Meniscus injuries tend to be complicated regardless of the mechanism of injury. A meniscus tear can be one of 4 or 5 different shapes and level of severity. This complexity makes it difficult for therapists to accurately confirm, diagnose and treat. And that’s why we are going to simplify the process for you in this article.
Note: For the purpose of this article we’re going to focus on non-surgical cases. For those individuals that have had a surgical procedure done for a meniscus injury we highly recommend you seek assistance from a licensed Physical therapist for rehab and recovery.
In other words, this article will cover what to do when you’ve suffered a straight forward meniscus tear.
We’re going to break it down into a step by step action plan that you may use as a blueprint to recovery.
Understanding the Biomechanics of the Meniscus
This step is solely focused on the acute management of your injury. Minimizing pain and inflammation will speed up your recovery process significantly. Think about it, if you have pain you won’t want to start moving. Without movement there is no rehab. Without rehab, well, you can see where we’re going with this!
Rest, Icing, Compression and Elevation (RICE). It may sound simple, but yet it remains the gold standard because it simply works.
Do this twice daily!
Once your pain has significantly minimized or has completely subsided, you can solely start moving the affected joint. Because we tend to immobilize the joint to prevent any worsening of symptoms, it can lead to stiffness and immobility within the joint capsule as well as the surrounding structures.
Therefore, non-load bearing movements such as supine or prone flexion and extension at the knee joint can help improve initial mobility. This can be done after or alongside your daily RICE protocol.
And the sooner the better!
Here is our go to exercises to kick start your recovery process!
Hold up, before we dive into this section, we feel we need to briefly touch on an important aspect of rehab specific exercise:
OPEN CHAIN VS CLOSED CHAIN EXERCISES
When the body part you are using is moving then it is classified as an open chain exercise. While a closed chain exercise is when the limb you are using isn’t moving. So think of a squat (closed) your lower limb is firmly planted into the ground compared with a leg extension (open) where the lower limb needs to move in order to do the exercise.
Why is this important? Well, with regard to meniscus rehabilitation open and closed chain exercises play a vital role. More specifically the timing of either, as when you start implementing both may lead to progression or even regression.
So to simplify, you start always with open chain work as this focuses on strengthening muscle groups in isolation. This isolated work also tends to be safer to implement in the early stages of your rehab.
After progressing through the initial phases of rehab you can slowly start introducing closed chain work. Closed chain focuses on strengthening multiple muscle groups by loading one or more joints. This acts as a fundamental factor in correcting movement patterns after injury.
However, it’s due to this complexity that closed chain work cannot be introduced too soon at the risk of re-injury.
Now let's get back to what we were going to cover.
As you may glean from the above, this stage of the rehab process is far more open chain oriented with a bit of closed chain work getting introduced. This allows for a safer and more gradual progressive overload ultimately protecting your menisci from further re-injury.
To improve strength you need a stimulus. And that stimulus is called load. Now loading can be external or internal.
Internal loading is when you are using your own body weight as a source of resistance.
External loading is generated through resistance from weights or bands etc.
The primary function of the meniscus is to act as a shock absorber for forces traveling from the ground all the way to the hip joints and vice versa.
When the meniscus gets damaged (hurt) it’s primary function gets hindered and problems ensue. Thus the only real way to restore the menisci’s primary functions is to mimic the circumstances the knee joint will face. But in a controlled manner i.e. Loading.
Now that we’ve covered what loading is and the important role it plays in your recovery, let’s dive into some examples shall we?
Here is when the going gets tough, as we focus the majority of our exercises on closed chain multi joint exercises. We do this to facilitate the shift in transition from isolation exercises to more functional movement patterns. Movements such as squatting and lunging mimic real life movements and the forces accompanied by them. This essentially acts as a way of preparing the patient for the exact movement patterns they will need to perform successfully.
Now this builds on the point we highlighted at the end of the previous section. Ultimately, this section often gets overlooked. This is because at this stage of the rehabilitation process the patient often “feels good”. And we use this term lightly, because even though they usually feel good or even great, there is a marked difference between being pain free and fully functional.
You can have no pain with hindered biomechanics.
Which is why we suggest getting specific with your rehabilitation.
By identifying compensatory mechanisms, bad postural patterns and even muscular imbalances. We can establish why the patient was predisposed to a meniscal injury in the first place. And ultimately “fixing” those issues to prevent you from getting injured again.
A running analysis is a great tool to utilise post injury when the patient is either a runner, sprinter or plays a sport that requires running for a basis of performance. As an observational tool, a running analysis can identify any inefficiencies in your running pattern. These can be tell tale signs of whether your injury has fully recovered or not, or any risk factors that could lead to further injury.
Sport specific drills such as jumping drills for athletes or running, cutting and change of direction drills for those playing high octane team sports like American football or rugby league. By mimicking the game play scenarios and the forces accompanied with them, can greatly improve your recovery.
Please note that the above mentioned are suggestions only. These are based on our opinion formulated from various experiences and professional knowledge. There are many ways to skin a cat, we’ve just found that our way works for us. That’s not to say it will work for you, but there is a good chance it will.