Knee Pain: Could It Be A Meniscus Tear

Physical Therapist’s Guide to Meniscal Tear  (reposted from Move Forward PT)

 

Meniscal tears are common injuries to the cartilage of the knee that can affect athletes and nonathletes alike. These tears can be either “acute,” meaning they happen as a result of a particular movement, or “degenerative,” meaning they happen over time. Your physical therapist can help you heal a meniscal tear and restore your strength and movement. If surgery is required, your physical therapist can help you prepare for the procedure and recover following surgery.


 

What is a Meniscal Tear?

The meniscus is a cartilage disc that cushions your knee. Each of your knees has 2 menisci (plural of meniscus); one on the inner (medial) part of the knee, and the other on the outer (lateral) part of the knee. Together, they act to absorb shock and stabilize the knee joint.

Meniscal tears can be classified in 2 ways: acute or degenerative. An acute meniscal tear typically is caused by twisting or turning quickly on a bent knee, often with the foot planted on the ground. This mechanism of injury often produces related injuries, such as an ACL tear. Degenerative meniscal tears occur over time, due to repetitive stress being put on the knee, such as in a job or sport that requires a lot of squatting.

How Does it Feel?

When you tear the meniscus, you might experience:

  • A sharp, intense pain in the knee area
  • A “pop” or a tearing sensation in the knee area (acute injury)
  • Swelling within the first 24 hours of injury
  • Difficulty walking or going up or down stairs because of pain or a “catching or locking” sensation in the knee
  • Difficulty straightening or bending the knee fully

How Is It Diagnosed?

Your physical therapist will:

  • Conduct a thorough evaluation that includes a detailed review of your injury, symptoms, and health history.
  • Perform special tests to measure the range of motion (amount of movement) in your knee and determine which specific movements and positions increase your symptoms.
  • Use a series of tests that apply pressure to the meniscus to determine whether it appears to be damaged.

The results of these tests may indicate the need for further diagnostic tests—such as magnetic resonance imaging (MRI)—or a referral to an orthopedic surgeon for consultation.

How Can a Physical Therapist Help?

Meniscal tears can often be managed without surgery. A short course of treatment provided by a physical therapist can help determine whether your knee will recover without surgery. Your physical therapist can help control pain and swelling in the knee area and work with you to restore full strength and mobility to your knee. Your treatment may include:

Manual therapy. Your physical therapist may apply manual therapy—hands-on treatment that may include massage, stretching, or joint mobilization—to help reduce swelling and stiffness, and restore muscle function around the knee.

Icing. Your physical therapist will apply ice packs to the knee to help control any pain and swelling, and may instruct you to apply icing at home. Swelling is an important “guide” during your rehabilitation and can indicate your level of ability and recovery. If you experience an increase in swelling, your physical therapist will modify your treatment program or activity level to ensure your safest, most effective recovery.

Compression. Your physical therapist may recommend the use of compression bandages, stockings, or pumps to assist in the reduction of or prevent further accumulation of edema (swelling). Your physical therapist may include them as part of your regular treatments and teach you and your family how to use them at home.

NMES. Your physical therapist may use a treatment called neuromuscular electrical stimulation (NMES). NMES uses electrical current to gently stimulate/contract the muscles around your knee to help improve their strength.

Assistive devices. It may be necessary to use assistive devices such as crutches, a cane, or a walker in the short term. Your physical therapist will make recommendations about which device is best for you and will instruct you in how to use it properly.

Strengthening exercises. Your physical therapist will design exercises to build and maintain your strength during recovery and help restore full movement to the knee. You will be given a home program of exercises that are specific to your condition. Strengthening the muscles around the knee and throughout the leg helps ease pressure on the healing knee tissue.

Fitness counseling. As you recover, your physical therapist will advise you on ways to improve and maintain your fitness and activity levels, and will help you decide when you are ready to return to full activity.

