Skating toward a loose puck in the corner of the rink, Jake Smith is checked into the boards sending a rippling bang around the rink. He suddenly hits the ground screaming out in severe pain. Fans watch in horror as athletic trainers rush the ice — determined to assess the severity of the injury. Smith cannot bend his knee or have any pressure placed on his leg. He is carried out on a stretcher to be taken to the nearby hospital. There, doctors determined he has severely torn his MCL and will be out of playing hockey for the rest of the season. Because of the vicious nature of hockey, injuries are quite common. While Jake Smith’s situation is a fictitious one, MCL injuries are a daily occurance in hockey. According to Reggie Ronning a certified athletic trainer at TRIA Orthopedic Center, “MCL injuries in the knee are the second most common injury in NCAA hockey behind concussions” (Ronnings). The MCL known as the medial collateral ligament is one of the major ligaments holding the knee joint together. It is located on the medial side, or inside, of the knee, but outside of the joint (Martel). Because of hockey’s violent nature, it is important to know the occurrence of MCL injuries, treatment of them, and prevention of these injuries in the future.Recognition of MCL InjuriesMCl injuries occur in a number of situations in hockey. These injuries normally involve a collision. Physical Therapist John Snyder reports that 77 percent of MCL injuries occur in contact situations (Snyder). This shows that the physicality of hockey is what causes most of these injuries, not just skating around the rink. According to Reggie Ronning, MCL injuries are usually the result from taking a hit to the outside of the knee causing the knee to bend inward, which the knee is not designed to do. Additionally, injuries can occur when the knee twists. This twisting is an unnatural motion which causes damage to the knee. The twisting motion can occur when a hit is delivered on one side of the body causing the player to twist while the lower part of the leg remains in place. Also, twisting can occur when changing direction causing the upper body to spin like a helicopters blades, while the skate prevents the lower leg from rotating. The severity of this injury is classified on a three grades scale: one, two, three. In grade one injuries, the MCL is in decent condition. It may have a small tear or just be stretched. Similarly, grade two injuries are more severe, the MCL has large tears, but is still attached. Finally, grade three injuries are the most damaging, the MCL is completely torn and may need surgery in some cases (Ronning). With any of these injuries comes along some symptoms athletes, parents, and coaches should look out for. Pain will be located on the medial side of the knee and may be tender to the touch; furthermore, there may also be swelling and stiffness to the knee. In grade two cases, the joint may appear unstable. Likewise, in grade three cases, the joint will be unstable and the individual may have an anterior cruciate ligament, or ACL, injury as well (“Medial Collateral Ligament”). In a situation where the knee bends inward or twists causing a hockey player to collapse, a MCL injury may have occurred.Treatment for MCL Injuries After an MCL injury occurs, it is important that proper recovery measures are taken in order to ensure that the MCL heals properly. According to UCSF Medical Center, If the MCL is not properly healed, the knee joint will remain unstable and the athlete may greet another MCL injury. Treatment usually starts by reducing pain and inflammation. This is done by elevating, icing, and resting the knee. Elevating the knee can help reduce the swelling by reducing blood flow to the knee. Also, taking mild painkillers like ibuprofen can additionally help reduce pain and swelling in the knee. Braces may be applied completely immobilize the knee. This helps the MCL heal anatomically. Immobilization braces can make life difficult and are not always used due to this inconvenience (“MCL Tear Treatment”). After the swelling and pain start to subside, strength exercises are implemented. These exercises will help to improve the flexibility of the knee and restrengthening of the quadriceps and hamstrings, which have weakened from lack of use. Range of motion exercises will also be used to help regain the original functionality of the knee prior to injury (“MCL Injuries”). In grade one injuries, recovery takes anywhere from a couple of days to a week and a half before returning to the ice. Grade two injuries recovery time is between two to four weeks. Grade three injuries take from four to eight weeks to heal unless surgery is needed (“MCL Tear Treatment”). Janelle Martel mentions that surgery is uncommon and only occurs when other ligaments are damaged, or that the MCL cannot repair itself on its own. An MCL surgery will include a small incision on the inside of the knee. Once inside, a surgeon will either reattach the MCL to the femur or Tibia using a number of different methods, or suture the two ends of the MCL back together. Recovery time for surgery on the MCL is generally longer because there is normally other complications, such as an ACL tear, to the knee (Martel). Overall, MCL injuries are generally heal within eight weeks, and on their own without additionally help from surgery or other measures.Prevention of MCL Injuries. Once a hockey player has finally healed from an MCL injury it is important to help prevent future MCL injuries. While complete prevention of future MCL injuries is impossible, there are a number of steps that can be taken to help decrease chances of future injury. As mentioned in SportMedBC, there are a number of different exercises that can be used to help prevent future injuries. Balance exercises can be propitious for the MCL. By working on balancing, stabilizer muscles are activated in the knee. These muscles help the control the movement and stability of the joint. By strengthening these muscles, the stability of the joint is being strengthened to help prevent the knee from moving in a way that could be dangerous. Another exercise beneficial to preventing MCL injuries is stretching. Through stretching the muscles that make up the knee, flexibility will increase allowing the leg to take and recover from hits that it may not have without the proper flexibility. Also, proper skating and hitting technique can be beneficial to the prevention of MCL injuries (“MCL Injuries”). Overall, while MCL injuries may be an unpreventable accident, preventative exercises can be done to help strengthen the stability of the knee joint reducing the chance of re-injure to the MCL and the other ligaments that make up the knee. Ultimately, MCL injuries are a part of hockey. Learning about how MCL injuries occur, how they are treated, and how to prevent future MCL injuries may be important steps to making this frequent injury less prevalent. MCL injuries are like obesity. They are both unhealthy and cause dramatic lifestyle changes. Luckily, with a knowledge on MCL injuries, hockey players can take preventative steps to make this change. While Jake Smith may be off the ice for a while, by learning about these injuries, Jake Smith’s injury may become a rare occurrence instead of the prevalent injury that it is in hockey today.