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A Knee Meniscus Tear – Identify, Treat, and Dr. Sarah’s Soapbox

Fixing a knee meniscus tear can be an arduous process. There’s lots of bumps along the road, but it is possible to resolve symptoms. How do we know? We’ve treated them – a lot. It’s a fairly common injury, especially in individuals who are forty or older and continue to stay active.

The key to resolving discomfort from a meniscus tear is to first correctly identify the injury. After you correctly identify it, a combination of the appropriate dose of exercise and hands-on treatment eliminates the pain. We’ll go over how you can do that.

 

How do you Know if you Have a Meniscus Tear?

There’s two parts of information we look for to determine if an individual has a meniscus tear. The first part is what you tell us – the type of pain you have, how things feel, and what makes it hurt. When it comes to meniscus tears, this information often looks like –

  • Pain is described as achy or deep
  • Rapid knee bending causes more pain than slowly bending the knee
  • A feeling of swelling, tightness, or fullness around the knee

The second part of information is what we test for. This information includes –

  • Pain on the joint line
  • A positive McMurray test (involves bending and straightening the knee)
  • Pain with applying extra pressure to the knee when it is fully bent
  • Pain with applying extra pressure to the knee when it is fully straight
  • A history of joint locking

These lists are by no means all inclusive, but they are what we typically see when someone comes in with a meniscus tear.

 

How do you Treat a Meniscus Tear?

Since the joint is the irritated part, we start there. This looks like joint mobilizations and self-mobilizations we give you for at home. The two videos below show the mobilizations we start clients with.

Beyond mobilizing the joint, we address any soft tissue (muscle) restrictions. This looks like soft tissue work (massage), dry needling, and cupping. The goal here is to calm down the irritated structures around the knee. When these are calmed down, it takes more to aggravate the knee joint itself.

Lastly, we identify side-to-side strength discrepancies and muscle imbalances. After these are identified, we treat what we found. As discrepancies resolve themselves, symptoms come down and stay down. This is because the structures around the knee are now strong enough to adequately support the knee.

We understand our advice on how to resolve meniscus tear symptoms is vague. It’s not that way on purpose. In truth, it’s near impossible to put together a list of “knee meniscus exercises” because everyone is so unique. We’ve seen some individuals have hamstring tightness whereas others have gluteal and quadriceps weakness. There isn’t a one-size-fits-all plan when it comes to knee meniscus tears.

 

Two Types of Meniscus Tears

It is important to discuss that different types of meniscus tears are treated differently. When we see individuals, we bucket them into two different categories.

The first category is adults 30+ and the second category is youth athletes. We divide individuals by age because the type of tear is usually different as you get older. Younger clients have traumatic tears that sometimes need surgery to repair. Older clients (older not old – there’s a difference!) have tears that are usually classified as degenerative, even when there seems to be a specific incident that caused it.

 

Meniscus Tears in Older Adults

The classic example of this is someone has something randomly but abruptly happen (a bad dance move, gets run into by a dog, turns too quickly getting out of the car, etc.) and has knee pain as a result. It appears, based on how the pain started, that the incident caused the meniscus tear and that the meniscus tear is causing the pain.

However, we’d like to suggest something different. By the time you’re 30, your body has already started showing age-related changes. If we were to x-ray your spine, we’d find arthritis. We may even find an asymptomatic bulging disc. (If you’re 40 or older, there’s a 50% or more chance you have one). The same thing would show with your knee – there’s probably arthritis there too. In fact, there may actually be a “degenerative” meniscus tear.

 

A Quick Aside

We don’t like the word “degenerative,” which is why it’s in quotation marks. Degenerative implies that your body is fragile and that you should stop being active in order to protect yourself against future injury. Neither of those statements are true.

In fact, the opposite is true. If you’re not active, if you’re not strength training, or if you’re not pushing your body, you will experience “degenerative” changes much more quickly than someone who stays active.

 

Meniscus Tears are Relatively Normal

But, back to our story. It’s fairly common to have “degenerative” meniscus tears without actually experiencing pain. About 25% of individuals have them. How then do we know your pain is coming from that tear? How do we know it wasn’t there before? Was there a previous MRI that showed no tear?

Unless you have a habit of taking random MRIs, you don’t have a previous one to compare it to. There is no way we can know if that meniscus tear was already there or if your sub-par dance moves caused it. What we do know is that you’ve probably got some knee swelling and muscle irritation going on as well. Nothing in the human body is injured in isolation. And, knee swelling and muscle irritation are things we can fix.

We also know that addressing all the factors around the knee causes pain to go down – even if the actual meniscus was never “fixed.” We will go so far as to say that if you’ve been going to physical therapy for a meniscus tear and you’re not getting results, you may not be with a good PT. (This is of course assuming you’re following that physical therapist’s guidance).

 

Put More Clearly

We understand that this may be difficult to conceptualize. We are essentially saying that you don’t need surgery for a meniscus tear when it’s degenerative in nature.

And, we’re arguing that the large majority of tears in older adults are degenerative. These tears typically occur over time but don’t end up getting imaged until an incident (that’s largely incapable of causing a meniscus tear) occurs and knee pain results.

So, to be even more clear, if you are over 30 and you have a meniscus tear, you don’t need surgery to eliminate your pain.

Yes, this is bold. But, it’s what medicine needs now. The large majority of our problems that are orthopedic in nature don’t need pain pills or surgeries. They need competent physical therapists to effectively treat individuals so they can get back to doing what they love and view their body as resilient.

 

Circling Back to The Meniscus Tear

You may be wondering, How on earth did Dr. Sarah get on such a tangent in this blog post? Here’s the thing – there’s a few areas of medicine where she is incredibly passionate about individuals knowing the facts so they can make an informed decision for themselves.

One of those areas is how over-utilized (and poorly used) images are in America. Knee meniscus tears are one incredibly common example of this. Others are low back pain, neck pain, and rotator cuff tears, but she’ll save those for a different time.

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