If Surgery Is Required

Patients with more serious meniscal tears, or those who don’t respond to a course of physical therapy, may need surgery to repair the injured knee. Surgically removing the torn cartilage (a procedure called a meniscectomy) usually is a simple procedure that requires a course of physical therapy treatment following surgery. Many people are able to return to their previous level of activity, including sports, after approximately 4 months of treatment.

Meniscus removal. Following a simple meniscectomy, your rehabilitation will likely be similar to that for nonsurgical meniscal injuries. Your physical therapist may use ice and compression to control pain and swelling and will show you how to use these treatments at home. The focus of your treatment will be on helping you get back your strength and movement through a series of exercises performed in the clinic and at home, as well as with hands-on treatment (manual therapy). Initially, it is likely that you will need to use crutches or a cane for walking. Your physical therapist will help guide you in gradually placing your weight on the knee to stand or walk, to allow the meniscus and other tissue in the knee joint to slowly adjust to increased pressure.

Meniscus repair. Sometimes your surgeon will decide that the torn meniscus can be repaired instead of removed. Research studies show that if a meniscal repair is possible, it can reduce the risk of arthritis developing later in life. Rehabilitation following a meniscal repair is slower and more extensive than with meniscal removal because the repaired tissue must be protected while it is healing. The type of surgical technique performed, the extent of your injury, and the preferences of the surgeon often determine how quickly you will be able to put weight on your leg, stop using crutches, and return to your previous activities.

Following surgery for meniscal repair, your physical therapist will:

  • Help you control pain and swelling
  • Guide you through progressive reloading of weight to the knee to allow the cartilage to slowly adjust to increased compressive stress and pressure
  • Help restore your knee and leg range of motion
  • Teach you exercises to help restore your muscle strength

Return to Activity

Whether your torn meniscus recovered on its own or required surgery, your physical therapist will play an important role in helping you return to your previous activities. Your physical therapist will help you learn to walk without favoring the leg and perform activities like going up and down stairs with ease.

Return to work. If you have a physically demanding job or lifestyle, your physical therapist can help you return to these activities and improve how you perform them.

Return to sport. If you are an athlete, you may need a more extensive course of rehabilitation. Your physical therapist will help you fully restore your strength, endurance, flexibility, and coordination to help maximize your return to sports and prevent reinjury. Return to sport varies greatly from one person to the next and depends on the extent of the injury, the specific surgical procedure, the preference of the surgeon, and the type of sport. Your physical therapist will consider these factors when designing and adjusting your rehabilitation program, and will work closely with your surgeon to help decide when it is safe for you to return to sports and other activities.

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Can this Injury or Condition be Prevented?

There is little research at this time to support exercise or other interventions such as bracing for prevention of meniscal injuries. However, you can make choices to help improve your overall fitness and keep your knees as strong and as healthy as possible. Practices that can help keep your knees strong include:

  • Regular exercise to help strengthen the muscles that support your knees
  • Staying physically active to prepare your body for the demands of a sport or strenuous activity
  • Avoiding twisting or turning quickly while your foot is planted on the ground, to help prevent stress to the knee that can cause a meniscal tear

If you already have knee problems, your physical therapist can help you develop a fitness program that takes your knees into account. Some exercises are better than others for those with a history of knee pain. Many exercises can be modified to fit your specific needs.

Real Life Experiences

Beau is a college sophomore who plays on his intramural lacrosse team. During a recent practice game, Beau twisted his left knee while performing a sharp turn to make a catch. He immediately heard a “pop” and felt pain in his knee joint. He was helped off the field by teammates and led back to his room, where he applied ice and rested for the rest of the evening.

The next morning, Beau felt pain when he put weight on his leg to get out of bed, and found he had difficulty walking; he also noticed some swelling on the inside of his knee. His roommate is in the physical therapy program at his university; he suggested Beau see a physical therapist.

