MCL Tear: Your Path to Knee Pain Recovery

Your knees are incredible. They absorb shock, provide stability, and let you move freely—whether you’re sprinting, squatting, or just walking up the stairs. But when something goes wrong, like a medial collateral ligament (MCL) tear, it can feel like your entire life is put on pause.

You’re not alone—MCL injuries are among the most common knee ligament injuries, especially in athletes and active individuals². In fact, studies show that the MCL is the most frequently injured ligament in the knee, yet most cases don’t require surgery⁶. That’s the good news—many people recover fully with the right treatment.

But here’s the challenge: an MCL tear isn’t just about pain. It weakens your knee, making it feel unstable or wobbly—like it might buckle under pressure. Whether your injury happened during a sports game, a bad fall, or a sudden twist, the road to recovery can feel uncertain.

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What is a Medial Collateral Ligament (MCL) Tear?

The medial collateral ligament (MCL) is one of the key ligaments that help keep your knee stable. It runs along the inside of your knee, connecting your thigh bone (femur) to your shin bone (tibia).

Its main job? Preventing your knee from bending too far inward. But when too much force is applied—like a hard hit or a sudden twist—the MCL can stretch or tear, leading to pain, swelling, and instability¹.

How Common is an MCL Tear?

MCL injuries are one of the most common knee ligament injuries, especially in contact sports like football, soccer, and basketball². Studies show that MCL injuries make up about 40% of all knee ligament injuries³.

The highest risk groups include:

• Athletes – sudden changes in direction, jumping, and contact can put massive strain on the MCL⁴.
• People in physically demanding jobs – those who work in construction, landscaping, or any job that requires a lot of knee movement are at risk.
• Older adults – as we age, ligaments naturally lose elasticity, making them more prone to injury³.

Why Does It Happen?

Most MCL tears happen when the knee is forced inward too far. This can be due to:

• Direct impact – A hit to the outside of the knee (common in football, rugby, and martial arts).
• Sudden twisting motions – Quick pivots or awkward landings can put excess stress on the MCL.

Common Signs and Symptoms of an MCL Tear

• Pain on the inside of the knee – A sharp or aching pain along the inner side of your knee, especially when moving or putting weight on it.
• Swelling around the knee – The knee may swell quickly after injury, making it feel stiff and puffy.
• Tenderness to touch – Pressing on the inner side of your knee feels sore and sensitive, especially near the ligament.
• Knee feels unstable or wobbly – Walking, pivoting, or turning can make the knee feel like it might buckle or give out.
• Pain when bending or straightening the knee – Moving the knee through its full range of motion can feel stiff or painful.
• Bruising on the inner knee – Dark purple or blue bruising may appear within a day or two after injury.
• A popping sound at the time of injury – Some people hear or feel a “pop” when the ligament tears, especially in more severe cases.
• Pain when squatting or climbing stairs – Putting pressure on the knee, such as squatting, lunging, or going up stairs, makes the pain worse.

Why Does an MCL Tear Happen?

An MCL tear happens when the ligament on the inside of your knee is stretched or torn due to excessive force. This isn’t always caused by a single event—sometimes, it builds up over time through repeated stress. Let’s break down what’s happening inside your knee.

The Role of the MCL

The medial collateral ligament (MCL) is a strong band of tissue that runs along the inner side of your knee, connecting your thigh bone (femur) to your shin bone (tibia). It prevents your knee from bending too far inward and helps keep it stable when you walk, run, or pivot¹.

When too much force is applied to the outside of your knee, the MCL stretches beyond its limit. If the force is too strong, the ligament partially or fully tears, causing pain, swelling, and instability².

What Causes the Overload?

MCL injuries happen when the ligament takes on more stress than it can handle. Some of the most common causes include:

• Direct impact to the outer knee – A hit from the side, such as in football, rugby, or martial arts, can force the knee inward, overstretching the MCL.
• Sudden twisting motions – Pivoting, cutting, or landing awkwardly can put too much strain on the ligament, especially in sports like basketball or skiing^[5].
• Overuse and repetitive stress – Activities that involve frequent knee bending and quick changes in direction (such as soccer or tennis) can weaken the MCL over time, making it more likely to tear.

