Medial Knee Ligament: Time Off

author : AMSSM

comments : 0

How much rest is required in a half-iron training schedule to rehab a strained medial knee ligament?

Member Question

"Hi, I am signed up to do a 70.3 on 2 August!! I train moderately all year round and completed my last 70.3 in Feb. 5 weeks ago I strained my medial ligament in right knee and have not been able to train in that period. I’m hoping to get at least 5 proper weeks of training in before race day if my knee allows. Do you think this is enough training time to complete the race? I won't go for a specific time, just to finish... Thanks."

Answer from Sarah L. Kennedy, D.O.
Member AMSSM

Good question! First, I would want to know if you acutely injured the medial part of your knee or if pain developed without an injury or accident.

Knee pain is the most common complaint of cyclists and can be due to positioning in the bike or training errors. If no known injury occurred, your pain is likely due to one of these factors. 

Bike fit and knee pain

If your pain is located medially (as in your question), this may be a result of outward pointing toes, excessive float in the pedals, or having your feet too far apart. If your toes point outward in your cleats, modify your cleat to a toe in position or consider floating pedals. If you have floating pedals, limit your float to 5 degrees. If you have pain with exiting clipless pedals, lower the tension. Modify your cleat position, shorten bottom bracket axle, or use cranks with less offset if your feet are too far apart. Ensuring a proper bicycle fit is essential for maximizing performance and preventing injury and pain.

Medial knee injuries involving the medial collateral ligament (MCL) have three different grades from I with no frank tear to III, which is a full thickness tear. If the injury is due to a noncontact injury, usually is it a result of a force causing valgus (inward) movement of the knee.

The most recent literature shows that immediate motion and early rehabilitation with functional-type stresses speeds up recovery with early return to activity. The goals of a successful rehabilitation should include early protected range of motion, preventing quadriceps atrophy, decrease effusion (swelling) and pain in the initial stages, and then advancing therapy to eventually include full range of motion, no instability, strength at least 85% of opposite side, satisfactory balance, no tenderness over MCL, and no effusion.

A good physical therapist should be able to help you return to your prior level of function. Being able to return to full training will depend on the level of pain and injury. Grade I sprains heal significantly faster than grade III, with one study citing approximately 11 days to return to competition following a grade I sprain and 20 days following a grade II.

If the underlying issue is the bicycle fit, and no corrections are made, you may continue to have pain. In regards to being fit for the 70.3, it sounds like you are physically fit and know what to expect from your prior race. Beginners should start training at least 6-9 months prior to race, but if you have already been training, four weeks of 13-15 hours per week is usually recommended prior to the race, so if you are able to train at this level without pain, you should do great!

Sarah L. Kennedy
DO Primary Care Sports Medicine 
Assistant Professor Dept of Orthopedic Surgery 
UNTHSC Teaching Faculty Primary Care Sports Medicine Fellowship 
Bone & Joint Institute at the Ben Hogan Center

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date: October 29, 2015