A Physical Therapy Guide to Meniscus Tears
You may have read news articles recently stating that surgery is no longer necessary for meniscus tears. Scientific research has undoubtedly evolved over recent decades, and surgery is not always the go-to treatment for a meniscus injury as it once was. While surgery still has its place, there are many instances when a physical therapist is the best person to help you with your torn meniscus injury.
Physical therapy effectively manages knee pain and dysfunction caused by a torn meniscus. Plus, working closely with a physical therapist can reduce your long-term risk of developing arthritis and chronic knee pain. Continue reading to learn more about how a CityPT physical therapist can help you assess and recover from an injury to your meniscus.
- Understanding a Meniscus Tear
- Symptoms of a Meniscus Tear
- What are the Most Common Causes of a Meniscus Tear?
- Diagnosing a Meniscus Tear
- What to Expect from Physical Therapy
- Preventing Meniscus Tears
- Is It Time to Seek Treatment?
You have two menisci in each knee, medial and lateral. When viewed from above, they are crescent-shaped. In cross-section, they are shaped like a wedge. The meniscus transmits force vertically across your knee. The meniscus absorbs shock and transfers weight when you push through your legs, such as walking, running, jumping, or climbing stairs.
Interestingly, the meniscus does not merely serve a mechanical role during physical activity. The menisci also protect the knee joint and cartilage over time.1 They may also contribute to proprioception — your ability to sense the position of the joint — in your knee.2
A sudden awkward movement, such as a forceful twist, may cause an acute meniscus tear. A succession of micro-injuries over time may cause a chronic knee meniscus tear. Below, we discuss whether chronic changes to the meniscus may be a "normal" part of aging.
Acute meniscal tears can occur in athletes and people who are less active. In general, chronic meniscal tears tend to occur more in older individuals.
Many of the common symptoms of a meniscus tear are similar to other knee injuries, such as pain and swelling and difficulty bearing weight or climbing stairs. If it is an acutely (traumatic) injured knee, you may notice a painful pop at the moment of injury with an inability to put any weight on that leg. With chronic or acute meniscus injuries, you may also experience the following:
- Knee pain along the joint line
- Difficulty walking
- Sensation of catching or locking when moving the knee
- Difficulty fully straightening or bending the knee
Some people even have meniscus tears without any symptoms and can live their lives normally. This is particularly true of older individuals with chronic meniscal tears. In one study, asymptomatic people had their knees imaged. Among those over age 70, more than 50% had meniscus tears or damage without any symptoms.3 In addition to older individuals, this may be the case for athletes. In one study of asymptomatic athletes, meniscus pathology was present in over 30% of those able to compete or participate in their sport.4
Just as you develop wrinkles on your skin with age, the same may occur inside your body. The types of peer-reviewed studies referenced above indicate that chronic meniscal "damage" may not be anything to cause alarm as long as it's not causing you any difficulty.
A knee meniscus tear results from a sudden force or a succession of repeated forces across the meniscus. When the force is too much for the local tissues, a tear occurs. This could occur with squatting, pivoting, or even sudden misstep.
People participating in certain sports, such as football, soccer, basketball, and wrestling, are at a higher risk.5
There is also a higher incidence among people who work in occupations that require repetitive activities such as squatting, lifting, and carrying weights greater than 10-20kg.6
Before any assessment, your physical therapist will have you describe the details of your injury, how it happened, and what symptoms you have been having since sustaining the torn meniscus. Your physical therapist will then perform several tests and measures to determine whether a meniscus tear is likely:
- Observing your walking and other movements.
- Measuring your knee range of motion and strength.
- Performing special tests that apply stress to the meniscus to help determine the likelihood that a torn meniscus contributes to your knee pain and symptoms.
Historically, a meniscectomy—partial or total removal of your meniscus—was the typical treatment for a torn meniscus. However, more recent research shows conservative treatment, such as physical therapy, to be as effective, if not more effective, than surgical removal.7,8,9 Thus, in most cases, it's best to avoid surgery.
In very few instances, a surgical repair is indicated. The type of situation that would warrant surgical repair would be an acute tear in young adults or an athletic person when the meniscal tear occurs in a region with good blood flow.10 If your physical therapist believes this is the case after evaluating you, they will refer you to an orthopedic surgeon. The surgeon would likely recommend magnetic resonance imaging and possible repair surgery, based on their interpretation of the imaging.
Once your physical therapist performs your evaluation and diagnosis of your meniscal tear, they will recommend a plan of care based on their assessment results.
Initial symptom management
For initial physical therapy treatment, your therapist may recommend icing for short durations throughout the day to help with the pain. They may also recommend compression wrapping to reduce swelling if there is any.
Range of motion
You and your therapist will likely initially focus on restoring your range of motion through the knee joint. Each physical therapy session will teach you exercises to perform daily to help you regain the ability to bend and straighten your knee. They may perform manual therapy—hands-on stretches, joint mobilizations, and therapeutic massage to the area to enhance the recovery process.
Your therapist will also guide you through progressive exercises to help your strength, control, and confidence to return over time. The types of physical therapy treatments and exercises are similar if you have undergone a meniscectomy or have not had surgery. Initial physical therapy exercises include straight leg raises, hamstring curls, and heel slides. Then, advanced exercises specific to your needs will be added when your knee is ready.
