Physical Therapy for a Knee Meniscus Tear

If you have knee pain due to a meniscus tear, you may benefit from physical therapy to help you regain normal motion in your knee and improve your overall strength and mobility. Your physical therapist can show you what you need to do—and what you should avoid—to help you recover fully from a knee meniscus injury.

Knee pain can get in the way of your everyday activities. It can make walking painful, and it may limit your ability to climb and descend stairs or rise up from a seated position. It can also prevent you from enjoying your normal work or recreational activities.

There are different causes of knee pain, including:

• Knee osteoarthritis
• Ligament sprains
• Patellar (kneecap) tracking issues or patellofemoral stress syndrome
• Iliotibial band friction syndrome
• Meniscus tears

When a meniscus tear causes your knee pain, you may notice various signs and symptoms that limit your normal functional mobility. Understanding what a meniscus is and how PT can help you recover after a meniscus injury can help you make the best choices when managing your condition.

Meniscus Overview

A meniscus is a small cartilaginous structure in your knee that is situated between your tibia (shin bone) and femur (thigh bone). Each knee has two meniscii (the plural of meniscus)—one on the inner part and one on the outer part of your knee. The inner meniscus is called the medial meniscus, and the outer one is called the lateral meniscus.

Your meniscii are crescent-shaped structures that provide shock absorption to your knee joint, and they help the joint to glide and slide properly when you bend and straighten your knee.

How It Gets Injured

There are some things that can cause injury to your meniscus. These may include:

• Trauma that includes twisting over your knee while your foot is planted
• Hyperextending your knee
• Wear and tear and degenerative conditions such as knee osteoarthritis
• No apparent reason

Sometimes, people experience knee pain that comes on without injury, and subsequent diagnostic testing reveals a meniscus tear.

Signs and Symptoms 

If you have knee pain, you should check in with your healthcare provider to have your knee examined. He or she may perform knee special tests to determine the cause of your pain, and diagnostic tests may be ordered.

Typical signs and symptoms of a knee meniscus tear may include:

• Knee pain
• Swelling in your knee joint
• Clicking in your knee
• Feeling like your knee is "giving out"
• Painful locking of your knee joint when moving it from a bent to a straightened position
• Difficulty with functional tasks such as rising from sitting, getting into and out of the car, or ascending and descending stairs

Diagnosis

If your healthcare provider suspects that a meniscus tear is causing your knee pain, he or she may order diagnostic tests. In general, simple X-rays are typically taken to rule out a fracture or to confirm knee arthritis. Your meniscus cannot be visualized with an X-ray, so an MRI may be ordered to visualize your meniscii and knee ligaments and to assess if a tear is present.

A word of caution: while an MRI can be helpful in confirming a knee meniscus tear, it should be noted that a significant number of people with no knee pain have meniscal tears. The presence of a meniscus tear on an MRI does not necessarily mean the torn meniscus is the source of your knee pain The MRI should be considered one piece of the puzzle when caring for your knee pain.

Once your healthcare provider has diagnosed your meniscus injury, he or she may refer you to physical therapy for treatment. If not, you may benefit from asking for a referral, or you may be able to attend PT under direct access.

Physical Therapy 

When you first visit a physical therapist for your meniscus tear, he or she should perform an initial evaluation to assess your condition and to develop a plan of care. Components of your evaluation may include:

• Taking a detailed history of your problem
• Gait analysis
• Palpation
• Measures of knee range of motion (ROM)
• Measures of ankle, knee, and hip strength
• Balance assessment
• Assessment of your functional mobility
• Performing special tests for your knee

Some components of the evaluation may be painful; just let your PT know if there pain or discomfort, and he or she can adjust the examination accordingly. Your session with your therapist should feel like a therapeutic alliance; both of you are working together to help you move better and feel better.

