The knee is of the most commonly injured areas in the body. Generally we see a pretty even spread between acute knee injuries sustained from a traumatic event such as during sport or from a trip or fall; on the other hand we have the overuse knee problems…. the runners that pump out a huge amount of km per week resulting to overload or inflammation of some of the structures in and around the knee.
The meniscus or menisci (we have two in each knee) and one of the internal cartilages within the knee joint that can be prone to injury both acutely and as a result of overuse.
The menisci are moon shaped cartilages that are located in the knee. They are the ‘shock absorbers’ which permit us to undertake such high intensity and high impact activities. We have one located on the inside and one on the outside of the knee.
The signs & symptoms of a meniscal injury will vary significantly depending on the severity of the damage:
- An inflamed or irritated meniscus will present with joint line tenderness, discomfort at end of range extension (straightening the knee) and a reproduction of pain at end of range flexion (bending). There may be a small amount of swelling present.
- A meniscus that is torn will have swelling, joint line tenderness and potentially an inability to move the knee through full range of motion due to pain. In cases where the tear is large you may experience locking of the knee in certain positions.
- A Baker’s cyst which is a pocket of swelling directly behind the knee may be present & can be an indication of a tear in the meniscus
A diagnosis can be made by a skilled physiotherapist based on your history & from a proper examination. There are special tests that assess the integrity of the meniscus. Further investigation, usually an MRI, may be warranted to confirm the diagnosis & make decisions regarding future management of your injury.
Treatment of a meniscal injury will again depend on the severity. Being cartilage in nature these structures don’t receive a very good blood supply, making the healing process slightly slower.
An inflamed meniscus can take up to 6 weeks to settle down. A torn meniscus can be managed conservatively in some cases, however in others surgical intervention may be required. This will depend on the size & position of the tear and the degree to which it is affecting your function.
Physiotherapy treatment can include the following:
- Soft tissue massage to tight, overactive muscles
- Electrophysical therapy to assist with management of swelling & pain
- Dry needling – targeted towards overactive tight muscles or to assist with management of swelling, pain & inflammation
- Exercise prescription: stretching & strengthening exercises to target tight & weak muscles around the knee
- Advice regarding activity modification
If surgical intervention is required your physiotherapist will prepare you for surgery and also be able to assist you with the post surgery rehabilitation.
Probably the most common question we get from clients is if and when can they go back to sport, whether it be running, soccer, netball. The time frame unfortunately isn’t that clear cut as it comes down to the severity of the injury. Generally speaking its at least 6 weeks before people get back into higher intensity exercise BUT that is very ball park. Those that end up in surgery take a little longer as many surgeons are in no rush to have you placing heavy loads through the knee.
I recently was working with a professional snowboarder who injured his knee. He ended up in surgery & its been about 9 weeks now and he is just beginning to become confident with jumping, running & high intensity exercise that puts alot of load through his knee. The good news this is just in time for him to hit the slopes for the Australian Ski Season…. that is if we actually get any snow this year!
If knee pain is holding you back from exercise or its just there irritating you throughout your day to day life I would suggest getting it checked out by your physiotherapist.