Lateral Collateral Ligament (LCL) Injuries: Common Causes and How to Treat It

Your knee is a complex structure, and where it hurts can tell you a lot of information. For instance, pain in the front of the knee could be the result of a common condition called runner’s knee. Pain on the outside of the knee, on the other hand, could be related to an injury to one of the knee’s key ligaments called the lateral collateral ligament, or LCL. 

LCL injuries, specifically tears, are a relatively common contributor to knee pain, though they are less common than other types of knee injuries like ACL (anterior cruciate ligament) and MCL (medial collateral ligament) tears, according to research.

The good news: If you have injured your LCL, it typically responds well to conservative treatments, including exercise and physical therapy, says Vanessa Matos, PT, DPT, a physical therapist at Hinge Health. 

Read on to learn more about LCL tears — their symptoms, causes, and treatment options — including exercises recommended by Hinge Health physical therapists.

What Is the Lateral Collateral Ligament?

The lateral collateral ligament is one of four primary ligaments that support the knee joint. Ligaments are strong fibrous bands of tissue that connect one bone to another. The LCL is on the outside of the knee and connects the femur (thighbone) to the fibula (the small bone of the lower leg). It plays a pivotal role in maintaining knee function and stability by preventing the knee from moving too far outward. 

The LCL works in parallel with the medial collateral ligament (MCL) that’s on the inside of the knee to help control lateral knee movements.

What Is an LCL Injury?

LCL injuries, in which the ligament is sprained or torn, often occur when playing sports that

involve frequent starts, stops, twisting, changes in direction, jumping, or lateral movements, like football, soccer, tennis, basketball, pickleball, or downhill skiing. Direct impact to the inside of the knee that forces it outward, like when playing football or soccer or in a car accident, can also cause an LCL injury.

You can also injure your LCL during everyday activities like playing with your kids or dog, moving quickly to catch something before it falls or to avoid an obstacle while hiking. But that doesn’t mean you should avoid these activities. Staying active and strengthening muscles that support your knees can help to prevent an LCL injury or reinjury.

LCL injuries are divided into three levels of severity: 

• Grade 1 is a sprain, in which the LCL has been overstretched, not torn. It still provides stability, and you haven’t lost any knee function. You may have some pain and swelling, but you can walk on it and perform most everyday activities.

• Grade 2 is a partial tear, in which the LCL has been overstretched to the point that it is loose and can’t provide full stability, making walking and stair climbing difficult. You may feel like your knee is going to give out as you do these activities, especially when changing directions. 

• Grade 3 is a full tear, sometimes referred to as a rupture. When this happens, you’ll feel less stable putting weight on your injured leg, and walking will be more difficult.

“The LCL is rarely injured in isolation,” says Dr. Matos. LCL tears can occur in conjunction with injuries to other structures of the knee, like the ACL or meniscus, because of their proximity.

LCL Tear Symptoms

No matter how you injure your LCL, the symptoms are generally the same, though they can vary in intensity depending on the severity of the injury. They include:

• Sharp pain on the outside of the knee at the moment of injury

• Feeling or hearing a popping sound when the injury occurs

• Swelling in the first few hours

• Loss of range of motion

• Difficulty walking or bearing weight on the injured knee

• Sense of instability

• Feeling like the knee is going to give out or having the knee give out

• Soreness or tenderness on the outside of the knee

LCL Injuries: A Hinge Health Perspective

Anytime you hear that you’ve torn something in your body, it’s perfectly natural to be a little alarmed. And the more severe your LCL injury is, the more hesitant you may be to get back on your feet, which is entirely understandable. You may feel unstable putting weight on the injured leg or worry about moving your knee. Your concerns are valid, but take heart: Ligaments, including the LCL, are resilient bands of connective tissue. They’re designed to recover and heal.

One of the most important components of recovery — whether you need surgery or not — is movement. As our Hinge Health care team likes to say, movement is medicine. It helps to maintain range of motion, brings nutrients to the knee joint for healing, and strengthens supporting muscles.

A physical therapist can help you overcome any hesitations you have about moving with a torn LCL. They can design an exercise program tailored to your symptoms and abilities. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

Causes of an LCL Injury 

LCL injuries occur when the ligament absorbs too much force. Here are some common ways that can happen:

• Rapid change in direction

• Sudden twisting

• Direct impact to the inside of the knee, such as a car accident, fall, or collision while playing sports

• Abrupt stop

• Pivoting when your foot is firmly planted

• Landing awkwardly, perhaps after a fall or jump

Treatment Options for an LCL Injury

Most LCL injuries and tears can be treated without surgery. The following tips from our Hinge Health physical therapists and medical doctors can provide relief for LCL injuries:

• P.E.A.C.E and L.O.V.E. protocol. You may be familiar with the advice to rest, ice, compress, and elevate an injury (the R.I.C.E. approach). As mentioned earlier, though, rest isn’t best when it comes to recovering from injuries, and that’s where P.E.A.C.E. (protect, elevate, adjust anti-inflammatories, compression, and educate) and L.O.V.E. (load, optimism, vascularization, and exercise) come in. This new, more comprehensive approach prioritizes movement and exercise as a vital component to your healing.