Beau’s physical therapist gets his medical history and asks him to describe what happened in the game to get a sense of what might have happened to his knee. She then performs some tests that include movements that selectively stress the tissues of the knee to see if the symptoms can be provoked. She tells Beau that his symptoms may indicate a meniscal tear. She recommends that he consult with an orthopedic surgeon, who orders magnetic resonance imaging (MRI). The surgeon confirms a diagnosis of a medial meniscal tear. After consultation with the surgeon, Beau chooses to have the tear “cleaned up,” and have a small piece of the meniscus removed—a procedure called a meniscectomy.

Prior to surgery, Beau works with his physical therapist, who prescribes exercises and manual therapy to reduce the swelling, improve the knee range of motion, and restore muscle function around the knee—treatments that have been shown to improve surgical outcomes.

Following his surgery, Beau’s physical therapist controls the swelling around the knee joint with ice, and shows Beau how to ice his knee at home. She applies electrical stimulation to speed the recovery of the quadriceps muscle. She teaches him range-of-motion exercises and tells him how often he should be doing them at home. She teaches him how to use crutches to avoid putting pressure and weight on the knee while its tissues heal.

After 1 week, Beau is able to walk without his crutches, but has difficulty bending his knee fully or straightening it when he walks. His physical therapist works with him on improving his walking pattern, and continues to address his knee range of motion, strength, swelling, and pain. His exercises are adjusted as he heals to continue to challenge him and move his recovery forward.

After 3 weeks, Beau has full range of motion and increased strength in his involved leg. He has good balance and no pain while walking. His physical therapist guides him as he returns to jogging and then running. She gives Beau feedback on how much he should be running, how running should feel, and what to do to ensure a symmetrical running pattern to keep his knee and his other joints safe.

At 4 weeks, Beau’s treatment progresses to sports-related rehabilitation activities, which include moving quickly from side to side and learning how to safely turn to field a catch. His physical therapist provides guidance and training to help Beau avoid reinjury. Beau reports his leg muscles have gained strength, and he feels more stable as he executes his movements.

After 6 weeks of treatment, Beau rejoins his team for a playoff game and, with newfound confidence, sets up his teammate for a winning goal!

This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat a variety of conditions or injuries. You may want to consider:

  • A physical therapist who is experienced in treating people with orthopedic (musculoskeletal) problems or sports injuries.
  • A physical therapist who is a board-certified orthopaedic clinical specialist or who completed a residency or fellowship in orthopedic physical therapy or sports physical therapy has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you’re looking for a physical therapist:

  • Get recommendations from family and friends or from other health care providers.
  • When you contact a physical therapy clinic for an appointment, ask about the physical therapist’s experience in helping people with a meniscal tear.

During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

Further Reading

The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.

The following articles provide some of the best scientific evidence related to physical therapy treatment of meniscal injuries. The articles report recent research and give an overview of the standards of practice for treatment both in the United States and internationally. The article titles are listed by year and are linked either to a PubMed* abstract of the article or to free access of the full article, so that you can read it or print out a copy to bring with you to your health care provider.

Beaufils P, Pujol N. Management of traumatic meniscal tear and degenerative meniscal lesions: save the meniscus. Orthop Tramatol Surg Res. 2017 September 2 [Epub ahead of print]. doi: 10.1016/j.otsr.2017.08.003. Article Summary in PubMed.

Moses MJ, Wang DE, Weinberg M, Strauss EJ. Clinical outcomes following surgically repaired bucket-handle meniscus tears. Phys Sportsmed. 2017 May 23 [Epub ahead of print]. doi: 10.1080/00913847.2017.1331688. Article Summary in PubMed.

Skou ST, Lind M, Holmich P, et al. Study protocol for a randomised controlled trial of meniscal surgery compared with exercise and patient education for treatment of meniscal tears in young adults. BMJ Open. 2017;7(8):e017436. Free Article.

Hare KB, Stefan Lohmander L, Kise NJ, et al. Middle-aged patients with an MRI-verified medial meniscal tear report symptoms commonly associated with knee osteoarthritis. Acta Orthop. 2017 August 8 [Epub ahead of print]. doi: 10.1080/17453674.2017.1360985. Free Article.

