Cycling injuries: Do I have an injured MCL?

Cycling is a suitable alternative to running but an individual might be at risk for an injured MCL. Even though the knee joint is large and highly complex, it can be easily damaged due to its dependence of neighboring ligaments and muscles for stability. The medial collateral ligament is one of these stabilizing ligaments.

Anatomy

There are 4 main ligaments which connect the femur to the lower leg bones – posterior and anterior cruciate ligaments. These form an X in front and behind the knee joint while the lateral and medial collateral ligaments are positioned on the interior and exterior sides of the joint.

The MCL or medial collateral ligament is responsible for maintaining the alignment between the femur and tibia. If there is an issue with the MCL, the knee will buckle inwards. Since the layers of the MCL communicate with various structures in the knee, a MCL injury can lead to secondary damages.

What are the causes?

The mechanism behind a MCL sprain is a valgus stress or exterior turning at the knee joint. Overuse of the knee joint and twisting injuries can lead to an injured MCL.

The abrupt increase in the intensity or changes in direction while cycling at high speeds can lead to hard muscle contractions that place significant stress on the MCL. Although it is less likely, sustaining a direct blow on the exterior of the knee joint can also damage the MCL such as during a cycling accident.

Injured MCL

Individuals who suffer from a MCL injury such as a sprain often experience tearing, popping or pulling sensation at the time of injury.

Classification of MCL injuries

Just like with all ligaments, MCL injuries are categorized as sprains and grouped in 3 grades.

  • For a grade I sprain, the ligament is minimally damaged but able to stabilize the knee joint.
  • A grade II sprain involves a partial tear due to the stretching of the ligament up to the point of looseness. The ligament is still functional.
  •  A grade III sprain involves a full tear in which the ligament is split into 2 pieces which makes the ligament no longer functional and the knee joint is unstable.

What are the signs and symptoms?

Individuals who suffer from a MCL injury such as a sprain often experience tearing, popping or pulling sensation at the time of injury. Other common indications of an MCL injury include stiffness of the knee, tenderness and pain at the interior side of the knee along with limping with a bent knee, swelling and bruising at the site after 24 hours.

The immediate swelling at the time of an MCL injury can indicate that the neighboring structures are also damaged.

Management

The immediate treatment for an MCL injury involves adequate rest, application of ice, compression and elevation. The 1st and 2nd grade MCL injuries are managed conservatively with a cast or brace.

The main objective is to protect the knee against valgus stress and continue knee movement within 1-2 weeks.

Preventive measures

Proper road safety measures as well as bicycle safety equipment are vital in preventing injuries. A MCL injury can be prevented by several measures including proper physical conditioning in order to develop muscle strength as well as flexibility, proprioceptive training, safe-training techniques and hinged braces to minimize valgus stress.

Always bear in mind that it is equally vital not to skip proper warming up and stretching before a cycling session. Additionally, it is also vital to ensure proper fit of the bicycle and not to place the knee in full extension or hyperextension while cycling.

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