Why Do MCL Tears Take Time to Heal?

Ligaments heal much slower than muscles because they don’t get as much blood flow. If you keep using your knee without proper treatment, the ligament stays irritated, delaying recovery. That’s why just resting isn’t enough—you need the right rehab exercises and support to fully recover⁸.

How Bad Can an MCL Tear Be?

Grade 1 – A Mild Stretch (Minor but Annoying)

A Grade 1 MCL injury means the ligament is stretched but not torn. This is the most common and least serious type of MCL injury. If you have this, you might feel:

• Mild pain on the inside of your knee, but it’s still stable.
• A little swelling, but nothing too extreme.
• Discomfort when bending your knee, but you can still walk without it giving out.

With the right rehab, most people recover from a Grade 1 MCL injury within 1-3 weeks¹.

Grade 2 – A Partial Tear (More Pain, Less Stability)

A Grade 2 MCL injury is a partial tear, meaning some of the ligament’s fibers have been damaged. This is more serious than a simple stretch and comes with noticeable symptoms:

• Moderate pain and swelling, especially along the inner side of your knee.
• Your knee might feel loose or unstable, especially when turning or walking downhill.
• Difficulty bending or straightening your knee, with stiffness after rest.

This type of tear takes about 4-6 weeks to heal with proper rehab, including bracing, strengthening, and balance exercises².

Grade 3 – A Complete Tear (Serious and Unstable)

A Grade 3 MCL injury is a full tear, meaning the ligament is completely torn in half or very close to it. This is the most severe type of MCL injury and comes with significant pain and instability:

• Severe pain, although some people feel less pain than expected because the ligament is completely torn.
• Major swelling and bruising, making the knee look puffy and discolored.
• Knee instability, where it feels like your knee is going to give out if you try to walk.
• Difficulty putting weight on the leg—many people need crutches or a brace.

A full tear can take 8-12 weeks to heal and may require more intensive rehab. The good news? Most MCL tears don’t need surgery, even when fully torn, as long as the knee remains stable⁶. However, if the tear is combined with other ligament injuries (like an ACL tear), surgery might be necessary⁷.

What Other Conditions Could It Be?

Medial Meniscus Tear

A cartilage tear inside the knee, usually from twisting or deep bending. Like an MCL tear, it causes pain on the inner knee and swelling, but it often locks, catches, or feels stuck⁴.

Anterior Cruciate Ligament (ACL) Tear

A major knee ligament tear, often from a sudden stop or twist. Both ACL and MCL tears cause pain and swelling, but an ACL tear often comes with a loud pop and severe instability⁷.

Patellofemoral Pain Syndrome (Runner’s Knee)

A dull, aching pain in the front or inside of the knee, worsened by running, squatting, or sitting too long. Unlike an MCL tear, it develops over time and doesn’t cause instability⁵.

Pes Anserine Bursitis

Inflammation of the small fluid-filled sac on the inner knee, causing pain and tenderness. It differs from an MCL tear because pressing below the knee joint causes pain, and movement isn’t always limited⁸.

Medial Plica Syndrome

Irritation of the plica, a small fold of knee tissue, causing clicking, catching, and pain with movement. Unlike an MCL tear, plica syndrome doesn’t cause swelling or instability and often improves with stretching and relative rest¹.

Common Mistakes When Treating an MCL Tear

Ignoring the Injury and “Pushing Through the Pain”

Many people assume knee pain will go away on its own, so they keep walking, running, or playing sports without relative rest. This can turn a minor MCL strain into a more serious tear. If you don’t let the ligament heal, the pain can linger for months, and your knee may never feel fully stable again⁸.

