I need some meniscus tear exercises. I think I tore it.

This was a statement from a colleague. She is an avid runner and came into work one day limping. Her knee began hurting on a run and was swollen and painful. The signs and symptoms were consistent with a meniscal tear. She was determined not to have surgery. The other physical therapists at the clinic, including myself, would treat her knee between patients. Luckily, she knew all the meniscus tear exercises to help. It did get better without surgery and she did return to running. However it did take several months. Read on to learn more about meniscus tears and how to treat them.

Now this is not the case for every meniscal tear. For one, there are several different types of tears and they can be in different areas of the meniscus. To better understand the meniscus and its role, let’s take a closer look at the knee.

Knee anatomy

The knee is the largest joint in the body. It is made up of the femur, tibia, and patella. The femur is the large thigh bone and it sits on top of the tibia which is the shin bone. These two bones create the tibiofemoral joint. The patella is the knee cap and slides along the lower part of the femur. This is the patellofemoral joint. These two joints make up the knee.

The menisci are attached to the top of the tibia and provide cushioning between the femur and tibia at the tibiofemoral joint. There are two menisci, the lateral meniscus and the medial meniscus. The menisci are crescent-shaped cartilaginous discs that act as shock absorbers for the knee. They also aid in stability of the knee.

“Blausen 0597 – Anatomy of the knee (Lateral view) – English labels ” by Blausen.com staff (2014), license: CC BY. Source: “Medical gallery of Blausen Medical 2014” https://en.wikiversity.org/wiki/WikiJournal_of_Medicine/Medical_gallery_of_Blausen_Medical_201

Much of the meniscus has no blood supply. Only the outer quarter is vascularized meaning that it has a blood supply. This is important because the outer portion is much more likely to heal if it is torn whereas the inner portion is unable to heal normally.

How do you tear your meniscus?

There are acute meniscal tears and degenerative meniscal tears.

Acute meniscal tears
- These type of tears are the result of an injury to the knee.
- The injury often occurs from an excessive force applied to a healthy meniscus. The most common mechanism of injury is twisting on a slightly bent knee that is planted on the ground.
- These tears are also associated with anterior cruciate ligament (ACL) and/or medial collateral ligament (MCL) tears.
- They commonly occur as a result of a sports injury.
Degenerative meniscal tears
- These tears are not the result of an accident or trauma.
- These can occur with a deep knee bend or just an awkward twist.
- The meniscal tissue tears because of deterioration from wear and tear.
- They normally occur after the ages of 40 or 50.

Who gets meniscal tears?

Anyone can tear their meniscus. It is very common and is one of the most prevalent knee injuries that I treat. Meniscal tears are very common in athletes and are often accompanied by other ligament injuries as well. During a sports injury, the ACL and/or the MCL might tear along with the meniscus. The medial meniscus is more commonly injured than the lateral meniscus.

Meniscal tears are also prevalent in older adults as well. As we age, it creates more wear and tear on the menisci. This makes them easier to injure. A very deteriorated meniscus could tear with little or no stress. However I also have noticed that older adults are staying active longer and this is also contributing to more meniscus tears in that population.

What are the symptoms of a meniscus tear?

There are symptoms that are indicative of a meniscal tear. These include:

A sharp, intense pain in the knee
A pop or tearing sensation for acute injuries
Swelling at the knee
Difficulty walking
Difficulty going up and down steps
Catching or locking at the knee
Difficulty straightening or bending the knee

Is surgery necessary?

Not all meniscal tears require surgery. There are many factors to consider when deciding if surgery is necessary. These include the type of tear, the activity level and age of the patient, the location of the tear, and if the person is responding to conservative treatment. There are two types of surgery for the meniscus – meniscectomy and meniscal repair. A meniscectomy is a surgery that removes the torn area of the meniscus. Recovery is usually pretty quick from this surgery. A meniscus repair is a procedure in which the surgeon repairs the piece of torn meniscus. This procedure is more common in young athletes especially if the tear is in conjunction with an ACL reconstruction. The recovery from meniscal repair is much more involved than a meniscectomy.

For the majority of us who are not young athletes, it is preferable to attempt conservative treatment before surgery. Conservative treatment includes physical therapy, medications for pain relief and inflammation, and self-management strategies. There are some types of tears that will not respond to this treatment and surgery would be appropriate for those individuals. Some indications that conservative treatment is not going to work would include continued locking and catching in the knee, swelling and loss of motion, and increased pain in the knee with sports or daily activities.

How can physical therapy help?

Physical therapy can help decrease the pain and inflammation, decrease the swelling, and improve the ability to fully bend and straighten the knee. PT can provide strengthening and stretching exercises to stabilize the knee. It can also help the person gradually return to all previous activities including sports or recreational exercise. PT may or may not be needed after a meniscectomy but is required after a meniscus repair.

What can I do at home?

There are many things you can do at home to aid in your recovery. These include:

Ice – This is very important right after the injury. Ice the knee with an ice pack several times a day right after the injury especially if there is a lot of swelling. Elevate the knee above the level of the heart while icing to decrease the swelling. This can be done by lying on a couch and propping the leg up on a few pillows. Ice for about 20 minutes. Place a thin barrier, like a pillow case, between your skin and the ice pack. You can continue to ice even after the initial injury especially if there is still pain and swelling.
Range of motion exercises – These are very important to perform after the initial injury. They are very simple exercises designed to increase mobility of the knee while preventing the knee from getting overly stiff while recovering. They should be performed several times a day during the initial recovery. See the video below for some range of motion exercises for the knee.

Flexibility exercises – These exercises are focused mainly on the stretching the quadriceps, hamstrings, and the calf muscles. These muscles surround the knee and will tighten up when there is an injury to the knee. Improving the flexibility of these muscles will aid in the mobility of the knee. See the video below for instructions in how to stretch these muscles. You will need a stretch strap, dog leash, yoga strap, or something similar.

Strengthening exercises – There are a couple of different phases of strengthening when rehabbing from a meniscus tear. These include weight bearing and non-weight bearing exercises. Weight bearing refers to putting weight through the joint. Examples of weight bearing include standing, running, walking – basically anything performed when standing on your feet. Non-weight bearing exercises are to be performed first to start strengthening the muscles with no impact through the knee joint. Once some healing has occurred and the person can walk/stand with little discomfort then it is time to progress to weight bearing exercises. All of these exercises will focus on strengthening muscles around the knee and hip, especially the quadriceps. The quadriceps is the large muscle in the front of the thigh. When there is an injury to the knee it tends to shut down. This can lead to the feeling of the knee giving out. It is important to turn that muscle back on asap. Using resistance bands or ankle weights can add resistance and strength. See the video below for weight bearing and non-weight bearing exercises.

Bracing – A brace or knee sleeve can be helpful in decreasing pain and swelling. It can also provide feelings of support and increase stability when returning to previous sports or recreational activities.

In review

The menisci are crescent-shaped cartilaginous discs that act as shock absorbers for the knee.
There are two types of meniscus tears.
- Acute – common in athletes
- Degenerative – common after age 40
You may or may not require surgery
Physical therapy plays a large role in conservative treatment for meniscus tear.
There are many things that you can do to help your meniscus heal.
- Ice
- Range of motion exercise
- Stretching
- Strengthening – especially quadriceps
- Bracing