The ultimate goal of these exercises is for you to return to your prior level of activity: your occupation, your daily routine, or your sport. A secondary goal would be to help you develop the quad muscle strength and coordination necessary to protect the knee joint and decrease the risk of future injury in the long term. Read more about physical therapy for injury prevention below.
After a surgical meniscal repair, your surgeon will likely recommend physical therapy. The initial 4-6 weeks tends to involve a strict protocol of non-weight bearing on your repaired side: using crutches for all standing and walking.
Your physical therapy sessions will follow rehabilitation guidelines to gradually restore your range of motion, strength, and control and to return to your prior level of athletic performance.
What If Conservative Treatment Doesn't Work?
When weighing the pros and cons of physical therapy versus surgery, new research shows that knee surgery is not always the best choice (as once thought) due to its correlation with arthritis and chronic knee dysfunction.1,2
Most people with a meniscus tear do well with a conservative approach (physical therapy treatment). If the symptoms do not improve even after working with a physical therapist, then you may be a candidate for surgery, likely an arthroscopic surgery called a meniscectomy, as described above.
Furthermore, if you participated in physical therapy pre-operatively (before your knee surgery), you will have the advantage of going into surgery with a stronger and more flexible knee, improving your outcomes after surgery.
Unfortunately, there is not a lot of research yet about how to prevent a torn meniscus, in particular. General tips for injury prevention and better health include:
- A good warm-up before engaging in sport or strenuous activity
- Training and cross-training to keep your body prepared for the physical demands of your sport or occupation
- Proper hydration and nutrition
- Adequate sleep
- Stress management
- Physical therapy to assess any concerns related to your sports, hobbies, and other activities
Other factors, such as obesity, hypertension, or diabetes, may also increase the risk of musculoskeletal-related injuries (such as meniscal tears). However, it is still being determined how much those conditions impact the risk of an injury if we control for other lifestyle factors, such as nutrition or physical activity.
If you suspect a meniscus tear — whether you recently injured your knee or you experience chronic knee problems — a physical therapist will help you get your diagnosis figured out and guide you on the path to recovery.
CityPT can connect you to a therapist with training and experience in knee conditions and sports. Click to book with one of our skilled clinicians.
This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.
Roemer FW, Kwoh CK, Hannon MJ, et al. Partial meniscectomy is associated with increased risk of incident radiographic osteoarthritis and worsening cartilage damage in the following year. Eur Radiol. 27, 404–413 (2017). https://link.springer.com/article/10.1007/s00330-016-4361-z. Accessed July 26, 2022. ↩ ↩2
Basar B, Basar G, Aybar A, Kurtan A, Basar H. The effects of partial meniscectomy and meniscal repair on the knee proprioception and function. J Orthop Surg (Hong Kong). 2020 Jan-Apr;28(1). [https://journals.sagepub.com/] (https://journals.sagepub.com/doi/pdf/10.1177/2309499019894915). Accessed July 26, 2022. ↩ ↩2
Englund M, Guermazi A, Gale D, et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med. 2008; 359:1108-1115. https://www.nejm.org/doi/full/10.1056/nejmoa0800777. Accessed July 12, 2022. ↩
Beals CT, Magnussen RA, Graham WC et al. The prevalence of meniscal pathology in asymptomatic athletes. 2016. Sports Med. 46:1517–1524. https://link.springer.com/article/10.1007/s40279-016-0540-y. Accessed July 12, 2022. ↩
Gee SM, Tennent DJ, Cameron KL, Posner MA. The burden of meniscus injury in young and physically active populations. Clin Sports Med. 2020 Jan. 39(1):13-27. https://pubmed.ncbi.nlm.nih.gov/31767103/. Accessed July 12, 2022. ↩
Bahns C, Bolm-Audorff U, Seidler A, et al. Occupational risk factors for meniscal lesions: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2021 Dec. 22. https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-021-04900-7#article-info. Accessed July 12, 2022. ↩
McDermott ID, Amis AA. The consequences of meniscectomy. 1 Dec 2016.Bone Joint J. https://online.boneandjoint.org.uk/doi/full/10.1302/0301-620X.88B12.18140. Accessed July 12, 2022. ↩
Beaufils P, Pujol N. Management of traumatic meniscal tear and degenerative meniscal lesions: save the meniscus. Orthop Traumatol Surg Res. 2017 Dec;103(8S):S237-S244. https://www.sciencedirect.com/science/article/pii/S1877056817302311?via%3Dihub. Accessed July 12, 2022. ↩
Sihvonen R, Paavola M, Malmivaara A, et al. Arthroscopic partial meniscectomy for a degenerative meniscus tear: a 5 year follow-up of the placebosurgery controlled FIDELITY (Finnish Degenerative Meniscus Lesion Study) trial. Br J Sports Med. 2020 Aug;54:1332–1339. https://bjsm.bmj.com/content/bjsports/54/22/1332.full.pdf. Accessed July 12, 2022. ↩
Mordecai SC, Al-Hadithy N, Ware HE, Gupte CM. Treatment of meniscal tears: an evidence based approach. World J Orthop. 2014 Jul 18;5(3):233-41.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4095015/#B20. Accessed July 12, 2022. ↩