When it comes to knee injuries, it’s like alphabet soup. There’s the ACL, PCL, MCL, and LCL. You’ve probably heard of the ACL (anterior cruciate ligament), especially if you’re a sports fan. The ACL is the most frequently injured knee ligament, and tears are common in football, soccer, and basketball players, and skiers.

But you may not be as familiar with the PCL (posterior cruciate ligament), the counterpart to the ACL. PCL injuries are less common, though they can still impact daily activities in a big way. The good news: They typically can be treated with conservative treatments, like exercise and physical therapy, alone.

Read on to learn more about posterior cruciate ligament (PCL) injuries and their symptoms, causes, and treatment options — including exercises from Hinge Health physical therapists.

What Is the PCL?

The PCL is the strongest of four ligaments in the knee joint. Ligaments are strong fibrous bands of tissue that connect one bone to another. The PCL is nearly twice as strong as the ACL, but they work together.

“The ACL and PCL cross inside the knee to help stabilize it,” says Mary Kimbrough, PT, DPT, a physical therapist at Hinge Health. Both connect the femur (thighbone) to the tibia (shinbone). The PCL is behind the ACL and prevents the shinbone from moving too far backward. The ACL prevents it from moving too far forward. Together, along with the medial collateral ligament (MCL) and lateral collateral ligament (LCL) on the sides of the knee, they play a pivotal role in maintaining knee function.

What Is a PCL Injury?

A PCL injury refers to a sprain or tear of the PCL ligament in the knee. A PCL injury can occur when an excessive amount of force is placed on the ligament, for example, in a car accident when the dashboard and a bent knee collide or if you fall hard on a bent knee. PCL injuries also happen if you hyperextend (bend too far backward) your knee, which can occur playing sports, skiing, or stepping the wrong way on an uneven surface.

PCL injuries are less common than other ligament injuries. “The PCL is a really, really strong ligament, so it has to be a pretty significant event that leads to injury,” says Dr. Kimbrough. Because of that, PCL injuries often occur along with injuries to other areas of the knee, like the meniscus or other ligaments, although it is possible to injure the PCL only.

A PCL injury can vary in severity from a grade 1 sprain to a grade 3 complete tear. A grade 1 sprain is when the PCL is overstretched. You may have some pain and swelling but can walk on it and perform most everyday activities. A grade 2 partial tear of the PCL may make walking and stair climbing difficult. A grade 3 tear is a nearly full or full tear. When this happens, you may feel less stable putting weight on your injured leg, and walking may be more difficult.

PCL Tear Symptoms

Symptoms can vary depending on the severity of your injury. Here are the most common symptoms of a PCL injury. 

• Sharp pain in the back of the knee at the moment of injury

• Swelling

• Stiffness or loss of range of motion

• Difficulty walking or bearing weight on the injured leg

• Sense of instability

• Having the knee give out or feeling like it’s going to give out

PCL Injury: A Hinge Health Perspective

A key component of conservative treatment is movement. Movement is medicine. It helps to maintain range of motion, brings nutrients to the joint for healing, and strengthens the supporting muscles. But because many PCL injuries involve serious events like a car accident, bad fall, or significant sports injury, people often have a lot of fear and anxiety about their injury. “They think that because it was a traumatic injury, they’ll never get back their normal function without surgery,” says Dr. Kimbrough. “But PCL injuries, even severe ones, respond really well to conservative treatments, and you can often recover more quickly compared to an ACL injury.”

It’s natural to be worried about resuming activity. A physical therapist (PT) can help you manage your fears. “We can prescribe exercise therapy based on where you are in your recovery, gradually dose your exercise, and help you return to your activities in a way that’s safe and protects your healing knee,” says Dr. Kimbrough. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

PCL Injury Causes

Here are some common ways PCL injuries can happen. 

• Direct impact to the knee, such as in a car accident, fall, or sports-related collision 

• Hyperextending the knee (bending too far backward)

• Non-contact injuries, such as from changing directions quickly or landing awkwardly from a jump

• Sports-related activities that involve high-speed movements, sudden stops, changes in direction, and jumping 

Previous injuries, muscle imbalances and weaknesses, and normal age-related changes in the knee may make some people more susceptible to PCL injury than others. 

PCL Tear Treatments

Non-surgical remedies are the first line of treatment for a PCL injury. “Even grade three PCL tears respond really well to conservative care,” says Dr. Kimbrough. Here are some conservative ways to manage a PCL injury.

