This information has been prepared to help you fully understand your condition so you will be in the best position possible to work with your physio and follow the steps to your full recovery. Understanding the goals of your treatment and having complete confidence in your physio are vital elements of your recovery plan, so if you have any questions then please feel free to ask your physio.
The meniscus is a commonly injured structure in the knee and problems can occur in any age group. In younger people the meniscus is fairly tough and rubbery and tears usually occur as a result of a forceful twisting injury during sporting activities. The meniscus grows weaker with age, and meniscal tears can occur in ageing adults as the result of fairly minor injuries, even from the up-and-down motion of squatting.
The medial (inner) and lateral (outer) menisci are horseshoe shaped pieces of cartilage situated in your knee joint between your thigh bone (femur) and shin bone (tibia). They are designed as shock absorbers when we are weight bearing and spread the forces transmitted through the joint as we walk, run and squat etc. They also enhance the stability of the knee joint by forming a shallow socket for the femur to sit in. The entire rim of the medial meniscus can be torn in what is called a bucket handle tear. The meniscus can also have a flap torn from the inner rim.
The symptoms of meniscal damage will vary depending on the severity of the tear. If it is only a minor tear then it may not cause immediate symptoms, and pain and swelling may develop over 24-48 hours. With a larger tear, pain, swelling and restriction of motion will develop immediately or soon after the injury and you may feel a tearing sensation in the knee. There may also be intermittent locking of the knee joint as the flap of the torn meniscus is caught or impinged in the knee joint. The pain is often felt along the line of the knee joint or it may be diffuse throughout the whole knee.
Left untreated a torn meniscus can cause long-term problems. The displacement of the torn fragment usually causes the knee to lock and give way, making normal function impossible. Constant rubbing of the torn meniscus on the articular cartilage may also cause the joint surface to become worn, leading to knee osteoarthritis.
The menisci are slow healers due to their poor blood supply—if there were blood vessels entering the menisci they would be squashed every time you put weight on the knee! Depending on the severity of the tear it may take 6-12 weeks to get back to full activity, and the sooner you start treatment, the faster your recovery will be. If your knee does not improve as expected with physio then it may be necessary to see an orthopaedic surgeon for an MRI and possible keyhole surgery (arthroscopy). Your physio will discuss this further with you if necessary.
Your physio has been extensively trained to thoroughly assess and diagnose your injury. They will give you a step-by-step recovery plan to make your treatment easier for you to understand. The most common phases, or steps, that you will go through during your recovery plan are outlined below. The order and timing of the phases are tailored individually for you and so may vary form this list. Please feel free to ask your physio if you have any questions about your recovery plan.
Inflammation is the redness and swelling that occurs whenever you injure yourself. Our bodies need inflammation to start the normal healing process but we also need to control it.
Techniques your physio may use to manage your inflammation include specific local massage, ice and compression support. Sometimes we will use taping or Kinesio-Taping to help support your knee and help settle down your symptoms faster. Your physio will also discuss rest from aggravating activities and anti-inflammatory medications if needed. More severe meniscal injuries may require bracing or crutches.
Meniscal injuries usually result in some loss of knee bending, straightening or both. The kneecap can also become irritated due to swelling and limping and stops moving as freely. It is vital to restore full movement to be able to return to normal activity.
Techniques your physio may use to restore movement in your knee include joint mobilisations, soft tissue releases and massage, physio-assisted stretches, muscle re-activation drills and stationary cycling. You will also be given exercises at home to reinforce these clinical techniques.
This phase follows on from restoring movement in your knee and involves more intense stretching of the muscles around your knee. These muscles may have tightened up in response to the injury, eg. quadriceps and hamstring tightness, or they may have already been tight and so predisposed you to a knee injury, eg. the iliotibial band. This phase uses soft-tissue releases and focussed stretches in the clinic and for you to do at home.
When you have a meniscus injury some muscles surrounding and controlling your knee become weak due to swelling, pain and disuse. It is important to restore the strength to these muscles because they are vital in providing the control and support that your knee needs to be able to return to normal activities.
Your physio will guide you through specific exercises to strengthen your muscles, and will ensure your home program is quick and easy whilst still being highly effective. In the clinic you may use an EMG biofeedback machine to help you switch on the right muscles at the right time.
Your biomechanics (how you move) play a big role in causing, repairing and preventing knee problems. When you have poor foot or hip biomechanics your body is not working as well as it could, and this puts extra strain on your knee. Correcting your biomechanics is an important step in helping your current problems settle down, and also in minimising the chance of more problems in the future.
Techniques used to correct biomechanics include specific muscle strengthening drills, Gaitscan Custom Orthotics, supportive taping and examining training techniques. We often make extensive use of video to help you see and correct movement problems. Your physio may also recommend a Biomechanical Assessment with our exercise physiologist to help determine which movement patterns may have contributed to your current problem, which movement patterns may cause problems in the future and how you can improve your movements patterns to enhance your performance.
This is the last phase of your recovery plan and is essential for getting back to your previous level of performance and preventing re-injury. You need to be able to move at full speed and with full force in training first, before returning to your normal level of sport. Persisting background weakness or poor co-ordination will lead to inferior performance and increased risk of re-injury.
This phase is achieved by doing advanced sports-specific strengthening and high speed movements combined with rapidly changing directions. Exercises are tailored specifically to your activity to ensure correct technique, co-ordination and strength are restored.
Many clients find that seeing one of our Exercise Physiologists, Strength and Conditioning coaches or Personal Trainers is a great way to build strength, ability and confidence for a smooth return to full sporting activity. If Pilates is more your style then our great Sports Pilates program is an ideal way for you to continue to build your stability and strength. As well as being an important part of your rehab program these services can help you lift your sports performance whilst staying safer and reducing your risk of future injury.