PCL Sprain – Symptoms, Causes, and Treatment Options

Overview of PCL Sprain

A PCL sprain occurs when the posterior cruciate ligament, which connects the thighbone (femur) to the shinbone (tibia), is injured. Unlike the more commonly injured ACL (anterior cruciate ligament), the PCL is stronger and less frequently sprained. Still, when injured, it can make daily activities like walking, running, or climbing stairs difficult.

The PCL plays an important role in keeping the shinbone from sliding backward under the thighbone. A sprain happens when the ligament is overstretched but not fully torn. Doctors grade these injuries from Grade I (mild stretching) to Grade III (complete tear).

How common is a PCL sprain?

PCL sprains are less common than ACL injuries, making up about 3–20% of all knee ligament injuries depending on the population studied. They are more likely to occur in high-contact sports like football, rugby, or hockey, and in car crashes when the shin hits the dashboard.

How does a PCL sprain affect daily life?

Living with a PCL sprain can impact your:

• Work: Sitting for long periods, especially with bent knees, may increase discomfort. Jobs that require squatting, kneeling, or lifting can be particularly challenging.
• Sports: Activities involving running, jumping, or sudden changes in direction are often painful and risky. Many athletes notice reduced performance and confidence after the injury.
• Sleep: Night pain or discomfort when rolling onto the injured knee can disturb sleep.
• Relationships and mental health: Ongoing pain and reduced mobility can increase frustration, stress, and social withdrawal.

Reference: Schulz MS, Russe K, Weiler A, Eichhorn HJ, Strobel MJ. Epidemiology of posterior cruciate ligament injuries. Arch Orthop Trauma Surg. 2003;123(4):186–191. doi:10.1007/s00402-003-0518-7

Symptoms of PCL Sprain

A PCL sprain typically presents with knee pain, swelling, and instability. Unlike an ACL injury, which often causes a sudden “pop” and collapse, PCL sprains may feel more subtle at first.

What are the main symptoms of a PCL sprain?

• Pain: Usually at the back of the knee, but can also radiate around the joint.
• Swelling: Mild to moderate swelling develops within hours of the injury.
• Instability: A sensation that your knee might “give out,” especially when walking downhill or going down stairs.
• Stiffness: Limited range of motion, making it harder to fully bend or straighten the knee.
• Bruising: May appear at the front of the shin or back of the knee, depending on the cause of injury.

How severe can PCL sprain symptoms get?

1. Mild sprain (Grade I): Slight pain and tenderness, but you can still walk.
2. Moderate sprain (Grade II): Noticeable instability and difficulty with sports or heavy activity.
3. Severe sprain (Grade III): Significant instability, swelling, and difficulty bearing weight.

Functional impact on daily life

• Work: Standing jobs or those requiring physical labor may become difficult.
• Sports: Sprinting, pivoting, and contact play are often limited.
• Sleep: Discomfort in bent-knee positions can disturb rest.
• Mood and mental health: Fear of re-injury and reduced mobility may affect confidence and overall wellbeing.

Reference: Fanelli GC, Edson CJ. Posterior cruciate ligament injuries in trauma patients: Part II. Arthroscopy. 1995;11(5):526–529. doi:10.1016/0749-8063(95)90127-2

Causes and Risk Factors for PCL Sprain

A PCL sprain occurs when excessive force pushes the shinbone backward relative to the thighbone, overstretching the ligament.

Common causes

• Sports injuries: Collisions or awkward landings in football, rugby, basketball, or skiing.
• Car accidents: “Dashboard injuries,” where the shin hits the dashboard and forces the tibia backward.
• Falls: Landing hard on a bent knee can overstretch the PCL.
• Twisting motions: Though less common, sudden pivots with the knee bent can stress the ligament.

Who is at higher risk?

• Athletes: Especially those in contact or high-speed sports.
• Older adults: Age-related weakening of ligaments makes them more vulnerable.
• People with weak quadriceps muscles: Since strong quads help stabilize the knee, weakness increases strain on the PCL.
• Occupations requiring kneeling or squatting: Construction, plumbing, and floor work may elevate the risk.
• Obesity: Extra weight increases stress on knee structures.

Lifestyle impacts of risk factors

If you are overweight, physically inactive, or working in a job with repetitive knee strain, your risk of developing or worsening a PCL sprain increases. On the other hand, athletes with poor landing technique or lack of strength training also face a higher risk.