Katz JN, Brophy RH, Chaisson CE, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med. 2013;368:1675-1684. Article Summary in PubMed.

Logerstedt DS, Snyder-Mackler L, Ritter RC, Axe MJ. Knee pain and mobility impairments: meniscal and articular cartilage lesions. J Orthop Sports Phys Ther. 2010;40(6):A1-A35. Free Article.

Heckmann TP, Barber-Westin SD, Noyes FR. Meniscal repair and transplantation: indications, techniques, rehabilitation, and clinical outcome. J Orthop Sports Phys Ther. 2006;36:795-814. Article Summary in PubMed.

Lowery DJ, Farley TD, Wing DW, et al. A clinical composite score accurately detects meniscal pathology. Arthroscopy.2006;22:1174-1179.  Article Summary in PubMed.

Fitzgerald GK, Piva SR, Irrgang JJ. A modified neuromuscular electrical stimulation protocol for quadriceps strength training following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther. 2003;33:492-501. Article Summary in PubMed.

*PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI).  PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.

Authored by Christopher Bise, PT, DPT, MS. Reviewed by the MoveForwardPT.com editorial board.

Custom Fit Orthotics

Custom Orthotics

Need help putting your best foot forward?
Orthotics are any support, brace, insert or splint used to support, align, prevent, or correct the function of movable parts of the body.

Custom fit shoe inserts or orthotics are specifically made for your body and can be an absolute God-send when it comes to getting rid of persistent or recurrent pain in the

  • Back
  • Hips
  • Knee
  • Ankles
  • Feet

One patient reported his migraines went away once he started wearing his custom fit orthotics. Though we can’t guarantee that it will help with headaches and migraines if there is a bio-mechanical issue (meaning an issue with how your body is aligned… one leg shorter or longer than the other, tight muscles and weak muscles unable to stablilize the joint, foot arches falling in or very high, etc)  orthotics can be the icing on the cake if you just can’t get rid of the pain or the problem completely after trying exercise, physical therapy, chiropractics or other treatments.

Want To Know If Custom Orthotics Are Right For You?
• Do your arches fall in when you do a little squat or one falls in more than the other?
• Does your arch seem like it rolls outward a lot when standing and walking. Or one does roll out or in more than the other. Tip: Watch your arches when you walk directly towards a mirror or while you are doing a squat.  Do they roll in and pronate (flat foot) or do they roll out and supinate (high arch)?
See the image below. These are all pictures of a right foot:


______________________
• Correcting leg length discrepancies: Is one leg longer than the other? When you stand in front of a mirror do you notice that you put more weight on one side than the other? Common with scoliosis (a significant curvature of the back but can also cause a slight scoliosis or curve in the spine if one leg is longer than the other). The picture below is a little exaggerated but when you stand barefoot in front of a mirror is one shoulder higher than the other, one hip higher than the other or any pronation or supination (see above photo) happening at the foot?


__________________________

• Reducing stress on and slowing the progression of those god forsaken bunions!

_________________________________
• Minimizing plantar fascia stress, prevent or reduce Plantar Fasciitis symptoms

_________________________________

• Increasing foot and ankle stability: Lots of sprained ankles in the past or present?
• Reducing foot and Lower extremity fatigue. Do you seem like you tire out too quickly with exercise or do your feel or legs feel extremely tired after a regular workout?

• Prevent or reduce symptoms related to
• Achillies Tendonitis
• Calf strain
• Plantar Fasciitis
• Patello- femoral syndrome (Pain around your knee cap)
• Hip pain
• Knee pain
• Low Back Pain
• Some types of neck pain/headaches
• Arthritis/Degenerative joint Disease
• Shin splints and other leg pain

__________________________________

Still not sure if orthotics could benefit you? Stop by the Smart Clinic for a Free Injury Assessment and we can let you know if orthotics may be the right choice for you.
We want you to “Be Active Be Happy and Get Back to Being You!”
The SMART Clinic accepts most insurance carriers & is conveniently located in most of the Elite Sports Club location.

