Your Guide to Meniscal Injuries
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 & follow the steps to your full recovery. Understanding the goals of your treatment & 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 & problems can occur in any age group. In younger people the meniscus is fairly tough & rubbery & tears usually occur as a result of a forceful twisting injury during sporting activities. The meniscus grows weaker with age, & 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) & lateral (outer) menisci are horseshoe shaped pieces of cartilage situated in your knee joint between your thigh bone (femur) & shin bone (tibia). They are designed as shock absorbers when we are weight bearing & spread the forces transmitted through the joint as we walk, run & 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, & pain & swelling may develop over 24-48 hours. With a larger tear, pain, swelling & restriction of motion will develop immediately or soon after the injury & 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.
What Happens If I Don`t Fix My Knee?
Left untreated a torn meniscus can cause long-term problems. The displacement of the torn fragment usually causes the knee to lock & 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.
How Long Does It Take To Get Fully Better?
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, & 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 & possible keyhole surgery (arthroscopy). Your physio will discuss this further with you if necessary.
Your journey to peak performance with Central Physio
Your physio has been extensively trained to thoroughly assess & 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 & timing of the phases are tailored individually for you & so may vary form this list. Please feel free to ask your physio if you have any questions about your recovery plan.
Phase 1: Optimise & Control Inflammation
Inflammation is the redness & 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 & compression support. Sometimes we will use taping or Kinesio-Taping to help support your knee & help settle down your symptoms faster. Your physio will also discuss rest from aggravating activities & anti-inflammatory medications if needed. More severe meniscal injuries may require bracing or crutches.
Phase 2: Restore Range Of Motion
Meniscal injuries usually result in some loss of knee bending, straightening or both. The kneecap can also become irritated due to swelling & limping & 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 & massage, physio-assisted stretches, muscle re-activation drills & stationary cycling. You will also be given exercises at home to reinforce these clinical techniques.
Phase 3: Restore Muscle Length
This phase follows on from restoring movement in your knee & involves more intense stretching of the muscles around your knee. These muscles may have tightened up in response to the injury, eg. quadriceps & hamstring tightness, or they may have already been tight & so predisposed you to a knee injury, eg. the iliotibial band. This phase uses soft-tissue releases & focussed stretches in the clinic & for you to do at home.
Phase 4: Specific Muscle Strengthening
When you have a meniscus injury some muscles surrounding & controlling your knee become weak due to swelling, pain & disuse. It is important to restore the strength to these muscles because they are vital in providing the control & 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, & will ensure your home program is quick & 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.
Phase 5: Correct Biomechanics
Your biomechanics (how you move) play a big role in causing, repairing & preventing knee problems. When you have poor foot or hip biomechanics your body is not working as well as it could, & this puts extra strain on your knee. Correcting your biomechanics is an important step in helping your current problems settle down, & 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 & examining training techniques. We often make extensive use of video to help you see & 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 & how you can improve your movements patterns to enhance your performance.
Phase 6: Sports/Ballistics & Advanced Strengthening
This is the last phase of your recovery plan & is essential for getting back to your previous level of performance & preventing re-injury. You need to be able to move at full speed & 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 & increased risk of re-injury.
This phase is achieved by doing advanced sports-specific strengthening & high speed movements combined with rapidly changing directions. Exercises are tailored specifically to your activity to ensure correct technique, co-ordination & strength are restored.
Many clients find that seeing one of our Exercise Physiologists, Strength & Conditioning coaches or Personal Trainers is a great way to build strength, ability & 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 & strength. As well as being an important part of your rehab program these services can help you lift your sports performance whilst staying safer & reducing your risk of future injury.
For more information or to speak with one of our physio’s to discuss your symptoms please call us on 9280 2322 or contact the clinic.