Reference: LaPrade RF, Chahla J, DePhillipo NN, et al. Posterior Cruciate Ligament Injuries: A Practical Guide to Management. Am J Sports Med. 2018;46(2):507–516. doi:10.1177/0363546517697718

Clinical Path for PCL Sprain – Diagnosis, Recovery, and Management

A PCL sprain can be challenging to recognize because its symptoms may be subtle compared to other knee ligament injuries. Diagnosis, recovery, and management require careful evaluation and a structured approach to ensure full healing and reduce the risk of re-injury.

Diagnosis of PCL Sprain

A PCL sprain is diagnosed through physical examination, functional testing, and sometimes imaging. Clinicians look for signs of instability, pain, and abnormal knee motion.

How do doctors test for a PCL sprain?

Diagnosis usually starts with a detailed medical history and physical exam. Your provider may ask how the injury happened (e.g., a fall on a bent knee, a sports tackle, or a car accident).

Key physical tests include:

1. Posterior drawer test: With your knee bent, the doctor gently pushes your shin backward. Excessive movement indicates a PCL injury.
2. Quadriceps active test: When you try to contract your thigh muscles, forward movement of the shinbone can signal PCL damage.
3. Posterior sag sign: When lying with your knee bent, the shin may drop backward due to ligament weakness.

What imaging is used for PCL sprains?

• X-rays: Rule out bone fractures or dislocations.
• MRI (Magnetic Resonance Imaging): Provides a clear view of ligaments and soft tissues, confirming the grade of sprain.
• CT scans: Occasionally used if detailed bone alignment needs to be assessed.

How is a PCL sprain different from an ACL tear?

• PCL sprains usually result from a direct impact on the shin or a bent knee.
• ACL tears often happen during twisting or pivoting movements.

Both can cause instability, but PCL injuries often feel less dramatic at first.

Recovery & Prognosis for PCL Sprain

Recovery from a PCL sprain depends on the severity of the injury, your overall health, and your activity level. Healing timelines range from a few weeks to several months.

How long does a PCL sprain take to heal?

1. Mild sprain (Grade I): 2–4 weeks of rest and rehabilitation.
2. Moderate sprain (Grade II): 6–10 weeks with structured physical therapy.
3. Severe sprain (Grade III): 3–6 months or longer; surgery may be required in some cases.

Factors affecting long-term outcomes

• Muscle strength: Strong quadriceps help stabilize the knee.
• Activity demands: Athletes or people with labor-intensive jobs may need longer rehab.
• Re-injury risk: Returning to sport too quickly increases the chance of chronic instability.
• Weight and lifestyle: Excess weight or sedentary habits can slow recovery.

Decision pathway for prognosis

1. If mild (Grade I): Conservative treatment, return to light activity in weeks.
2. If moderate (Grade II): Structured rehab with gradual return to sport over months.
3. If severe (Grade III): Surgery may be considered, followed by long-term rehabilitation.

Return-to-work and sport

• Office jobs: Often within a few weeks, especially with mild sprains.
• Physical jobs: May require 2–3 months depending on knee stability.
• Sports: Full return to pivoting or contact sports often requires 4–6 months.

Reference: Fanelli GC, Beck JD, Edson CJ. Current Concepts Review: The Posterior Cruciate Ligament. J Bone Joint Surg Am. 2010;92(3): 732–746. doi:10.2106/JBJS.I.00848

How to Manage a PCL Sprain

Management of a PCL sprain combines rest, rehabilitation, strengthening, and prevention strategies. Most sprains heal without surgery, especially mild to moderate cases.

What’s the best way to manage a PCL sprain at home?

• Rest & protection: Avoid activities that stress the knee, such as deep squats or heavy lifting.
• Ice therapy: Apply cold packs for 15–20 minutes, 3–4 times daily to reduce swelling.
• Bracing: A hinged knee brace may be recommended for added support.
• Elevation & compression: Elevating the knee and using compression wraps help control swelling.

Step-by-step self-help tips

1. Control pain and swelling with rest, ice, and compression.
2. Strengthen your quadriceps with exercises like straight-leg raises or mini-squats.
3. Improve flexibility with gentle hamstring and calf stretches.
4. Work on balance and stability using single-leg stands or balance board training.
5. Gradually return to sport once cleared by a medical professional.

Therapy and prevention strategies

• Physiotherapy: Core strengthening, gait retraining, and progressive loading programs.
• Activity modification: Avoid sudden stops, pivots, or high-impact movements early in recovery.
• Ergonomics: Adjust work or sport positions to reduce strain on the knee.
• Lifestyle support: Weight management, good nutrition, and consistent exercise reduce long-term risk.
• Community/social support: Returning to group activities or working with coaches can boost motivation and confidence.