• P.E.A.C.E and L.O.V.E. protocol. This new, more comprehensive approach replaces the well-known R.I.C.E. method (rest, ice, compression, and elevation). Instead of rest, P.E.A.C.E. (protect, elevate, adjust anti-inflammatories, compression, and educate) and L.O.V.E. (load, optimism, vascularization, and exercise) focuses on movement and exercise as a vital component of your recovery plan while still protecting and rehabbing the injured knee.

• Exercise therapy. “Exercise strengthens the muscles around the joint to help stabilize it and compensate for the injured PCL,” says Dr. Kimbrough. “It also helps manage swelling and prevents any loss of range of motion and strength after an injury.”

• Ice and heat. Icing can help reduce swelling and pain immediately following an 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 delay healing. 

• Physical therapy. PT is a research-backed treatment for PCL injuries that increases strength, stability, flexibility, power, coordination, and function. Physical therapy can also help you regain confidence in movement and get back to the activities and sports you enjoy. Research shows that people who return to doing the activities they did before a knee injury report a higher quality of life than those who don’t.

• Knee brace. Bracing the knee in full extension is sometimes used to stabilize the joint and prevent overuse during the first few weeks of recovery to protect the joint. 

If you’re not getting better with conservative care or have a lot of instability, your doctor may recommend surgery. PCL injuries may also be repaired surgically if you also have other injuries like a torn ACL or meniscus that require surgery. If you have surgery to repair your PCL, physical therapy will be a vital part of your recovery to ensure you regain maximum strength and function, which may take about six to 12 months, depending on your injuries.

The above exercises recommended by Hinge Health physical therapists focus on strengthening the quadriceps in the front of the thigh, a vital muscle that can compensate for an injured PCL. Strong quads provide support and stability to the knee joint.

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.

How to Protect Your PCL

You can’t prevent all PCL injuries — accidents happen — but here are some strategies that can help reduce your risk and minimize the severity if a PCL injury happens.

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

• 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. Varied exercises such as dynamic stretches, agility work, strength training (including the core), and even plyometrics (jumping activities) condition your body for more intense activity.

• Employ good technique and form. While there is no right or wrong way to walk, sit, or do anything, paying attention to your movement mechanics during certain activities like downhill skiing, soccer, or pickleball may help prevent a PCL injury. Lessons can be helpful to ensure good technique and form, or look for a physical therapist who can give you a sport-specific evaluation and recommendations.

• Get the right gear. Properly fitting, sports-specific footwear can help protect against injury. That means you may want to avoid running shoes when playing soccer, basketball, or tennis 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. One piece of equipment you can skip, unless recommended by your doctor, is a knee brace. There is no evidence showing that the general use of knee braces prevents PCL injury.

PT Tip: Protect Your Knees During a Fall

Falling on your knees can result in a PCL injury. While avoiding falls is the best way to prevent this injury, that’s not always possible. But being aware of how you land when you fall can help you react in a way that will minimize injury. If you take a tumble, you can protect your knees by shifting your body to land on your side so your knees aren’t directly hitting the ground. “When you roll on your side as you land, there’s a broader area of impact to disperse the force of the fall and help prevent injuries,” says Dr. Kimbrough. Physical therapists can also help you practice this technique.

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. Raj, M.A., Mabrouk, A., and Varacallo, M. (2023, August 8). Posterior Cruciate Ligament Knee Injuries. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK430726/

2. Alaia, M.J. and Throckmorton, T.W. (2021, October). Posterior Cruciate Ligament (PCL) Injuries. OrthoInfo. American Academy of Orthopaedic Surgeons. Retrieved from https://orthoinfo.aaos.org/en/diseases--conditions/posterior-cruciate-ligament-injuries/

3. Posterior Cruciate Ligament (PCL) Injuries. (2021, September 10). Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/21793-pcl-posterior-cruciate-ligament-tears

4. Agolley, D., Gabr, A., Benjamin-Laing, H., & Haddad, F. S. (2017). Successful return to sports in athletes following non-operative management of acute isolated posterior cruciate ligament injuries. The Bone & Joint Journal, 99-B(6), 774–778. doi:10.1302/0301-620x.99b6.37953

5. 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

6. Randi Gram Rasmussen, Julie Sandell Jacobsen, Birgitte Blaabjerg, Torsten Grønbæk Nielsen, Lene Lindberg Miller, & Lind, M. (2023). Patient-reported Outcomes and Muscle Strength after a Physiotherapy-led Exercise and Support Brace Intervention in Patients with Acute Injury of the Posterior Cruciate Ligament: A Two-year Follow-up Study. The International Journal of Sports Physical Therapy, 18(4). doi:10.26603/001c.83214