Treatment for Bilateral Mild MCL Strain in a Female with Hypermobility
Functional treatment with a combination of exercise therapy, proprioception training, and temporary bracing is the recommended approach for treating bilateral mild MCL strains in a female patient with hypermobility history.
Initial Management
Rest and Protection
- Implement relative rest rather than complete immobilization to prevent muscle atrophy 1
- Avoid activities that provoke pain for 1-2 weeks to prevent further damage
- Consider a knee brace for initial protection and stability:
- For mild MCL strains, a hinged knee brace is appropriate for 1-3 weeks 2
- Bracing should be temporary to avoid muscle atrophy and dependency
Pain and Inflammation Management
- Apply ice for 20 minutes, 3-4 times daily using an ice-water mixture in a plastic bag with a damp cloth barrier 1
- Consider NSAIDs for short-term pain relief (7-10 days) if not contraindicated 1
- Compression with an elastic bandage may help control swelling
Rehabilitation Program (2-6 weeks)
Exercise Therapy
- Begin with gentle range of motion exercises once acute pain subsides
- Progress to strengthening exercises focusing on:
- Quadriceps (particularly vastus medialis)
- Hamstrings
- Hip abductors and external rotators
- Core stability exercises
- Eccentric strengthening exercises are particularly effective 1
Proprioception and Balance Training
- Single-leg balance exercises progressing to unstable surfaces (balance pad, BOSU ball) 1
- This is especially important for patients with hypermobility to improve joint stability
Functional Support
- For a patient with hypermobility, consider a functional knee brace during higher-level activities 2
- Prefabricated foot orthoses may be beneficial if biomechanical assessment indicates they would help 2
Special Considerations for Hypermobility
Modified Exercise Approach
- Focus on controlled movements through appropriate ranges
- Emphasize quality over quantity of exercises
- Avoid end-range stretching which may exacerbate hypermobility
- Include more isometric exercises initially before progressing to dynamic exercises
Proprioception Focus
- Patients with hypermobility require additional emphasis on proprioceptive training
- Include exercises that enhance joint position sense and neuromuscular control
- Consider taping techniques to improve proprioceptive feedback 2
Return to Activity Protocol (6+ weeks)
Gradual Progression
- Begin with low-impact activities (swimming, cycling) before returning to hiking 1
- Implement a walk/hike interval training program
- Gradually increase duration and intensity (no more than 10% increase per week) 1
Return Criteria
- Pain-free movement through full range of motion
- Restored strength (at least 90% compared to unaffected side or baseline)
- Adequate proprioception and balance
- Confidence in knee stability during functional testing
Prevention of Recurrence
Long-term Management
- Continue maintenance exercises focusing on strength and proprioception
- Consider hiking poles to reduce knee loading during hiking activities
- Proper footwear with adequate support and shock absorption
- Gradual progression of hiking distance and difficulty
Education
- Educate on recognizing early symptoms of strain
- Teach self-management strategies for minor flare-ups
- Emphasize the importance of consistent exercise for joint stability
Red Flags for Further Evaluation
- Persistent pain despite 2-3 weeks of conservative treatment
- Instability during daily activities
- Joint locking or catching
- Night pain or pain at rest
- Consider imaging if symptoms persist beyond expected recovery timeline
This treatment approach prioritizes functional rehabilitation while addressing the specific needs of a patient with hypermobility, focusing on improving joint stability and preventing recurrence while allowing for a safe return to hiking activities.