Multidisciplinary Care for PCL Sprain at CARESPACE

A PCL sprain often requires more than one type of care to fully recover. At CARESPACE, you benefit from a team-based, coordinated approach that combines physical, mental, and lifestyle support. This model goes beyond standard single-discipline treatment, helping you recover faster, prevent re-injury, and return to the activities you love.

How does CARESPACE treat a PCL sprain differently?

At CARESPACE, you won’t just see one provider. Instead, you’ll receive a personalized care plan designed by a team that may include physiotherapists, chiropractors, massage therapists, kinesiologists, and fitness trainers. Each professional focuses on their area of expertise while coordinating closely with others, ensuring your knee heals properly while your overall health is supported.

For example, your care might start with a physiotherapy assessment to measure strength, stability, and range of motion. From there, you could be referred to:

• Massage therapy for pain relief and muscle relaxation.
• Chiropractic care to improve joint mechanics and reduce compensatory stress in your hips or spine.
• Kinesiology and fitness training to gradually restore performance, balance, and confidence in movement..

Why does a team approach help a PCL sprain recover faster?

A multidisciplinary model works because it addresses not only the injured ligament but also the whole body and mind. A PCL sprain can cause pain, swelling, and instability, but it can also lead to:

• Sleep disruption due to nighttime pain or bracing.
• Mental stress about returning to sport or work.
• Loss of confidence in knee stability.

CARESPACE integrates:

• Psychotherapy and mental performance coaching to help you cope with stress, anxiety, or fear of re-injury.
• Nutrition support to optimize healing through anti-inflammatory foods and proper fueling.
• Acupuncture and naturopathic medicine as natural methods to reduce pain and improve circulation.

This combination ensures that both your physical recovery and mental resilience are supported.

A coordinated journey: from acute pain to long-term strength

Your recovery plan at CARESPACE is structured around the three key phases of healing:

1. Acute phase (first days to weeks)

• Focus: Reduce pain and swelling.
• Interventions: Physiotherapy-guided rest, bracing, massage for muscle relaxation, and gentle mobility exercises.

2. Subacute phase (weeks to months)

• Focus: Restore range of motion, improve quadriceps strength, and rebuild balance.
• Interventions: Chiropractic adjustments, targeted strength training, supervised exercise therapy, and nutrition for tissue repair.

3. Maintenance phase (months and beyond)

• Focus: Prevent recurrence and return to sport or active living.
• Interventions: Advanced strength programs with a kinesiologist, sport-specific training, and mental performance coaching to rebuild confidence.

Compared to isolated treatment approaches, this integrated model ensures continuity of care—your providers share progress notes and adapt your plan as you recover, reducing gaps or duplication of care.

What makes CARESPACE’s approach unique for PCL sprain care?

Traditional treatment often focuses only on the knee itself. CARESPACE’s model is different because it:

• Coordinates multiple providers so you don’t have to manage separate care plans.
• Addresses the mental side of injury, including stress, insomnia, and loss of motivation.
• Provides natural, evidence-based strategies that work alongside medical care.
• Focuses on prevention by correcting biomechanics, improving posture, and building lifelong movement habits.

This approach lowers the risk of chronic pain, instability, or early arthritis, which can occur if a PCL sprain isn’t fully rehabilitated.

The bottom line: CARESPACE helps you recover stronger

A PCL sprain doesn’t just affect your knee—it impacts your daily life, work, sleep, and confidence. CARESPACE’s multidisciplinary care ensures every aspect of your recovery is covered, from hands-on pain relief to mental health and long-term prevention. With coordinated care, you don’t just get better—you return stronger, with tools to protect your health for the future.

Related Conditions for PCL Sprain

A PCL sprain can sometimes be confused with, or occur alongside, other knee injuries. For example, an ACL tear often causes similar instability, while meniscus injuries may produce locking or catching in the joint. MCL and LCL sprains can mimic medial or lateral knee pain and swelling, making proper diagnosis essential. In some cases, knee osteoarthritis or patellofemoral pain syndrome may coexist, especially if the knee has been unstable for a long period.

Because the knee is a complex joint, symptoms of one condition often overlap with another. If you experience persistent knee pain, instability, or swelling, your care provider may evaluate for multiple conditions at once to ensure nothing is overlooked.

Looking for information on a different condition? Visit our full Conditions List.