Meniscus tear: Rehabilitation exercises

A meniscus tear is a common knee joint injury. Meniscus tears commonly occur during sports when the knee is twisted while it is partially flexed and the foot is firmly planted on the ground, but they are also common with normal movement in people older than age 40 whose menisci (plural of meniscus) are worn down. The medial and lateral menisci of the knee are two crescent-moon-shaped disks of tissue (fibrocartilage) that lie between the ends of the upper leg bone and the lower leg bone that form the knee joint. The rubbery tissue acts as a shock absorber between the upper and lower leg bones, evenly distributing the load across the knee.

Symptoms of a meniscus tear depend on the size and location of the tear and whether other knee injuries occurred along with it. Pain at the inside of the knee can indicate a tear to the medial meniscus, while pain at the outer side of the affected knee may indicate a tear to the lateral meniscus.

• Symptoms of a small tear include pain at the time of injury, with slight swelling over several days. You are able to walk and your pain is minimal, although your pain may get worse when you squat. Your symptoms usually go away within 2 to 3 weeks, although they may recur with bending or twisting.
• Symptoms of a moderate tear include pain at the side or in the center of your knee, although you may still be able to walk. The swelling increases over 2 to 3 days, and your knee feels stiff. You may have sharp pain when twisting or squatting. The symptoms may diminish in 1 to 2 weeks, but they may recur with twisting or overuse if untreated. The pain may come and go for several months or a year or more if untreated.
• Symptoms of a larger tear include pain, with swelling and stiffness that start right away. Or symptoms can get worse over 2 to 3 days. Your knee may catch, pop, or lock, and you might not be able to straighten your knee. It might also feel "wobbly" or unstable, or give way without warning.

Treatment of a meniscus tear depends upon the size, type, and location of the tear, your age, your health status and activity level, and when the injury occurred. Treatment options include:

• Nonsurgical treatment with rest, ice, compression, elevation, and physical therapy. This may include wearing a temporary knee brace.
• Surgical repair to sew the tear together.
• Surgical removal of the torn section (partial meniscectomy). Total meniscectomy, which removes the entire meniscus, is generally avoided because of the increased risk for osteoarthritis.

Test Your Knowledge

After a physical examination and, possibly, diagnostic tests, you and your health professional will make a treatment plan for your meniscus tear.

1. A meniscus tear may result in long-term injury to your knee.

   1. True

      This answer is correct.

      The menisci are very important to the health of your knee. Acting as shock absorbers, they stabilize the knee joint and evenly distribute the load across the knee.

   2. False

      This answer is incorrect.

      The menisci are very important to the health of your knee. Acting as shock absorbers, they stabilize the knee joint and evenly distribute the load across the knee.

The goals of rehabilitation are to restore range of motion, strength, and endurance of your knee. A rehabilitation program usually includes treatment with a physical therapist at a therapy center and home treatment in your home or at a gym or health club. Your physical therapist will design a program that guides you through exercises to reach these goals on a schedule that takes into account your health status, age, and activity expectations. Generally, as you see less of your therapist, you do more on your own.

Recovery from a meniscus tear depends on many factors. If the tear is minor and your symptoms go away, your health professional may recommend a set of exercises to increase your flexibility and strength.

If you have surgery to repair your meniscus, your surgeon may recommend that you do not move your knee more than absolutely necessary (immobilization) in the days after surgery. This may be followed by a period of limited motion before you are able to resume daily activities. Some health professionals believe that it helps to begin a physical therapy and exercise program soon after surgery, while others believe that heavy stresses, such as running and squats, should be postponed for some months. Physical therapy that is guided by your health professional and designed for your individual needs is a key part of regaining strength and flexibility in your leg, as well as helping prevent future degeneration in the knee joint.

Test Your Knowledge

Your health professional's recommendations will be tailored to the condition of your knee and your individual preferences.

1. Physical therapy is optional after meniscus tear surgery.

   1. True

      This answer is incorrect.

      Physical therapy is a key part of regaining strength and flexibility in your leg, as well as helping prevent future degeneration in the knee joint.

   2. False

      This answer is correct.

      Physical therapy is a key part of regaining strength and flexibility in your leg, as well as helping prevent future degeneration in the knee joint.

For most tears, some simple exercises can help maintain muscle strength in the front of the thigh (quadriceps), back of the thigh (hamstrings), calf, and hip. All of these areas are important for your overall leg function while your knee heals after an injury or after surgery. Exercises should only be done on the advice of your health professional, and only if you feel very minimal or no pain while you perform them at home. The list below has links to specific exercises with illustrations and instructions.

• Quad sets
• Straight leg raises
  • Straight-leg raise to the front
  • Straight-leg raise to the outside
  • Straight-leg raise to the back
  • Straight-leg raise to the inside
• Hamstring curls
• Heel raises
• Unilateral stance
• Heel dig bridging
• Shallow standing knee bends

Test Your Knowledge

Rehabilitation is usually done in stages, starting with gentle toning exercises and working up to more strenuous exercises for people who do not have arthritis and are on a track to return to sports or other activities.

1. In exercising my knee, I should do all the necessary repetitions, even if I feel increasing pain.

   1. True

      This answer is incorrect.

      The goal of rehabilitation is to heal and strengthen the tissues, muscles, and tendons around the knee. Pain is a signal that you may be injuring your knee further. Stop any exercise if you feel anything more than minimal pain.

   2. False

      This answer is correct.

      The goal of rehabilitation is to heal and strengthen the tissues, muscles, and tendons around the knee. Pain is a signal that you may be injuring your knee further. Stop any exercise if you feel anything more than minimal pain.

For more information about rehabilitation for a meniscus tear, talk to:

• Your health professional.
• A sports medicine specialist.
• A physical therapist.
• An occupational therapist for work-related activities.