Once the initial evaluation is completed, your PT can work with you to develop goals for rehab. Treatment may be started during the first session. Physical therapy treatment for a knee meniscus tear may include:

Exercises

• Range of motion exercises: Exercises can be done to help improve the way your knee moves. A simple heel slide can improve the flexion ROM, and the prone hang exercise may improve extension ROM.
• Strengthening exercises: Your PT may prescribe specific exercises to strengthen the muscles around your knee. This can help support your joint and keep excessive pressure off your injured meniscus. Exercises may include short arc quads, straight leg raises, and hamstring strengthening with a resistance band. Your PT may avoid advanced strengthening exercises like squats or lunges, as these may put excessive stress and strain on your knee joint. 
• Balance exercises: If your PT feels your balance is impaired as a result of your knee pain, he or she may prescribe exercises to improve proprioception. Exercises may include the single-leg stance or the BAPS board. By improving your balance, you can keep your knee in the optimal position during functional activities, limiting stress and strain to your meniscus.

Remember, not every exercise is right for every person with a meniscus injury, so work closely with your PT to know which knee exercises are best for your specific condition.

Mobility training

• Functional mobility: A meniscus injury may cause difficulty with basic functional mobility like stair climbing or rising from a chair. Your PT may prescribe specific activities to improve your ability to do these things while minimizing stress on your meniscus.
• Gait training: Knee pain from a meniscus tear may cause you to walk with a limp, a term called antalgic gait. Your PT may perform specific exercises and activities to help restore pain-free gait. Video gait analysis may be done to analyze the way you are walking and to guide treatment for your gait.

Modalities

• Electrical stimulation: Various types of electrical stimulation may be used during your rehab for a meniscus tear. TENS may be used to help decrease pain, and NMES can be used to improve the way your muscles around your knee contract.
• Heat or ice: Your PT may apply heat to your knee to improve local blood flow, and ice may be used to decrease swelling and pain.
• Ultrasound: Ultrasound is used in PT to help improve circulation and overall blood flow, and it may be used by your PT during your knee rehab.
• Kinesiology taping: Some therapists use kinesiology tape to help improve overall muscle function. Your PT may use tape to improve the way your muscles around your knee contract, or it may be used to decrease pain and swelling.

Physical modalities like these are passive treatments that require little action on your part and have not been proven to have a major beneficial effect for knee meniscus tears. If your PT decides to use any passive physical modality during your rehab, make sure you understand what to expect from the treatment. Successful PT programs focus most on active engagement and exercises and less on passive treatments like ultrasound, heat, or ice.

Education

• Education about your condition: Your physical therapist should provide information about your condition as part of your treatment program. You likely have questions about meniscus tears and your overall prognosis. Your PT should be able to answer any questions you have about rehab for a knee meniscus tear.
• Strategies to prevent future problems: One of the most important things you can do in PT is learn how to prevent future problems with your knees. This typically involves learning the correct exercises to do as part of a home exercise program or fitness routine that can help keep your knees—and the muscles that support them—moving well.

A typical course of physical therapy for knee pain caused by a meniscus tear lasts about 4 to 6 weeks. You can expect to achieve full knee ROM and strength and regain pain-free functional mobility. Remember that everyone and every injury is different, and your course of PT may be shorter or longer. Some meniscus tears are severe, and you may require more invasive treatments, like injections or surgery, to completely resolve your condition.

Surgery Considerations 

When you are first diagnosed with a knee meniscus tear, your healthcare provider may refer you to an orthopedic doctor to consider surgery. Some tears do require surgery, but not all of them. A significant number of people have meniscus tears with no knee pain, so simply having a meniscus tear does not mean you need surgery. Plus, research studies have shown that physical therapy and exercise can help you avoid surgery if you have a meniscus tear.

If you actively participate in a course of PT for your meniscus tear and are still having pain and limited functional mobiltiy, your healthcare provider may recommend surgery. In that case, work with your practitioner to find the best course of care for you.

First Steps to Take

If you develop knee pain and feel you may have a meniscus tear, there are some steps you should take to get started on the right treatment. Don't panic; often you can quickly get back to your normal, pain-free activity. Visit your healthcare provider to get an accurate diagnosis, and participate in an active PT program designed specifically for you. You may find you are able to restore normal motion and strength to your knee so you can return to your optimal level of functional mobiltiy and activity.