Physical Therapy for Torn Meniscus
Physical therapy for Torn Meniscus
An Updated Approach to Treating Meniscus Tears
A 15 year old soccer player is running down the field toward the goal. The ball comes their way and they plant their left foot and turn to kick the ball with their right. The ball sails into the goal but the player feels a sharp pain in their left knee as they jump up to celebrate.
What happened? Well, they may have just torn their meniscus.
MEET THE MENISCUS
The menisci (plural for meniscus) are small but important structures found in the knee. So important, in fact, that you have not one but two menisci on each side. The knee, anatomically known as the tibio-femoral joint, consists of the articulation between the end of the femur, or long thigh bone, and the flattened top portion of the lower leg or tibia bone. As you probably know, the job of the knee joint is to bend and straighten while you walk, run, jump and squat. There are quite a few structures within the knee that provide it strength and stability. One–or rather two–of those structures are the menisci.
The menisci are wedged, c-shaped discs anchored onto the flattened end of the tibia bone. There is one on the medial (inner) side and one on the lateral (outer) side and they curve toward one another. Their job is both to act as shock absorbers/cushions in the knee and to help stabilize the knee joint. Because of their location within the joint, these little cushions are subject to the stress and strain of all of the activities we do throughout our life while on our feet.
HOW DO MENISCI GET INJURED?
If you think about all of the running, jumping, squatting, and stair climbing you’ve done throughout your life so far, you can imagine that the knees take on a lot of stress. Meniscus injuries, like any injury, occur when the stress or strain on the tissues of the meniscus becomes too great. When this happens, the meniscus can tear. Tears can be categorized as acute/traumatic tears which usually occur when leg is twisting while the foot is planted or as degenerative tears which occur in response to wear and tear over time. In either case, meniscus tears can be uncomfortable and painful and interfere with a person’s ability to walk and be active.
HOW DO I KNOW IF I’VE INJURED MY MENISCUS?
Meniscus injuries are definitively diagnosed using imaging technology like MRI or CT scan to visualize the tear. Clinically, however, we look for certain signs and symptoms such as:
An audible or felt pop
Pain in the knee joint on the inside (medial), outside (lateral), or back of the knee
Swelling
Catching or locking of the knee joint
Pain with walking
Inability to fully bend or straighten the knee
Pain when twisting the knee
Feelings of the knee giving out
These are signs and symptoms of a symptomatic meniscus tear but guess what? Not all meniscus tears are symptomatic. In fact, imaging studies have found incidental and asymptomatic meniscus tears in up to 5% of young people and up to 67% of older adults. In fact, the presence of a meniscus tear on imaging is not predictive of knee symptoms in middle age or older adults. It is associated with the presence of osteoarthritis in older adults, but not directly linked to symptoms. This is more evidence that as physical therapists, we treat symptoms, not imaging.
WHEN DO I NEED TO SEEK TREATMENT?
If you are experiencing knee pain or stiffness, locking or catching, instability or swelling it is time to have your knee examined. Physical therapists assess the knee through clinical tests like the Apley’s or McMurray’s tests and through palpation and examination of the knee. In the case of an acute or traumatic tear, the mechanism of injury combined with the symptom report may point your PT in the direction of suspecting a meniscus tear but they will also examine other structures in the knee. Due to the mechanism of injury with a meniscus tear, other structures in the knee such as the anterior cruciate ligament (ACL) or medial collateral ligament (MCL) may be injured at the same time. If your PT suspects a torn meniscus they will likely refer you to an orthopedist for further assessment.
PEACE & LOVE FOR MENISCUS TEARS
The acronym R.I.C.E used to be the standard of early treatment for an acute injury like a meniscus tear.
R: Rest
I: Ice
C: Compression
E: Elevation
Current practice guidelines continue to evolve, and many therapists now preach P.E.A.C.E. & L.O.V.E., baby. This creative acronym outlines a new, more active approach to addressing soft tissue injuries like a meniscus tear and you may encounter this approach you work with your physical therapist. Let’s take a deeper look at it. (*Note, this does not apply directly to post-surgical cases and as every case is different, your therapist or physician may still recommend ice and anti-inflammatories to manage pain and swelling)
(P)rotection: Protecting the injury in the first week or so is important to minimize disruption of early healing tissues which are still vulnerable. This includes avoiding activities that increase pain and swelling and sometimes modifying weight bearing with crutches or a walker.
(E)levate: elevate the limb above the heart as often as possible to allow swelling to drain from the area. You can achieve this by lying down and raising your leg on a stack of pillows.
(A)void taking anti-inflammatories: Unless recommended by your physician for other reasons, it may be beneficial to avoid interfering with the inflammatory process which is actually a necessary part of the healing process as it helps clear away unwanted debris and usher in helpful cells. This can apply to ice as well.
(C)ompression: apply an elastic band or taping around the knee to minimize swelling
(E)ducation: Your PT will educate you on how to protect the knee during the early healing phase and how to support your body in it’s natural healing process
AND
(L)oad: Gradually loading the tissues is important after the first week. The presence or absence of pain and inflammation will be your guide.
(O)ptimism: focus on what you can do and remain optimistic about your body’s power for healing
(V)ascularization: choosing pain-free cardiovascular training will increase blood flow to healing tissues
(E)xercise: Graded exercises should be used to help restore normal strength, balance, flexibility and proprioception in accordance with your stage or healing
While this acronym may seem a bit complicated, you won’t have to go through it alone. If you are dealing with a torn meniscus or think you may be, schedule an evaluation with one of our knowledgeable physical therapists and we will help you get on the road to recovery.
Click here to find out more information about physical therapy for a torn meniscus
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