7 Key Insights into Recovering from Knee Sprain

What are the different types of knee sprains?

There are several types of ligaments in the knee, and all of them can be damaged, either individually or simultaneously.

Internal knee ligaments: There’s one on the left knee and one on the right knee. It’s located inside the knee and is also called the medial collateral ligament.

External knee ligaments: There’s one on the right knee and one on the left knee. They’re located on the outside of the knee, on the side, and are also called the lateral collateral ligament.

Anterior cruciate, posterior cruciate, and anterolateral ligaments of the knee.

Additionally, there are different degrees of severity for knee sprains. You could have:

A mild sprain: The ligament(s) are simply stretched more than usual.

A severe sprain: The ligament(s) are torn or ruptured.

They could be:

• partially torn, referred to as a moderate sprain,
• or completely torn across their width (severe sprain).

So, for example, you could have a mild sprain of the internal knee ligament, which is the most common type and also known as a lateral collateral ligament sprain.

Or you could have a severe sprain of the external knee ligament, where your right external ligament is completely ruptured (you’ll generally recover quite well from this type of injury!)

How do you know what type of sprain you have?

Generally, you’ll consult a doctor, physiotherapist, or visit the emergency room if you injure your knee due to a fall or accident. Healthcare professionals will:

• Ask you questions to understand how the injury occurred and assess your current symptoms.
• Examine you, perform certain tests, and manipulate your knee to test the stability of your ligaments and the joint.
• Sometimes, they may conduct further imaging tests like an X-ray, ultrasound, or MRI, although this isn’t always necessary.

Based on this clinical examination (and sometimes additional imaging), your doctor or physiotherapist will make a diagnosis.

Their experience and expertise in evaluating knee injuries often allow them to diagnose without additional tests.

Is it serious if you don’t get an X-ray or ultrasound?

In some cases, additional tests such as X-rays, ultrasound, or MRI may be used to:

• Determine if the ligaments are completely torn or not.
• Rule out the presence of fractures or other injuries.

However, it’s not always necessary. Often, a clinical examination (coupled with the practitioner’s experience) is sufficient to rule out the likelihood of a fracture or other associated injury, or a tear.

Moreover, the treatment follows the same general guidelines, whether it’s a mild, moderate, or severe knee sprain! The specific type of injury isn’t the determining factor.

What matters most is your pain level, knee stability, and the activities you want to resume. And those factors aren’t visible on an MRI or ultrasound!

Here’s what experts in the management of knee ligament injuries conclude about the best approach for diagnosis:

Clinical examination, including the valgus stress test, is a highly effective method for diagnosing injuries to the internal knee ligaments and posterior cruciate ligaments. The importance of specific clinical tests, such as the dial test and the anteromedial drawer test, has also been emphasized for assessing anteromedial rotational laxity.

Regarding imaging, MRI has been considered a valuable tool for diagnosing acute pathology and should be requested if a grade III anterior cruciate ligament injury is suspected.

Stress X-rays in valgus are a commonly used diagnostic tool, particularly important for chronic injuries. Experts have agreed that these X-rays can be useful for determining residual laxity after conservative management and for evaluating graft/repair function post-surgery.

Chahla 2021

What is the duration of immobilization after a knee sprain?

If you have an injury to only one knee ligament, even if it’s a severe sprain, treatment is usually conservative, meaning surgery is not required.

In such cases, your knee may be recommended for relative immobilization, often through the use of a brace:

• Zimmer brace: quite rigid, it immobilizes the knee in extension.
• Hinged brace: allows for varying degrees of knee flexion.

These braces are removable; you can easily take them off for hygiene or when lying down without moving.

How long should you wear the brace? Your doctor will provide guidance based on your injury and their preferences.

I’ve noticed significant differences in approach for the same type of injury:

• Some doctors or surgeons don’t prescribe a brace at all.
• Some prescribe it for only a few days, primarily to alleviate pain.
• Others insist on strict brace use for at least 3-4 weeks, or even longer.

The goal of immobilization is to prevent knee instability. Due to stretching or tearing, your ligament no longer provides adequate stability to your knee.

However, other structures, notably your muscles, also contribute to knee stability. That’s why sometimes you can manage without a brace, exercising caution. You can discuss this with your physiotherapist.

The duration of immobilization after a knee sprain ranges from 0 days to several weeks. If multiple ligaments are affected, the knee is likely more unstable, and immobilization may be more appropriate.

How long is it impossible to bend the leg after a knee sprain?

Even though it might seem daunting, having difficulty bending the leg after a knee sprain is common. In some cases, it may even be impossible to bend it at all!

Several factors can explain this:

• Swelling: Fluid accumulates in the joint, causing swelling. This is a normal reaction of your body; the fluid carries nutrients and other substances to the tissues, aiding in their healing. However, the swelling interferes with knee flexion.
• Pain: Compression of tissues due to fluid accumulation can cause some discomfort. This discomfort may increase when bending the knee because it further compresses the tissues. However, it’s not dangerous.
• Instability: In cases of severe knee sprains, there may be joint instability. Ligament structures don’t properly hold the knee in place, leading to a sensation of weakness and reluctance to bend the knee for fear of causing further displacement or instability.
• Muscle protection: Muscles around the knee may contract to protect the injured joint, making it difficult to flex the knee.

