Meniscal tear rehabilitation
As an athlete, your number one concern is getting back to full strength as soon as possible so that you can return to training and competition. That is why appropriate rehabilitation is extremely important. Rehabilitation for a meniscal tear often includes the following:
Take a break from activities that stress the knee joint. With rest, the knee will be less painful. Some meniscal tears will heal with time.
Apply ice in 15-minute periods during the first 24 hours after the injury and for several days after if needed. This helps reduce swelling, inflammation, and pain.
Wrap the knee in an elastic bandage. This will help stop swelling and provide support and protection for the knee. Do not pull the elastic tightly.
Keep the injured knee raised for the first 24 hours, including during sleep. This will help drain fluid and reduce swelling.
Use anti-inflammatory medications such as ibuprofen to reduce inflammation and speed up recovery.
Blood vessels will feed the outer edges of the meniscus, giving that part the potential to heal on its own. Small tears on the outer edges often heal themselves with rest.
Although rest, nonsteroidal anti-inflammatory drugs, and avoiding the activity that caused the injury are the main steps for rehabilitating a meniscal tear, more serious conditions may require surgery. Your doctor may also prescribe physical therapy to stretch and strengthen the quadriceps muscle, which connects to the patella, to help maintain muscle strength, flexibility, and endurance.
Exercises for meniscal tears
The following exercises, which place no extreme mechanical or weight-bearing stress on the knee, patellar tendon, or kneecap and use full range of knee motion, can be very effective during rehabilitation. However, they are not a substitute for physician consultation or rehabilitation by a rehabilitation specialist. Please consult your physician for questions about your specific knee injury.
- Unloading the knee
Put a light weight (5 to 10 pounds) on your ankle and sit in a position that allows the leg to dangle (on a bench, tall stool, edge of bed). Hold for 5 to 15 minutes, 1 to 3 times a day. Repeat for the other knee.
- Knee extension
Sit in a chair and rest your foot on another chair across from you so that the knee is slightly raised. Gently push the raised knee toward the floor using only leg muscles. Hold the stretch for 5 to 10 seconds, then rest a minute. Repeat 10 times. Do every day up to 3 times a day.
- Alternative knee extension exercise
Sit on the floor or bed with your legs extended, and place a rolled-up towel underneath your Achilles tendon. Gently push your raised knee toward the floor. Hold the stretch for 5 to 10 seconds, then rest a minute; repeat 10 times. Do every day up to 3 times.
Resistance exercises for building strength
The following resistance exercises help to build strength.
- Knee extension
Use a leg extension resistance training machine. Begin the exercise seated with the knees at as nearly full flexion as the machine being used will permit. Start with an amount of resistance that can be overcome with no pain. Fully extend the knees and hold this position for 3 to 5 seconds. Slowly return to the beginning position, rest for 5 seconds, then repeat this cycle for a total of 10 times. Increase resistance from one training session to the next as pain permits.
- Knee flexion
Use a leg flexion resistance training machine. Begin the exercise laying face downward with the knee as extended as the machine will allow. Start with an amount of resistance that can be overcome with no pain. Fully flex the knees and hold for 3 to 5 seconds. Slowly return to the beginning position and rest for 5 seconds. Repeat this cycle for a total of 10 times. Increase resistance from one training session to the next as pain permits.
During rehabilitation from prepatellar bursitis, you’ll need to maintain strength of the thigh muscles. The following exercises do this without adding undue stress on the knee:
- Half-knee bends
Stand with back flat against a wall, arms at sides, feet at shoulder width, and heels about a foot from the wall. Allow the knees to bend slowly, lowering the body weight until the knees are flexed at a 45-degree angle, or until pain intervenes. Immediately return slowly to the upright position and rest for 5 seconds. Repeat this cycle for a total of 10 to 15 times.
- Quadriceps setting
While sitting in a chair, straighten your leg and hold. Repeat 5 to 10 times. Do the exercises with both knees, up to 3 times each day.
- Alternative quadriceps exercise
Lie on a flat, firm surface with legs extended. Then raise one leg, 12 inches off the surface and use it to trace a “T” pattern in the air. To start, repeat 5 to 10 times. Do the exercises every day, up to 3 times each day.
- Wall slide
Leaning with your back against a wall, bend your knees 30 degrees, sliding down the wall, then straighten up again. Move slowly and smoothly. Keep your feet and legs parallel, and center your kneecap over your second toe. Repeat 5 to 10 times, 1 to 3 times a day.
If you have increased soreness after doing these exercises, it may help to ice your
knee or knees for 10 to 20 minutes. Place a bag of ice or frozen vegetables over the joint, with a towel between to protect the skin. Other helpful measures include elevating your leg on a chair, and taking acetaminophen before or after exercise if ice alone is inadequate.
If increased soreness or pain lasts for more than 2 hours after exercise, you should cut back to fewer repetitions of the strength exercises; then gradually build up again.
During the period when normal training should be avoided, alternative exercises may be used. These activities should not require any actions that create or intensify pain at the site of injury. They include:
- water running
- stationary bicycle (add resistance gradually from one session to the next, as pain allows)
When can I return to my sport or activity?
The goal of rehabilitation is to return to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your meniscal tear recovers, not by how many days or weeks it has been since your injury occurred.
Generally, full use of the affected knee should be delayed until all symptoms subside. In the interim, activities that place no pressure on the knees, such as swimming or cycling, can maintain cardiovascular fitness.
You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:
- the knee can bend and straighten without pain
- you are able to jump on the injured leg without pain
- you are able to jog in a straight line without pain
- swelling is gone
- normal strength of the quadriceps muscles has returned
How long will the effects of the injury last?
A meniscal tear caused by overuse often resolves after two weeks if you refrain from the activity that caused the problem and use the proper rehabilitation techniques. In more serious cases, symptoms may last months and may require surgery.
When surgery is required
Keep in mind that if your meniscal tear requires surgery, the damaged knee needs time to heal before exercise can begin. While in the hospital, patients start partial weight bearing with exercises to re-establish knee joint mobility and normal gait. In these cases, you may be required to wear a brace and use crutches for the first six weeks.
A physical therapy program usually begins with range-of-motion and resistive exercises, then incorporates power, aerobic and muscular endurance, flexibility, and coordination drills.
Surgery to remove the damaged meniscus may be necessary if your knee locks and is accompanied by pain.
Meniscal tears also often happen in combination with other injuries such as a torn anterior cruciate ligament (ACL).