Clinical Indicators of Meniscal Tear

• Pain
• Swelling
• Difficulty bending or straightening
• Clicking
• Locking

Prognosis

Typically, medial meniscus injuries can take 4-8 weeks to recover for small tears in younger sufferers but larger ones will take longer and specific classification of tears are less likely to recover conservatively at all. As we get older the likelihood of knee cartilage resolving becomes lower. Often Physiotherapy can help with full recovery or overcoming the symptoms of the tear itself. However, if conservative measures fail, surgery to remove/repair the injured portion of cartilage becomes indicated.

With a self diagnosis of Medial Meniscal Tear in place I set to work!

Conservative Management

There are two main goals during the initial stages of cartilage injury rehab.

1. Manage Pain
2. Restore Range of Motion

Managing Pain

Regular icing helped my pain within days. I followed a regime of icing 3-4 times a day for up to 10 minutes at a time. Not only did it help my pain but it reduced my inflammation and the heat that I felt in the joint.

I chose not to take any over the counter pain relief or anti-inflammatories but these could be used if you’re struggling with mild to moderate pain. Over the counter medication such as paracetomol and/or iburprofen. Check with your doctor or pharmacist if you’re unsure if these are safe for you to take.

You could also consider ibuprofen in gel form. Remember not to take both ibuprofen tablets AND gel as you will be overdosing. Studies have also shown Arnica Gel to be as effective as topical anti-inflammatory gels and could also be considered.

Restoring Range of Motion

I set myself a task of performing some simple range of motion exercises in order to improve my reduced ability to bend and straighten the knee. If I was sat at my desk for any period of time I’d perform 20 simple bend and straightening movements, holding the end of each position briefly. As the inflammation in my knee started to settle and the pain reduced somewhat, I found that I was able to almost restore all the range of motion that I had lost since the injury.

My pain started to settle within 2 weeks and so I pushed on with my strengthening programme

Improving Leg and Gluteal Strength

I started doing some easy strengthening exercises from day 2-3 following the increase in pain. I would typically perform the following regime:

1. Straight (ish) Leg Raises 2-3 sets 12 reps
2. Knee extension into a rolled up towel 2-3 sets 12 reps
3. Bridges 2-3 sets 10 reps
4. Partial squats 2-3 sets 10 reps

I did these 2-3 times each day and ended it all with some ice to help manage the swelling.

Initially this would cause some minor discomfort but this soon eased and I was able to progress the exercises within about 2-3 weeks of working on them.

At 3-4 weeks post incident starting, I was able to complete my basic strength and mobility regime without any real pain. I was still struggling when walking for longer than 15 minutes or standing for 30 minutes and twisting my knee elicited a sharp knife like pain that actually made me feel a little sick. Overall however I was pleased with my progress and felt it was time to push on with my rehab.

Reducing Activity/Bracing

I always advise my patients to take “active rest” in the few days following injury or the development of symptoms. This would equate to reducing the amount of time that you are walking or standing if possible. If you are sportsperson you will need to stop playing any sport that makes your symptoms worse.

Knee Braces

There are no knee braces or compression sleeves that heal a meniscal tear. But they could help with inflammation and reducing the load on the joint itself. If you are one of the unfortunate people that suffer with knee locking after injury, you may find using a brace helps to provide additional support.

Personally, I have used one on the days I know I am on my feet or when attempting to take the dogs on a short walk. I’m not sure that they help with the pain but certainly give me a little more stability and may have helped slightly with my swelling too.

Weeks 5-8

Strength and conditioning was improving nicely and swelling although still evident was much improved. My dog walks were increasing again – I was up to about 40 mins but was limping a little by the end of the walk.

I was missing golf and went to the driving range.

I hit a series of wedges and short irons with no real pain – about 25 balls in total and finished my session with 15 mins of putting and chipping and I was pleased that my knee felt good with no increased pain at all. That night however I experienced some swelling and medial joint line pain and my knee was very stiff the next morning.

I didn’t let it deter me, just iced and continued with the exercises. The pain settled within 24 hours.

At 8 weeks I added the following exercises in the gym:

1. Goblet Squats (with a 16kg kettlebell)
2. Single leg deadlifts (with 5kg dumbbell)
3. Lying hamstring curls
4. Terminal extensions working with an exercise band