In general, this difficulty in bending the leg will last:

• A few days (or even 2-3 weeks) for mild or moderate sprains.
• Sometimes several weeks or even months for severe sprains.

Your physical therapist is one of the professionals who can show you exercises tailored to maintain or regain knee flexion. Here are some examples of positions.

What is the duration of time off work after a knee sprain?

There isn’t necessarily a standard duration of time off work for a knee sprain. It primarily depends on the severity of your symptoms and their impact on your professional activity, as well as the possibility of adapting your job.

In France, the Health Insurance Fund (Assurance maladie) does provide guidelines indicating the suggested duration of time off work for various illnesses, musculoskeletal disorders, or operations. There’s a guideline for knee sprains as well.

The Health Insurance Fund recommends a duration of time off work ranging from 0 to 21 days for a knee sprain, specifically for a sprained internal ligament (medial collateral ligament).

How long without driving after a knee sprain?

In France, the Highway Code determines under what conditions you’re allowed to drive or not. Here’s what it says:

“Every vehicle driver must be constantly in a state and position to execute comfortably and without delay all the maneuvers required of them.”

Article R. 412-6 of the Highway Code

So, it’s your responsibility to determine whether or not you’re fit to drive a car.

There’s also an order from December 21, 2005, which provides further information in case of “post-traumatic motor deficit,” meaning difficulty in moving due to a fracture, operation, or injury, including a knee sprain.

This order states that in some cases, there may be an inability to maintain a driving license.

These texts are somewhat vague, leaving room for interpretation by insurance companies in the event of an accident.

Here’s a situation where I think it’s impossible to drive after a knee sprain:

• You have a sprain in your right knee.
• You don’t have an automatic car.
• You can’t bend your knee at all.

On the other hand, a situation where driving seems completely feasible even the day after a knee sprain:

• You have a problem with your left knee.
• You have an automatic car.
• You have no difficulty bending your knee.
• You don’t feel any pain when you sit behind the wheel and press the pedals.

Are you in between? You can discuss this with a healthcare professional who is following you. You can also test at a standstill how you feel by pressing the pedals.

In general, you may refrain from driving for only a few days after a knee sprain. Sometimes, it may take a few weeks.

How long does it take for a knee sprain to fully heal?

What do we mean by “healing”? To avoid making assumptions for you, below are the average recovery times I observe among my own patients.

Then, I went to look for more rigorous data in scientific publications that follow individuals after a sprain.

Step	Typical Timeframe from Day of Sprain
You experience significantly less pain	A few days to a few weeks
Your ligaments are well healed	4-6 weeks
Swelling in your knee subsides	Several weeks to months
You resume walking with crutches	Immediately
You resume walking without crutches	Sometimes immediately, sometimes within a few weeks
You can drive a car	A few days to a few weeks
You return to work	A few days to a few weeks
It’s time to return to sports!	1-6 months
You have fully regained functional and muscular recovery	3 months – 1 year

Here are data from scientific publications, providing a broader overview than just my own experience:

In the case of knee ligament surgery, 100% of experts recommend avoiding sports for at least 6 months (Chahla 2021).

I will update this section if I find more information.

Can anything be done to speed up healing?

Asking about accelerating healing is essentially questioning the treatments for a knee ligament rupture or even a simple ligament sprain.

While I am preparing a more detailed article on this topic, here are the conclusions reached by 35 knee trauma experts who gathered to establish recommendations for internal knee sprains (Chahla 2021).

Treatment for a knee sprain with a single ligament involved

Experts agreed that conservative treatment (brace) alone is sufficient. Some recommended a brace that immobilizes the knee with slight flexion, while others said it wasn’t necessary.

Other points addressed:

• Platelet-rich plasma injections do NOT improve healing.
• Less than 40% of experts believed that nonsteroidal anti-inflammatory drugs (NSAIDs) impede healing.
• In case of persistent pain, some recommended peri-ligament corticosteroid injections, while others did not.
• Rehabilitation is essential for achieving good outcomes.

Treatment for a knee sprain with multiple ligaments involved

Experts agreed that the treatment of choice when there are:

• Partial or complete injuries to the internal ligament,
• Associated with an ACL rupture,

is: 1/ a period of relative immobilization with a hinged brace that allows for choosing the degree of permitted flexion or not; 2/ followed by delayed reconstruction of the ACL.

In practice, some individuals decide not to undergo surgery after an ACL rupture, whether associated with other knee ligament injuries or not.

There’s no “miracle treatment” to recover faster after a knee sprain, and no treatment accelerates ligament healing. Remaining as active as possible while minimizing the risk of knee instability and gradually reintroducing demanding activities is the main focus 🙂.