Meniscus tears are the most common knee injury, frequently occurring in the athletic and senior populations. This injury occurs due to a trauma involving bending or twisting the knee, or may develop over time from repeated wear and tear. However, don’t let a small tear slow you down—there are measures you can take to possibly avoid surgery and get back on your feet!
The menisci are cartilage strips on the lateral and medial sides of the knee, which act as shock absorbers to reduce the stresses between the tibia and the femur. Meniscus tears occur in patients of all ages. They commonly occur alongside other knee injuries, such as MCL (medial collateral ligament) and ACL (anterior cruciate ligament) sprains or tears. In fact, athletes often suffer from what is referred to as “the unhappy triad,” ACL, MCL, and medial meniscus tears.
While some severe meniscal tears require surgery to repair, small tears can be treated conservatively with rest and therapeutic exercise.
A tear in the meniscus typically occurs directly in the joint line. If the lateral meniscus tears, pain is felt on the outside of the knee, whereas a medial meniscus tear is felt on the inside of the knee. The medial meniscus is the most common to tear.
Pain is commonly most present when pivoting while bearing weight on the knee and with deep bending. In severe cases, walking and climbing stairs can be painful.
Patients may hear clicking, feel catching, or experience locking (inability to completely straighten knee) during motion.
A meniscus tear can prevent normal pain-free motion of the knee. Pain and swelling in the knee occurs in most cases. When the brain receives a signal from the meniscal tissue that there is a tear (via nerve endings), it creates an inflammatory response. This is part of the healing process, but can involve painful swelling in the injured region. The swelling, even a small amount, can shut down the activity of the quadricep muscle—this further weakens the integrity of the knee. Exercise to re-engage and strengthen the quadricep is critical to recovery, as is correcting the root cause of the misalignment that led to the issue.
Many instances of meniscus tears, especially traumatic ones, are freak occurrences that are due to mechanical forces acting on the knee that exceed the body’s ability to withstand it. As stated, acute tears are common in athletes, but also those whose professions focus on manual labor, such as construction workers.
In the case of chronic degenerated menisci that start to fray, the usual culprit is a combination of muscle weakness, especially in the quadriceps and glutials, and a pattern of misalignment. These muscles, when strong, act to take the pressure off of the menisci. When they are not working properly, typically due to misalignment of the knee, the menisci absorb more shock than they are intended to and suffer small tears.
Degenerative meniscal tears are common in the elderly, obese people, and smokers.
- Stay in shape. Make sure you have a good level of overall fitness and conditioning before playing sports. Many MCL tears occur in “weekend warrior” athletes. Weekend warrior athletes are not necessarily in top shape and do not work out consistently, but play sports on weekends. When you become fatigued, your form and technique can begin to break down. By staying in shape during the week through a combination of resistance training and cardio, you’ll have the strength and endurance to avoid injury on weekends.
- Stay slim! It is hypothesized that each pound of body weight over what is considered your ideal body weight yields four extra pounds of force on the knee joint; that is four extra pounds of stress. This extra stress results in a potential loss of mobility and knee strength that can ultimately lead to injury.
- Strengthen your legs outside the gym. When standing, keep feet and knees pointed forward. Imagine a dot on the side of the big toe, inner ankle bone, inner knee and lesser trochanter: align those dots and push down through the base of the big toe to align and strengthen the inner leg line. Now, imagine a dot on the side of the pinky toe, outer ankle bone, outer knee and greater trochanter: align those dots and push down through the base of the pinky toe to align and strengthen the outer leg line. By aligning and strengthening your inner and outer leg lines, you strengthen the muscles that help support the knee.
- Ground your feet. With any knee injuries, there may be a tendency to favor the inside edge of your foot, so the inner edge of the sole bears the body’s weight (pronate); or the outside edge of your foot, so the outer edge of the sole bears the body’s weight (supinate). Take time to evaluate your feet, and equalize your weight on the bases of your toes so the weight from the base of your big toe to the base of your pinky toe is equalized. Then, maintaining the equalization of weight on the bases of your toes, equalize the weight on the right side of the heel and the left side of the heel. Notice how your body weight is fully supported by your grounded feet.
- Pay attention to your alignment. Imagine a straight line from the middle of your knee, down the middle of your shin, and ending right between your second and third toes. Try to maintain this alignment while seated in a chair, while bending to pick up items off the floor, and while standing and talking to a friend. Being aware of alignment in everyday life strengthens the muscles to appropriately support your body, especially when playing sports or being active. Avoid injury by keeping your knees in correct alignment.
- Listen to your body. Fatigue results in poor technique. If your body feels fatigued, rather than push yourself to keep moving and risk injury, bring your workout to a close and end with stretching.
- Lie on your back with legs outstretched.
- Bend your unimpaired knee and ground the foot into the mat.
- Lift the straight leg until it aligns with the bent knee.
- Perform three sets of twenty-five repetitions with each leg.
- Lie on your side with your bottom knee bent and your head resting in your hand.
- Inhale; lift the top leg. Exhale; lower the top leg.
- Perform three sets of twenty-five repetitions with each leg.
- Lie on your back with knees bent and feet grounded.
- Lightly pull the injured leg in toward the chest to lift off the ground. Push down through the foot on the floor.
- Lift seat off the ground. Hold for three counts and return to the start position.
- Perform three sets of fifteen repetitions on both sides.