Not Wearing a Brace When Needed

A brace helps protect your MCL while it heals, but some people skip it because they think it’s unnecessary or uncomfortable. Without support, the ligament stays under stress, slowing down healing and increasing the risk of re-injury¹.

Resting Too Much and Avoiding Movement

Rest is important, but if you stop moving completely, your knee can become stiff and weak. This makes it harder to regain full function. Gentle range-of-motion exercises and strengthening work are key to a strong recovery².

Skipping Rehab Exercises

Even when the pain improves, your knee might not be fully healed. Without proper rehab, your muscles stay weak, and your knee remains unstable. This increases the risk of future injuries, especially if you return to sports too soon⁵.

Returning to Sports Too Soon

If you go back to running, jumping, or cutting movements before your knee is strong, you could easily re-tear your MCL or damage other knee ligaments like the ACL. Many athletes rush back and end up with a worse injury than before⁷.

What Happens If You Ignore an MCL Tear?

If left untreated, an MCL tear can lead to chronic knee instability, where your knee constantly feels weak, wobbly, or prone to giving out. This makes everyday movements like walking, climbing stairs, or getting up from a chair more difficult. Over time, an unstable knee can also increase the risk of arthritis and long-term joint pain³.

Types of Scans

MRI (Magnetic Resonance Imaging)

An MRI is the best scan for spotting an MCL tear. It uses a strong magnet to take detailed images of the soft tissues in your knee. With an MRI, we’re looking for:

• A stretched or torn MCL – This shows up as a dark or swollen ligament.
• Swelling or fluid buildup – This helps confirm how recent and severe the injury is.
• Other ligament or cartilage damage – It’s important to check if your ACL or meniscus is also injured¹.

Ultrasound

Ultrasound uses sound waves to create real-time images of your knee. It’s a quick and easy test, often done in the clinic. We use ultrasound to:

• See how much the MCL moves when the knee is pressed – A loose ligament means a more serious tear.
• Check for swelling and inflammation – If the ligament looks thick or there’s extra fluid, it’s a sign of injury.
• Find smaller tears that might not show on an X-ray⁸.

X-ray

An X-ray doesn’t show ligaments, but it’s often done to rule out broken bones. We look for:

• Fractures near the MCL – Sometimes, a strong impact can pull off a piece of bone along with the ligament.
• Changes in joint spacing – A widened gap inside the knee can suggest a severe MCL tear⁵.

Is Surgery Needed?

Most MCL tears heal without surgery, but in certain cases, surgery is the best option. The decision depends on how severe the tear is and whether other parts of the knee are injured.

When is Surgery Recommended?

Surgery is usually only needed for:

• A complete MCL tear with severe instability – If your knee keeps giving out and won’t hold your weight, the ligament may be too damaged to heal on its own².
• An MCL tear combined with other ligament injuries – If your ACL or meniscus is also torn, surgery may be necessary to restore full knee function⁷.
• A tear that doesn’t heal properly – If you’ve been in rehab for months and your knee is still unstable, surgery might be needed to reconstruct the ligament⁶.

How Physiotherapy Helps After Surgery

Surgery fixes the ligament, but physiotherapy brings your knee back to full strength. Here’s what to expect after surgery:

• Pain and swelling management – Ice, compression, and gentle movement help prevent stiffness.
• Strength training – Exercises focus on rebuilding the muscles around the knee to support movement.
• Balance and stability work – Retraining the knee so it feels strong and steady again.
• Return to sport/activity plan – A gradual process to get you back to normal without risking re-injury⁸.

Surgery is rarely needed, but if you do need it, physiotherapy is the key to a full recovery so you can move confidently again.

Treatment Options for an MCL Tear

Exercise Therapy

The right exercises help the ligament heal and prevent future injuries. Strong muscles around the knee take pressure off the MCL, allowing it to heal properly⁸. Here’s how we’ll do it:

• Quadriceps Strengthening
• Hamstring and Glute Activation
• Balance and Proprioception Work

Myofascial Release

Tight muscles around the knee can pull on the ligament and slow healing. I can use hands-on massage techniques to relax the inner thigh, quads, and hamstrings, helping ease tension and improve knee movement⁵.