Email Info@smart-clinic.com 
or call 1 262 754 3450 for your custom fit orthotics!!

Myths About Physical Therapy

Myths About Physical Therapy

Myth #1 You need a referral to be able to see a physical therapist.

Due to a law called direct access,  you do not need a referral to be evaluated by a physical therapist. However, some states have restrictions on the treatment a physical therapist can provide without a referral. So getting evaluated by a physical therapist can be covered by your insurance (check with insurance first) and then you may or may not need a doctor’s referral to continue with therapy.

Myth #2 It’s very painful.

Contrary to popular belief PT doesn’t stand for Pain and Torture.Many people avoid visiting a physical therapist because they’re worried it’s going to be painful. The objective of physical therapy is to reduce a patient’s pain, and the therapist works within the patient’s pain threshold to do so.  Though some work may be uncomfortable ultimately you will be feeling better.

Myth #3 It’s only for accidents and injuries.

Prevention and fitness is a focus of physical therapists as well. Due to extensive training in movement analysis, gait analysis and the biomechanics of the musculo skeletal system physical therapists are also skilled at anticipating problems before they happen or decreasing issues before they worsen.

Myth #4 Physical therapy can be performed by all health care professionals.

Physical therapy should only be carried out by a licensed physical therapist, despite a common misconception that all health care professionals, trainers or strength coaches are able to provide this service.

Myth #5. Insurance doesn’t cover physical therapy.

Most policies cover physical therapy. In fact, physical therapy can also reduce costs in other ways, by avoiding scans, surgery or prescription drugs, as well as reducing the possibility of falls and conditions becoming chronic. Check with your insurance regarding physical therapy evaluation and treatments.

Myth #6. If its “bone on bone” surgery is the only option

You hear this regarding joint replacement a lot.  The truth is a lot can be done to alleviate pain and possible avoid or significantly delay surgery.  At Smart Clinic in the Milwaukee area we have a few of the only machines know for speeding up healing time and significantly decreasing pain.  Called ARPwave therapy, and in adjunct with regular physical therapy sessions Arpwave therapy has helped our patients avoid surgery, delay surgery or more quickly recover from surgery.
My #7 If it’s torn surgery is the only option.

Not true.  Depending on the severity of the injury and the function that you are looking to get back to, sometime physical therapy can be just as effective as surgery.  Take knee arthroscopic surgery for knee pain or meniscus tear… a study of over 300 participants at multiple centers (Katz 2013) showed the having physical therapy is just as effective as surgery followed by physical therapy in reducing pain and returning to function.  About 30% of those that didn’t get better ended up having surgery after 6 months. Therefore 70% were able to avoid surgery.  Physical therapy can be as effective as surgery in treating a number of conditions so at times can provide an alternate to surgery.

Myth #8. I can do it myself.

Doing exercises incorrectly and not knowing it can be detrimental and can slow healing from an injury and can lead to further injury.  While the patient’s participation is essential, physical therapy should always be performed by a licensed professional. Like any medical professional however, the success of the treatment relies on a physical therapist’s expertise in order to draw up a detailed treatment plan specific to the patient’s needs.

Be Smart!  Come see us at the Smart Clinic for a free injury assessment or for your physical therapy needs.  We are located in the Elite Health Clubs of greater Milwaukee and look forward to helping you heal.

Stacey Roberts PT

call for your appointment with one of our licensed Physical Therapists today to get you back to where you want to be.  262 754 3450. Located at Elite Sports Clubs of Greater Milwaukee

Reference(s):

Katz, J et al N Engl J Med 2013; 369:683August 15, 2013

Ice versus Heat: Which one is better?

Ice versus Heat: Which one is better?

I have been a physical therapist for almost 30 years and this is still one of the most common questions that my patients have asked me over those three decades. Should I use heat or cold after an injury?

Well the answer is really, it depends.

