Treating a torn meniscus cartilage

Tearing your meniscus cartilage in the knee can be a very painful and debilitating injury. We know this first hand, as we have a severe and a moderate tear in each knee. It does not always mean surgery is required, even when it is recommended to us by our Specialist. Read on and get down to your Sports Physiotherapist for some assistance.

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​Meniscus Tear Rehabilitation

In the first instance of a tear, you will need to get medical assistance for a correct diagnosis and advice for the best way forward. Treatment can involve surgery if the knee is locking or there is advanced age/activity related degeneration. Loose cartilage can be trimmed and in some advanced more costly operations, some replacement can be made (just think of some of our elite athletes especially in first division football) .

The first port of call is to reduce inflammation. 
Ice 3 times a day for 10 minutes at a time across the front of the knee. Wrap a pack of frozen peas in a damp tea towel. Never ice around the entire knee. Never exceed 10 minutes of icing at a time. Repeat as much as you like, as long as the tissue has returned to its original colour and tone. If you have access to a swimming pool, water walking is great for reducing inflammation. Keep repeating until swelling subsides completely. Repeat as needed if swelling returns.

2. Tape the patella if it is suspected of mis-tracking. When the knee is injured, the quad muscles often lose their ability to anchor the patella adequately. Taping the knee cap to anchor it more medially is often a good idea. Use elastic therapeutic taping as it still allows unrestricted movement.  Kinesiology taping can be used for up to 5 days at a time if no allergy is present. Remove the tape slowly and carefully to avoided irritating the skin. Aim for two weeks of taping with a couple of days off to let the skin recover when the tape is due for a change. Stop if the skin is irritated.

3. Quadriceps stretch (front of thighs)
Grab hold of your ankle, take heel to bottom and keep your knees together. Repeat for other side. Perform again for the tighter quad. Do this stretch 5 X a day for two weeks and then review. We need to keep the quad muscles supple. If you find it hard to kneel, you need to keep practising this stretch.
Hold stretches for 20 seconds. If one side feels tighter than the other, perform the stretch again on the tighter side. When you feel symmetry, perform the stretch once per side.
Only perform when warmed up later on in the day. Modify if discomfort is present and stop if there is pain. Stretches should feel comfortable. If there is any shaking, release the stretch and attempt again with less effort. 

4. Strengthen the medial quad muscle with wide legged squats. Perform two sets of 10 twice a day for two weeks. Get a PT instructor to check your form if you are unsure, but aim to keep knees over the feet. A small range of movement is acceptable until you are able to get a little lower (never lower than 90 degrees however).

5. Try a single leg squat for the affected leg with a support strap to take most of your weight. Only do this if you have a strong and supportive strap/anchor. 2-5 X single leg squats once per day for two weeks.

6. If you have access to a gym, try a single leg press with the affected leg. Keep your foot flat against the platform and keep the weight very light indeed. 5-10 presses per day for two weeks, or for at least three days per week until you gain strength.

If there is pain, modify a technique or stop using the technique. 

7. Practise flexing and extending the knee. Start off by sitting on a tallish stool, and straighten and then bend the knee in a slow and controlled manner. Perform 2-4 times a day for two weeks. This can be done whilst standing and holding on to a surface for support. 

8. Develop your proprioception by standing on one leg for 10-20 seconds. When this is easy, try it with your eyes closed; but have something to steady you close-by, in case you lose balance. This exercise will strengthen your leg/ankle and re-develop any balance issues arising from the injury.

9. Other tips 

• Avoid activities that make the knee pain worse. 
• Make sure that you reduce tightness in the quad with sports massage, a foam roller or a massage stick (a rolling pin like massage stick with four revolving barrels to be used whilst sitting across the inside, mid and outer thigh). 
• Eat anti-inflammatory foods and spices/herbs (radishes, turmeric, cumin and black pepper). 
• Use anti-inflammatory essential oils such as German Chamomile - get help from a qualified Aromatherapist for suitability and safety.
• Use MSM (Methyl Sulphonyl Methane) to help reduce inflammation and pain. 
• Anti-inflammatory medicines may also have a place in your care regime for a limited time of a few days, but check with your Medical Professional first.
• Avoid impact sports until pain, swelling and range of movement have returned.
• Avoid sports with twisting movements as this can pinch the meniscus cartilage.
• Avoid maintaining an over flexed position of your knee by sitting on very low surfaces for prolonged periods of time, as this can encourage impingement.
• Review your progress and adapt the rehab programme after two weeks.

The overall aim of the programme is to:

1. Combat inflammation (feel around the knee cap for bogginess, sponginess and a delayed spring back of tissue post pressure application with a finger tip).
2. Anchor the knee cap adequately through strengthening the quads (our knees have good lateral support through the IT band, but poor medial support and this is often made worse during an injury as the quad muscles can not be used properly).
3. Keep the quads supple so we can have a good range of movement in the knee. 

This combination of flexibility and strength is key to managing most injuries. After two weeks of rehab review your progress. Is there any lingering inflammation? If so, continue with the icing and water walking. Is your knee feeling more comfortable? Can you feel the quad muscle on the inner knee getting stronger? Add another set of quad squat repetitions as long as there is no increase in pain. Continue for another two weeks and then review progress again. It can take three months of rehab to get to a more functional knee position once again. Then it will be a juggling act to maintain your progress, by keeping the quad strong and flexible, and being super vigilant for any inflammation flare ups or aggravating activities. Be aware that when you do return to activity, build up slowly and carefully so that your body adapts without any issues.

Author

Eva Evangelou, BA Hons, PGCE, Adv Diploma, ITEC & IFA Dips, is the UK Qualified Sports Massage Therapist behind Limassol Sports Massage. Being a Qualified Sports Massage Therapist has given her extensive training and experience in Injury Prevention, the Theory of Training and Injury Rehabilitation. She has been a Body Worker since 2004. Eva has run 3 full Marathons including Nicosia, Rome and the Limassol Marathon. She is usually injury free and believes that prevention via education is better than cure. She is the Author behind 'Say No! To Neck and Shoulder Pain' and she is a Qualified Teacher. Learn more about her by clicking here and contact her via email by clicking here.