• Physical therapy. Physical therapy is a research-backed treatment for LCL tears that increases strength, stability, flexibility, power, coordination, and function. In addition to recommending exercises, a physical therapist (PT) may use neuromuscular stimulation (low-level electrical impulses that cause muscles to contract) to enhance strength and function in surrounding knee and leg muscles. Physical therapy also helps you regain confidence in movement, helping you to get back to the activities and sports you enjoy. 

• Ice and heat. Icing can help reduce swelling and pain immediately following an LCL injury. Heating increases blood flow and can reduce stiffness. You can apply ice or heat as needed for 10 to 20 minutes at a time, but avoid using heat to treat a new injury, which can potentially delay healing. 

• Knee bracing. The use of a hinged knee brace is often recommended for an LCL injury. The brace is used during the early weeks of rehab to stabilize the knee as you perform exercises and increase strength in the injured ligament. Just remember to avoid wearing a brace for long periods since movement promotes healing. 

LCL Surgery: What to Know

Surgery isn't necessary for most people to recover from an LCL tear, especially if it’s grade 1 or 2. These injuries can often be managed with conservative, at-home measures. 

Grade 3 LCL tears are more likely to be treated surgically compared to ACL and MCL injuries.

Part of the reason may be due to other associated injuries. “If you're having surgery to repair something else, like the ACL or the PCL (posterior cruciate ligament), your doctor is more likely to also repair the LCL,” says Dr. Matos. 

If you need surgery for your LCL injury, physical therapy will still be a vital part of your recovery.

These exercises, recommended by Hinge Health physical therapists, strengthen big and little muscles from your hips to your heels to support your knees and promote healing. With a strong network of support for your knees, you’ll be able to get back to an active lifestyle and minimize your risk of future LCL injuries.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Prevention of an LCL Injury

Injuries happen, but here are some strategies that can help reduce your risk and minimize the severity if an LCL injury does occur.

• Ease into activity. A five to 10-minute dynamic warm-up prepares your body for activity and has been shown to reduce injury. Try butt kicks, side shuffles, high knees, and squats to warm up your lower body and knees.

• Exercise regularly. You’re more likely to get injured if you’re inactive during the week and then go out and play hard on the weekend. “Our bodies are the healthiest when we’re moving,” says Dr. Matos. Regular exercise, and even small movement breaks throughout the day, will keep you strong, agile, powerful, and flexible, reducing your risk of an injury. 

• Check your technique. If you’re starting a new activity, lessons can be helpful to ensure good technique during high-risk activities like downhill skiing, soccer, or pickleball. A physical therapist can also provide sport-specific recommendations.

• Get the right gear. Running shoes aren’t appropriate for soccer, tennis, or pickleball because they don’t have the lateral support needed for activities with a lot of side-to-side movement and quick changes in direction. If you’re a skier, make sure your bindings are properly adjusted. Properly fitted, sports-specific footwear can help protect against injury.

PT Tip: Be Patient With Recovery

You can make a full recovery even from a complete LCL tear with accompanying injuries, but it may take time. How much time you’ll need will depend on the severity of your injury and the treatment needed. The time frame can range from about a few weeks to several months or more. “It can be hard to be patient, but it’s worth the wait,” says Dr. Matos. Give yourself grace and lean into other meaningful activities you enjoy to help you stay consistent and active.

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Lateral Collateral Ligament (LCL)Tear: What Is It, Causes & Treatment. (2021, August 19). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/21710-lcl-tears

2. Yaras, R. J., O’Neill, N., & Yaish, A. M. (2020). Lateral Collateral Ligament (LCL) Knee Injuries. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK560847/ 

3. Majewski, M., Susanne, H., & Klaus, S. (2006). Epidemiology of athletic knee injuries: A 10-year study. The Knee, 13(3), 184–188. doi:10.1016/j.knee.2006.01.005

4. Filbay, S. R., Ackerman, I. N., Russell, T. G., & Crossley, K. M. (2016). Return to sport matters-longer-term quality of life after ACL reconstruction in people with knee difficulties. Scandinavian Journal of Medicine & Science in Sports, 27(5), 514–524. doi:10.1111/sms.12698

5. Davenport, D., Arora, A., & Edwards, M. R. (2018). Non-operative management of an isolated lateral collateral ligament injury in an adolescent patient and review of the literature. BMJ Case Reports, bcr-2017-223478. doi:10.1136/bcr-2017-223478