [SPEAKER_00]: can get seven free days as our podcast audience you can always use code optimal to give yourself

[00:24:09] [SPEAKER_00]: a little extra discount on your first month or your first year um and that's about all we have

[00:24:14] [SPEAKER_00]: on mcl's for today thanks for joining us for another pt pearl remember we have that free week

[00:24:20] [SPEAKER_00]: trial to our gen health membership you can find that down in the show notes it's just gen.health

[00:24:26] [SPEAKER_00]: backslash free trial if you found value from this episode or think you know somebody who

[00:24:30] [SPEAKER_00]: would benefit from it please pass it along consider leaving a rating and review as well

[00:24:34] [SPEAKER_00]: on your favorite podcasting platform and of course we will see you next time on the

[00:24:38] [SPEAKER_00]: our full body podcast