Meniscus problems are VERY common, especially if you are very active and/or over the age of 45 years old. And sometimes, they can be incredibly difficult to treat. So I’m going to give you an easy rundown without all the medical mumbo jumbo to help you better understand what it does, and how to treat it (hopefully without surgery!)
So in this picture, you are seeing the top of your lower leg. Imaging sitting and lifting up your thigh bone (femur) and looking straight down on your lower leg (tibia). Sitting on top of that bone are two boomerang looking structures called the meniscus. You have one on the inside (medial) and one on the outside (lateral). They don’t look the same either, because your bone is not the same on both sides! They are attached at a few points in the knee, but the “C” portion is thin and floats within the knee joint. Their main job is to provide shock absorption when standing, walking, running, twisting, jumping, etc. and to prevent the knee bones from rubbing together.
Often times my patients complain of bending down, squatting, getting out of the car, stepping wrong, etc. and hearing a loud POP followed by pain, swelling and difficulty walking. What happens is that too much load gets put on the meniscus on one side and the thin membrane will tear. Other times, the knee will just “start hurting” and won’t go away, and that could mean a degenerative tear where the membrane frays over time.
So if I have a tear, will it heal on its own? The answer is MAYBE. Unfortunately inside the knee joint, there is not alot of blood supply, so structures such as your meniscus and articular cartilage can’t heal itself well. It also depends on where the tear is and how it tore. A “bucket handle” tear is much more significant and can be very difficult to treat.
Well, that sucks. I guess that means surgery is my only option? WRONG!
You can get significant pain relief and long term healing by offloading the knee. That’s why rest makes it feel better. However, that doesn’t mean you are destined to be recliner bound for the next few months. You have several muscle groups that provide significant offloading of the knee when strengthened properly! Your muscles in your hips and core help support the spine and pelvis and will “hold up” your bones. This significantly reduces forces on the knee when you are standing and walking. And of course, we can’t forget about that diaphragm! Your diaphragm literally lifts you up, and correct breathing posture and alignment will improve inside and outside forces on the knee.
Whether you choose to have surgery or treat conservatively, those muscles HAVE to be strong either way! You need those core, hip and diaphragm muscles to recover from surgery and allow the knee to heal because there is a risk for re-injury if you don’t offload the knee.
So if you have to strengthen anyways, why not go the conservative route first?
Here’s the bad part. People think that 4-6 weeks of rest/inactivity/physical therapy is enough. They think that as soon as their pain stops, they are better and are “healed.” But that’s not the case. It takes 8-12 weeks for muscles to even START to make long term strength changes. Sorry guys, it’s been researched. I can’t change facts. So if you REALLY, and I mean REALLY want to actually heal your knee long term (whether you go the surgery route, or the conservative route), ESPECIALLY if this is a chronic or “degenerative” problem, then you will need to start including some long term changes in your lifestyle, and that will have to include 5-10 minutes of exercises a day.
Other changes may include weight loss, shoe wear, and activity modifications depending on your body type and lifestyle. Those are discussed on a one-on-one level depending on the individual. I could go on and on about nutrition and foods that help reduce inflammation and promote healing, but that’s for another blog post!
Points to take home: The only way to get long term, first class healing from a knee meniscus injury is OFFLOADING, through rest, strengthening, and lifestyle changes. Even if surgery is required, you need muscles in your hips, core, and diaphragm to promote correct healing and posture. And, depending on the individual, additional changes including weight loss and activity modifications may need to occur for proper care.
So if you are looking for treatment options, or have had physical therapy and it “didn’t work,” take a minute to chew on this information. Musculoskeletal problems take a very long time to heal, so before you decide to jump under the knife, make sure you have taken the appropriate amount of time and made the adjustments needed to make the biomechanical changes that are necessary!
Think you have a meniscus injury? A postural assessment will help figure out which of your “offloading muscles” need some work. Click here to contact me!