Orthopedic Manual Therapy

If the knee joint or surrounding structures are stiff, they can put extra pressure on the MCL. I can use gentle joint mobilizations and stretching to improve flexibility and restore normal movement¹.

Laser Therapy

Laser therapy uses low-level light energy to reduce inflammation and speed up healing. It’s a painless treatment that helps improve circulation, reduce swelling, and relieve pain around the knee².

Dry Needling

If there are tight knots (trigger points) in the muscles around your knee, dry needling can help release tension and improve blood flow. This can reduce pain and stiffness in the inner thigh and quadriceps, helping the knee feel looser and more comfortable.

Strapping and Taping

If your knee feels unstable, taping or bracing can support the ligament while it heals. Taping also reduces strain on the MCL, making it easier to move around without discomfort⁶.

Conclusion

An MCL tear doesn’t have to hold you back. With the right exercises, treatments, and patience, you can reduce pain, rebuild knee stability, and get back to doing what you love.

Recovery takes commitment, but every step—whether it’s strengthening your muscles, improving balance, or protecting your knee from unnecessary strain—moves you closer to healing. It won’t happen overnight, but with a solid plan, you’ll start seeing real progress and regain confidence in your movement.

I’m here to help you through every stage of recovery, making sure your treatment is right for you. You don’t have to go through this alone. Together, we’ll get your knee strong again so you can walk, run, and move pain-free. Let’s take that first step toward healing!

References

1. Meyer, P., Reiter, A., Akoto, R., & Bouillon, B. (2021). Imaging of the medial collateral ligament of the knee: A systematic review. Archives of Orthopaedic and Trauma Surgery, 141(12), 2145–2158. https://doi.org/10.1007/s00402-021-04200-8
2. Varelas, A., Erickson, B., Cvetanovich, G., & Bach, B. (2017). Medial collateral ligament reconstruction in patients with medial knee instability: A systematic review. Orthopaedic Journal of Sports Medicine, 5(4), 2325967117703920. https://doi.org/10.1177/2325967117703920
3. Lie, M. M., Risberg, M. A., Storheim, K., Engebretsen, L., & Axe, M. J. (2019). What’s the rate of knee osteoarthritis 10 years after anterior cruciate ligament injury? British Journal of Sports Medicine, 53(19), 1162–1168. https://doi.org/10.1136/bjsports-2018-099751
4. Ahmed, M., Alshammari, D., Alenezy, N., & Alenezy, R. (2024). Updates in prevalence and management of medial meniscal injury among adolescents and young adults: A systematic review. International Journal of Medicine in Developing Countries, 8(1), 15–28. https://doi.org/10.24911/ijmdc.51-1700329341
5. Roberts, S., Brown, O. S., Beattie, N., & Naylor, A. (2020). Systematic review of randomized controlled trials for interventions in medial knee ligament injuries. The Surgeon, 18(1), 14–24. https://doi.org/10.1016/j.surge.2020.03.003
6. Grant, J. A., Tannenbaum, E., Miller, B. S., & Bedi, A. (2012). Treatment of combined complete tears of the anterior cruciate and medial collateral ligaments. Arthroscopy, 28(1), 110–122. https://doi.org/10.1016/j.arthro.2011.08.293
7. DeLong, J. M., & Waterman, B. R. (2015). Surgical repair of medial collateral ligament and posteromedial corner injuries of the knee: A systematic review. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 31(11), 2249–2257. https://doi.org/10.1016/j.arthro.2015.05.010
8. Svantesson, J., Piussi, R., Weissglas, E., & Karlsson, J. (2024). Shedding light on the nonoperative treatment of medial collateral ligament injuries: A systematic review. BMJ Open Sport & Exercise Medicine, 10(1), e001750. https://doi.org/10.1136/bmjsem-2023-001750