Medial Collateral Ligament (MCL) Injuries in Surfers
First things first. Ligaments are short bands of tough, fibrous connective tissue that connect two bones. Consequently, ligaments provide stability at each of our joints. The medial collateral ligament (MCL) is one of the four ligaments within the knee and plays an important part in ensuring our knee performs as it should through varied movements and challenges.
The MCL is on the inner side of the knee, attached to the femur at one end and to the tibia at the other. The MCL is also in close contact with the joint capsule and meniscus which is the knee “shock absorber” between the femur and tibia. However, all injuries fall into 2 main ways MCL injuries happen.
How the MCL can get damaged or injured during Surfing
The MCL can be injured though contact and non-contact mechanisms. Both pretty unpleasant when you’re surfing, as just because it’s non-contact, doesn’t mean there’s not a serious set about to land on you while you try and get yourself out the water!
A contact mechanism could be a blow to the lateral or outer side of the knee. In contact field sports like rugby this mechanism is more common, though not unheard of for surfers if the board hits you, or you hit the reef or rocks below.
In surfing, a common non-contact mechanism is where the knee rotates and bends inwards towards the midline, straining the inner side of the knee. A flexed (bent) knee folding towards the midline and hip internal rotation is a common position in surfing, particularly for the back foot. The knee can grow accustomed to this position, however, a fast, forceful or unexpected movement deep into this range can injure the MCL.
A very common non-contact MCL injury can happen surfing when landing on both feet in the position described above, or when one foot slips off the board. The latter is what happened to Italo Ferreira at J-Bay this year (*see below for the vomit-worthy knee angle). In the clinic at Motus, we’ve seen MCL injuries in surfers from all kinds of causes; from one foot slipping off the board, collisions with other surfers, having a foot stuck in the reef while rocking off and landing heavily from an air. None pleasant, but that’s the reality of surfing!
Types and grades of MCL Injury
MCL injuries can be classified and graded based on the location of the tissue damage and the severity of damage. Classification and grading is useful in determining specific treatment and recovery times.
- Grade 1 MCL injury involves minor damage to the ligament and minimal joint laxity/instability.
- Grade 2 MCL injury is a partial tear of the ligament with moderate joint laxity/instability.
- Grade 3 MCL injury is a complete tear of the ligament with considerable joint laxity/instability.
In addition to injuring the MCL, there can also be associated injury to close by structures such as the meniscus, joint surfaces and the Anterior Cruciate Ligament (ACL) that should be assessed and treated accordingly. We’ll always test you for more than just your MCL injury if you come into the Motus clinic, just to ensure there’s nothing else lurking that we should deal with.
Treatment of MCL Injuries
An unstable joint needs stability, it’s simple. During the acute stages immediately after injury, higher grade MCL injuries may require bracing. Some higher grade injuries require an appointment with an orthopaedic surgeon to see if surgery is necessary. Sometimes taping may suffice for mid to lower grade injuries.
For Grade 1 injuries to the MCL, the knee is most often stable and does not require any external stability such as a brace.
For Grade 2 the knee might feel loose/unstable and painful, and depending on the severity require surgery, but not always.
For Grade 3 injuries, there will commonly be considerable pain and swelling and the knee will feel loose/unstable. It’s very likely that surgery will be the first step.
All grades of MCL injury will require and heal much stronger with regular sports physiotherapy until your return to sport. Initially, Physiotherapy focuses on swelling reduction and pain management. The focus shifts to restoring full range of motion, strength, proprioception, balance and the ability to perform the dynamic/athletic tasks your sport demands.
For surfers, we put a considerable load on our medial knee, and proper rehab and return to sports testing is essential if we want to be back out there as quickly and safely as possible. At Motus we’ll always ensure your return to surfing and sport is at the forefront of our minds when planning your rehab program. We’ll be looking after your knee joint and soft tissues with manual therapy and other techniques in your treatments. Then we’ll move into doing specific rehabilitation exercises for your return to sport in our large gym facility next door at Chocolate Box Training.
When can you start surfing after an MCL injury?
What can you do to avoid MCL injury?
With every sport there is an inherent risk and surfing is no different. Sometimes, injuries happen despite our best efforts to stay safe. Keeping ourselves strong, healthy and mobile is the best defence and the things we can control. When it comes to the MCL specifically, building the leg muscles up enough to support the knee, and regularly performing functional training movements that challenge the ligaments; increasing resilience is key.
Your surf injury risk could be greatly reduced by doing the following:
1. A solid warm up to get the body primed and ready to surf. Take a dedicated 5-10 minutes before you head out to run through some dynamic stretches as a warm up. Work through lower and upper body mobilisation so you’re already warm and the blood is pumping before you paddle out.
2. Find time to do some dynamic mobility stretches after your session, or later that day at home. Target your tight areas and where you hold tension, likely in your traps or lower back if you’ve been paddling a lot! Or, pop into our Monday night surfer mobility sessions at Chocolate Box Training at 5:30pm and 6:30pm!
3. Regular Strength and Conditioning training is another great option. You can’t go wrong getting strong and a well designed surf Strength and Conditioning program to prepare your body for the demands of the sport. Strength and Conditioning isn’t just reserved for surfings elite, training consistently can give you longevity in surfing and the ability to enjoy what you love to the best of your ability.
Motus HP and Chocolate Box Training: The Home for Surfers on the Northern Beaches!