A meniscus tear can cause knee pain and may occur with normal wear and tear, or a traumatic injury (typically sports). A meniscus tear does not typically require surgery unless the tear folds over causing the knee to be limited and painful when bent to end range (an example of this is a deep squat). Fortunately, most tears can be treated conservatively.
A meniscus is a cartilage structure in the knee shaped like a C. There are two menisci per knee, one medial and lateral. A meniscus is made up of cartilage and is designed to reduce the amount of load on the knee joint as you bend and move your knee. In our experience, most people have no known traumatic injury they know of that caused the tear.
If there was no known injury then conservative treatment is more likely to be successful. In our experience, many times the root source of the knee pain isn’t the torn meniscus, it’s something else. Research shows that most people with a meniscus tear experience no pain. This is important to understand because many people with knee pain and a torn meniscus are experiencing knee pain due to something other than the tear itself (see other reasons in the treatment section below).
When a torn meniscus is the cause of pain the symptoms should be fairly straightforward. There should be knee pain felt within the joint when bending the knee to end range. If the tear is severe there will be a ‘painful clicking noise’ felt when bending the knee to end range.
If you have been diagnosed with a meniscus tear be sure to ask which meniscus it is (i.e. medial or lateral). From our experience, many times people will be diagnosed with a torn meniscus and the pain is on the opposite side of the knee as the tear. This is a clear indication that the tear is not the source of knee pain.
If a meniscus tear is in fact the root source of pain then surgery may be necessary. However, strengthening the muscles surrounding the knee will decrease the load on the meniscus and knee joint. Here is what we find are generally the problems causing knee pain:
Stiff knee joint: The knee joint bends and straightens with a small amount of rotation. The most likely cause of knee pain will be limited knee extension (straightening your knee). If knee extension is stiff it can place more stress on the knee joint and cause pain. Knee flexion, rotation, and extension should all be assessed.
Stiff ankle or hip joint: When the ankle or hip joint is stiff it can cause the knee joint to compensate which can lead to knee pain. This is especially true if you have knee pain with squatting, going up/downstairs, or lunging.
Weak quads, hamstrings, or glutes: The muscles surrounding the knee must be strong to reduce the amount of load and demand placed on the knee. When the muscles are weak the knee joint can become inflamed, swollen, and possibly lead to osteoarthritis.
Poor balance: If you have knee pain with walking then poor balance may be part of the problem. Poor balance leads to compensation and can start causing knee pain. Try standing on one leg for 10 seconds. If you struggle with this then balance exercises should be part of your exercise routine.
Referred pain from quadriceps: The muscle on the front of the thigh connect to the knee. If you have pain deep to the knee cap then the quadriceps are often part of the problem. Dry needling and myofascial release are two interventions we find to work best for this problem.
Referred pain from adductors: The adductors are muscles that run up and down the inside of your thigh and connect just below the inside of your knee. If you have pain on the inside of your knee we have found this to be a likely source of the pain.
When does a meniscus tear need surgery?
As we stated above, a torn meniscus will likely need surgery when there is a ‘painful click’ associated with bending your knee. This is a sign that the tear is getting caught in the joint and surgery should be performed to minimize further tearing from occurring.
For most people, surgery can be avoided and conservative treatment will decrease knee pain and improve mobility. A physical therapist should assess the flexibility of your hip, knee, and ankle. They should also test your strength in these areas as well as overall balance.
If you live near Durham, NC, and are looking to avoid surgery for a torn meniscus then we invite you to schedule a free phone consultation with our physical therapy clinic. The phone call is designed to find out if our treatment is the best approach for your problem.
The meniscus may never heal. However, that doesn't mean it always leads to knee pain. This study showed 97% of knees had at least one knee problem, but none of the participants complained of any knee pain. Pain is far more complex than "what you see on the X-ray or MRI is the cause of pain". Before you assume the meniscus tear is the cause of knee pain we recommend you find someone who assesses your back, hip, knee, and ankle. Furthermore, the back, TFL muscle, and glute muscles can refer pain in the knee causing similar symptoms as a torn meniscus. The solution to these problems is a lot less invasive than surgery and can be overcome with proper physical therapy.
Yes, but it is unlikely. This does depend a lot on where the tear is. For example, the outer portion of the meniscus is the area where the blood flow is the highest — therefore it has the best chance of healing. However, most people who ask this question are really asking, "can I get out of pain even though I have a meniscus tear"? If there is no 'catching' or painful 'clicking' when you bend your knee then conservative rehab can lead to a fully functioning knee without pain. This often requires a full-body approach. More specifically, the ankle, knee, hip, and core all function as a single unit when you walk, run, or pivot. Therefore, all of these areas should be assessed and any dysfunctions should be addressed to improve knee function.
Maybe nothing. However, the literature shows that those with meniscus tears are more likely to experience osteoarthritis. It's best to seek treatment for any knee pain, meniscus tear or not.
Absolutely. If knee pain is present and symptoms aren't improving, please seek help from a medical professional. Our recommendation is to find someone who assesses movement and your spine, hip, knee, and ankle. Knee pain can be caused by dysfunction at any of these joints.
You first want to restore mobility at the joint. Then you'll need to assess for any movement dysfunctions at the ankle, hip, and spine depending on what activities lead to knee pain. After mobility is restored, strengthening the leg and trunk should be a priority. Stronger muscles take the stress off the joint and meniscus — thus leading to improved outcomes.
No. A steroid shot can help with pain and inflammation, but it will not heal a torn meniscus. In fact, cortisone shots have been shown to cause muscle and bone deterioration. Reducing knee pain may require a steroid shot, but it should never be viewed as a solution for any problem.
Yes. But this comes with the caveat that knee pain shouldn't be felt. Strengthening exercises are going to be best for a torn meniscus. Isometrics and slow controlled resistance movements will serve to build knee strength and stability to reduce the load on the meniscus and knee joint. Repetitive ballistic movements should be avoided until strength and mobility are returned to normal and pain has fully diminished.
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