Physical Therapy for Meniscus Tears
The knee equivalent of of a low back disc herniation is the meniscus tear. That is to say, they are very common, people are typically very afraid of them, and patients tend to think they need MRIs and surgery to fix them. The truth, as always, is a little more complicated.
What are menisci?
Menisci are tough c-shaped cartilage inside your knee joint. Knees have both a lateral (outer) and medial (inner) meniscus. Their primary roles are load transmission, joint lubrication, shock absorption, and proprioception—your ability to sense where your knee is in space.
Meniscus tears are the second most common injury to the knee—so yes, they happen very frequently. Tears fall into two categories—traumatic and degenerative. Traumatic tears typically happen between the ages of 18-35 and usually involve an injury from twisting, pivoting, or changing direction while weight bearing—think soccer, football, or other field sports. Degenerative tears are mostly found in people over 35, more common in the medial meniscus, and typically feel like a dull ache that can cause sharp pain with certain movements.
There aren’t any nociceptors (sensory pain receptors) in the meniscus. The pain you feel is actually coming from the outermost attachments of the meniscus, the knee joint capsule, or the altered sense of joint position due to the role menisci play in proprioception.
So if you think you have a meniscus tear—traumatic or degenerative—what should you do next? Get an MRI? Not so fast…
16% of asymptomatic patients (those with no pain or instability) had evidence of meniscus tears on MRI. That number increases to 36% when looking at patients >45 years old, and skyrockets to 89% in people over age 50. However, only 29% of those people had knee pain in the previous month. This is more evidence that findings on MRI may not be correlated with symptoms and might be doing more psychological harm than good.
Here’s some good news
Whether you get an MRI or not, the conservative (non-surgical) treatment for a meniscus tear is the same—unload the knee to decrease symptoms and then load the tissues back up. When I treat meniscus tears at MOTION RX, I modify any exercises that cause pain to less than 3/10 while working on improving strength. Movement is the key. Movement has been shown to cause a 4-fold vascular (blood flow) response which is a huge part of the healing process. This is why it’s so important to find a Physical Therapist that will help you stay moving and find ways to keep participating in your activities and sports as much as possible.
If you’ve tried adequately dosed Physical Therapy and your pain hasn’t improved after 6-8 weeks OR if you are having significant “mechanical symptoms” (i.e. knee catching or locking) then surgery might be a good option. A tear on the outer portion of the meniscus (where there is blood supply) in a younger individual is more likely to be repaired surgically and has range of motion and weight bearing restrictions during the rehab process.
Does surgery work for knee pain?
A tear to the inner portion of the meniscus is usually repaired using what’s called a meniscectomy. Unlike a repair, meniscectomies do not have the same restrictions after surgery but the utility of this surgery has been called into question in the past few years. Multiple lines of evidence suggest that sham surgery, where the surgeon makes an incision but doesn’t go inside the knee, has similar long term outcomes compared to actual meniscectomies. If NOT doing the surgery is just as good, why would we choose the riskier and more expensive surgical route? Exercise and physical therapy continues to the be the most evidence based (and coincidentally least risky and least expensive) treatment for degenerative meniscus tears.
We can help!
It’s temping to want quick relief from knee pain but surgery doesn’t seem to be the magic bullet that many surgeons and patients want to believe it is. Surgery is expensive, it can be risky, and it doesn’t always work. This is why finding a good Physical Therapist that can help you get stronger and improve your function without surgery is so important.