It depends on how long after the injury you currently are and what you are trying to accomplish.

I know, hang in there I will get more specific.

To decide whether you use heat or ice you have to know a little bit about how they both work with the body.

When you heat a body part you can tell that you increase the tissue temperature. But what does that do and why is it important?

Increasing the tissue temperature causes a dilation or widening of the blood vessels (think of an elongated balloon slowly getting blown up) . You essentially end up increasing blood flow and other “liquid” to the area. This can be very beneficial in a chronic injury where a muscle feels tight and due to excess tension or chronic pain resulting in decreased movement for prolonged periods, the muscle or tissue ends up experiencing less blood flow to that area.

So heating the area brings blood to it and helps it relax (remember the vessels expand and essentially relax or expand like a waist line after Thanksgiving dinner!) You probably can see why heat may help a chronically stressed muscle now. Increased blood flow to a tight muscle = decreased tension. This results in a decreased pain response temporarily. But if you go back to doing what you did prior to adding the heat and don’t correct why the muscle was tight in the first place, it may feel better in the short term but not always in the long term.

Think about your neck and shoulder muscles. Do you hold your tension there? When you let warm water from the shower beat against your neck and shoulders, it feels good doesn’t it?

When muscles are constantly fighting against gravity and our poor postural position over time without much movement throughout the day muscles begin to tense up, get sore, feel tight and blood flow through the muscle slows. Heat is your friend here and can bring temporary pain relief.

But when it comes to a brand new injury heat is not your friend. And sometimes up to six or even eight weeks after an initial injury heat alone may still not be a good option.

Ice is the preferred method directly following an injury and when swelling is present. This is due the cold temperature resulting in constriction of the vessels near the injury causing the swelling to decrease. By keeping this normal reaction to an injury under control with proper icing, elevation and often compression we can speed up the healing process.

Note: the body is not doing something wrong when it swells up after an injury. As a matter of fact, we need this reaction to begin our healing process. But too much of that good thing can be an issue over weeks after the injury. If swelling is not addressed it will be more difficult for the body to heal and also more difficult for us to return to our activities due to lingering pain and potentially instability.

So rule of thumb: Always ice an injury immediately after and as long as swelling remains. Make sure you rest the area effected, utilize compression if possible if the injury is on an arm or leg, and elevate the injured area (if possible). Remember the acronym RICE: Rest, Ice, Compression, Elevation.

In the weeks after the injury a combination of heat and ice can be used. Rule of thumb here? If it is a joint injury like an ankle sprain for example, versus something like a pulled muscle, stick with ice until the swelling is gone. It’s rare that directly over a joint that you would want to use heat especially if swelling persists. HOWEVER, if the muscle close to the joint effected is causing an issue or if a physical therapist or physician identifies “capsular” tightness in the joint, then heat to warm up the tissue around the joint followed by exercise and or massage of that area can be beneficial. But always end with ice after exercising the effected body part, especially in the six to eight weeks after an injury. The exception to adding heat in this scenario is if the area is already red and inflamed. It’s already hot so you don’t want to heat it up more.

How long should you ice or heat? Ice and heat can both be applied for the same length of time i.e. between 10-20 minutes generally for it to be effective. Five to ten minutes over smaller areas like fingers or a wrist.

If it is a new injury, ice on and off ever hour or two for twenty to 30 mins and follow the R.I.C.E method for at least 48 hours or longer depending on the severity of the injury, the pain you are experiencing and what structure is effected.

So in a nutshell remember:
• Ice for any new injury, and or when there is still swelling present.
• Never ice before exercise as you will numb your sensation to pain and may further injure yourself.
• A combination of heat and ice can be beneficial if swelling is not longer present or only present after activity (and then you would ice).
• Heat for chronic pain of a muscle or joint to help increase blood flow to the area and increase tissue elasticity. The can be followed by stretching and massage for further relief.

Hope this helps!

Kind regards,
Stacey Roberts PT, MH, Naturopath
Smart-clinic.com

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