I’ve struggled with a knee cartilage (meniscus) tear in my left knee for about 18-24 months.
This has been particularly difficult as a Physiotherapist as I’m meant to be the man to fix these problems!
But I had tried every conservative method possible (or so I thought). Improvements were not happening and I’d seen an Orthopaedic Surgeon and was lined up for a surgical repair.
But then I changed my thinking a little and tried 3 exercises I’d deemed inappropriate for me and achieved SPECTACULAR results!
The Problem
The incidence of meniscal tears is increasing year on year and this has been attributed to the rise in the number of people taking part in sport as well as on the other end of the spectrum, the rise of obesity and de-conditioning. It has been estimated that the incidence rate of meniscal tears is 60 per 100000 people.
The meniscus is the stabilizer and protector of the knee joint. It helps to facilitate efficient movement of the knee. It also provides the natural congruence of the knee as well as being a major shock absorber when we stand, walk or run. It is an essential part of our body and when injured can cause significant dysfunction and pain.
These menisci can become torn or damaged or even become degenerate (they develop a series of small micro tears over time).
My Meniscal Injury
I developed a torn medial meniscus (inner part of the knee). It was intensely painful and was completely affecting my ability to walk let alone run.
It was agonisingly painful and was waking me at night and making my work as a Physiotherapist, where sometimes I can be on my feet for up to 14 hours a day, extremely difficult.
I wrote a two part series of blog posts charting my journey. You can read more about how I managed them here if you’d like to find out more:
Knee Cartilage Meniscus Tear – My Personal Journey as a Physiotherapist – Pt 1 Conservative Management
Knee Cartilage Meniscus Tear – My Personal Journeyas a Physiotherapist Pt2 Surgical Intervention
I’d tried every conservative treatment option and worked hard to rehabilitate the knee. Unfortunately, all the conservative treatment options that I’d used with great success on the patients I treated in my clinic were not helping. In desperation and seeking an alternative solution, I made an appointment to see an Orthopaedic Surgeon.
The Exercises
Although I’d managed to reduce my pain and swelling to some degree with conservative treatment, I was still unable to squat with any weight in the gym and running was completely out of the question.
In desperation and wanting to avoid surgery I went back to the drawing board and tried some exercises that I normally give out to my older patients with meniscal tears. These patients often have osteoarthritis of the knees to some extent alongside their tears and they require a rehabilitation programme that is less demanding on the knee joint.
The overall aim is to increase the strength of the supporting musculature around the knee. But in hindsight, I’d started my rehabilitation programme too high up the effort scale.
So I decided to strip things back to basics, to give the foundation work a go.
I chose three exercises:
- Wall Sit
- Straight Leg Raise
- Glute Bridge
I completed them as a mini circuit. Starting with exercise 1 and working through to exercise 3 in order. Several rounds of the circuit completed the workout.
1. Wall Sit
This is a fantastic exercise for improving leg strength. Because it’s a sustained hold and the knee doesn’t move throughout the hold it makes it a good option for people with joint conditions such as osteoarthritis or meniscal tears.
How to perform:
- Stand with your back against a wall and your feet hip-width apart.
- Slide down the wall until starting with knees bent to 70 degrees.
- Keep your head, back and bottom against the wall. Try and keep your tummy drawn in and controlled throughout the movement. Your arms can be by your side. Try to avoid placing them on the legs if possible.
- Hold the sit for 20-30 seconds to begin with.
- Return to a standing position by pushing through your heels.
- Repeat for 2-5 repetitions.
I started at 70 degrees for 3 repetitions. Holding for 30 seconds with each repetition. My knee was mildly achy during and after the exercise.
I coped well and gradually over the coming weeks I managed to initially increase the time from 30-60 seconds whilst at the same time keeping my knee pain to a mild ache only.
Encouraged I added 2 more repetitions so that by week 4 I was ready to move from 70 degrees to 90 degrees.
I coped well with this, but you could choose to grade the progression a little slower if your knee pain increases when trying to progress to 90-degree holds.
Start by reducing the time to 15-20 seconds. Increase the number of repetitions completed and then when you can perform 5 repetitions without a corresponding increase in pain, add a further 15 seconds to each repetition.
The goal is always to keep the knee pain to a mild ache only during and after the exercises.
2. Straight Leg Raise
When designing my initial rehabilitation programme, I originally chose not to add this to my workout regime.
It’s a simple move and I already have good strength and quadriceps control, so I didn’t feel it was needed.
However, after adding it to my programme I noticed almost immediate improvements in my pain and walking ability.
It’s worth noting that following a period of pain, the timing of how the quadriceps work can change and this can alter the demand placed on the knee joint. The Straight leg raise is an excellent exercise for re-engaging the quadriceps in the right order. This will provide more stability to the knee.
How to perform:
- Lie completely flat. You can do this on a bed or the floor.
- Bend the knee that you’re not exercising.
- Pull the foot of the affected leg towards you and push the back of the knee down to engage the quadriceps muscles.
- Keep the knee as straight as possible and lift the leg off the floor/bed to approximately 6 inches.
- Hold for 2-3 seconds and slowly lower the leg back to the starting position.
- Repeat.
I originally started with 2 sets of 10 repetitions and then as a progression increased the 2-3 second hold to 4-5 seconds.
When starting you may choose to do a shorter set of 5 repetitions to build up your leg strength before progressing the number of repetitions.
Remember the mantra here, you should aim to make this exercise as pain-free as possible. Only working into slight discomfort.
3. Glute Bridge
Now this was an original exercise that I did choose to include in my regime. It did help originally and I’m sure it will help you too.
Engaging the gluteals (bottom muscles) will help to stabilise the leg in general and take pressure off the knee.
In fact, it’s so important I often ask patients to do some glute engagement exercises before starting an activity if they are struggling with meniscal or osteoarthritic pain.
It helps with the pain of the actual activity. Many patients report to me that their walking distances improve and they find that they can do more before discomfort sets in.
How to perform:
- Lie on your back with your knees bent and your feet on the floor. Your feet should be in a comfortable position and not painful in the set up.
- Push through your heels to lift your bottom off the floor.
- Feel like you are curling each individual vertebrae off the floor as you lift.
- Squeeze your glutes at the top so that your body is in a straight line from your shoulders to your knees.
- Don’t worry if you can’t quite get into a straight line position, instead just focus on pushing through your feet and squeezing your bum.
- Hold the position for 1-2 seconds.
Again, I originally started with 2 sets of 10 repetitions but progressed this quickly onto 3 sets. I also progressed onto single-leg glute bridges when this became easy and I could complete the original glute bridges without pain.
Outcome of Exercises
Having battled with disabling knee pain for months preventing me from running, playing golf, squatting or even walking my dogs comfortably, these three exercises made an incredible difference in a remarkably short space of time.
As a group, they have helped to improve the control of my quadriceps and engage my glutes.
This has led to a startling reduction in pain and dysfunction. In fact I have now been able to resume all previous activities and have even cancelled my planned Meniscal Repair surgery!
Conclusion
These exercises are perfect for all levels of meniscal tear or even osteoarthritis. Start slowly – even a few repetitions can provide a benefit but ultimately we want to add volume to maximise outcome.
You should progress slowly only adding repetitions when you can complete the current number with only a small corresponding increase in knee discomfort. Begin by performing one small set of each exercise and progress when able.
If you have pain post-exercise, especially if it lasts more than 24 hours, then you are doing too much and you should reduce the number of repetitions.
Good luck!
If you have further questions about this article, or if you’d like to book an appointment to see me you can book here.
