Knee-Injury

What is a Knee Meniscal Injury?

Physiotherapists describe knee meniscal injuries as tears in the tough “c” shaped cartilage that acts as a cushion between the thigh bone (femur) and the shin bone (tibia). These tears can be partial or complete. They are commonly referred to as torn cartilage. Although they are slightly different in shape, the types of injuries they receive are the same. Physiotherapists often see these injuries accompanied by pain, swelling or locking of the knee joint.

What Causes Meniscal Injuries?

When a meniscus is torn, the knee becomes painful and swollen. Pain is often well localized and made worse by specific movements such as bending or pivoting. There may be tenderness around the joint line of the knee and certain maneuvers of the knee (like compression tests) may produce clicking and pain. Swelling is caused by the irritation of the joint lining by the torn cartilage. If a piece of the meniscus is caught in the joint, it may prevent the knee from fully extending (this is known as locking). Locking can be intermittent (lasting several minutes), or persistent (lasting weeks).

The above collection of signs and symptoms can correctly diagnose meniscal injuries most of the time. Occasionally in complicated cases, special tests are needed such as magnetic resonance imaging (MRI). Arthroscopic surgery is now being used more for a treatment than a diagnosis.

How are Meniscal Injuries Treated?

Each treatment plan is individualized through discussions with your Physician and Physiotherapist, and progress should be monitored regularly. Physiotherapy treatment is administered in 3 phases:

Physiotherapy Phase 1 – Control Pain & Inflammation

Following a meniscal injury, reduction of pain and inflammation is achieved with ice and Physiotherapy modalities such as ultrasound. Anti-inflammatory medications may also be helpful. It is important to modify activity during this acute phase.

Physiotherapy Phase 2 – Restore Strength & Function

Once the knee is moving normally and the swelling has gone, a gradual return to activity program begins. Physiotherapists advise the gentlest activities to be started first, which include cycling and non-weight bearing exercises. Finally, a gradual return to sports involving twisting and pivoting is added.

If the above measures do not prove successful or if the knee remains locked, arthroscopic surgery may be required. With arthroscopy, the torn portion of the meniscus may be removed or repaired. Most commonly, the fragment is removed (called partial menisectomy), and the edges are smoothed. Every attempt is made to retain as much of the meniscus as possible, since it is an important structure for protecting the knee from stresses. Sometimes there is a tear in the outer edge of the meniscus that can be treated by stitching (suturing) the meniscus back together.

Can Meniscal Injuries be Prevented?

Some meniscal tears result from abnormal shear forces that occur in an unstable knee joint. For example, with anterior cruciate ligament (ACL) tears, the unstable knee can give way or buckle if not supported. Repeated episodes produce forces that may eventually cause a meniscal tear. Therefore, Physiotherapists believe appropriate treatment of the unstable joint will help prevent tears of the menisci.

Are there any Special Considerations?

In most cases, if the Physiotherapy plan is followed, a full return to all sporting activity is possible. However, arthroscopy may be appropriate if the swelling is keeping you from completing full rehabilitation.

Top Stretches for Hip and Knee Flexibility

Exercises for Knee Pain

  • Quadriceps Stretch

    1. While standing, hold onto a counter top or chair back to assist in balance.
    2. Bend your knee back by grasping your ankle with 1 hand.
    3. Hold for 20 seconds. Repeat 2 times. Do 1 session per day.

    quadriceptstretch

  • Groin Stretch

    1. Pull heel toward buttock until a stretch is felt in groin/abductors.
    2. Sitting straight or with back against wall, gently relax knees to floor until stretch is felt.
    3. Hold for 20 seconds. Repeat 2 times. Do 1 session per day.

    groin-stretch

  • Hamstring Wall Stretch

    1. Lying on the floor with involved leg on a wall and other leg through a doorway, scoot buttocks towards wall until a stretch is felt in back of thigh.
    2. Pull your foot up toward your head, hold for 3 seconds, then point the foot up the wall.
    3. Hold for 3 seconds. Repeat 30 times. Do 1 session per day.

    hamstring-wall-stretch

  • Hamstring Chair Stretch

    With your foot on a chair or stool, lean forward until stretch is felt. Place foot on a higher plane for more of a stretch.

    1. Bend knee and lunge (bend) trunk to thigh.
    2. Push knee down and buttock away.
    3. Hold for 20 seconds. Repeat 2 times. Do 1 session per day.

    hamstring-chair-stretch

  • Gastroc Stretch

    Keeping the back leg straight with your heel on floor and turned slightly inward, lean into a wall until a stretch is felt in calf. Hold for 20 seconds. Repeat 2 times. Do 1 session per day.

    gastroc-stretch

  • Soleus Stretch

    Keeping back leg slightly bent with your heel on the floor and foot turned slightly inward, lean into a wall until a stretch is felt in calf. Hold for 20 seconds. Repeat 2 times. Do 1 session per day.

    soleus-stretch

  • Drop Squat Program

    What is a Drop Squat Program?

    Drop squats are an important exercise for strengthening the front thigh muscles (called the quadriceps). The most effective and easiest way to strengthen these muscles is a program which uses your own body weight. In drop squat exercise, you allow your knees to “collapse” momentarily, and then rapidly contract the quadriceps muscles to stop further collapse.

    Why should I do Drop Squats?

    Drop squats are used to strengthen quadriceps muscles in a way that is specific to the forces your legs experience with most physical activities.  This is important since rest is insufficient on its own to heal many knee injuries.

    How do you do Drop Squats?

    In order to effectively gain quadricep strength, there are three important aspects to this program:

    1) Position

    Stand with your feet shoulder-width apart making sure your knees are pointing straight ahead. Avoid a position of being knock-kneed or bow-legged. If you are doing the squats correctly, you should be able to look down at your knee caps and see them aligned over your second toe. The squat is only ¼ depth (less than 45 degrees).

    2) Speed

    The first stage of the program is a slow squat. That is, you go down and up at a slow, comfortable speed. Once you have done this for 5 days and are comfortable that it does not increase your pain, you can begin fast drops.

    When performing fast drops, you should drop into the squat position quickly. This should feel as though someone has “kicked your knees out from behind you” or as though you are jumping from a height and must absorb the impact when you land.  To recover, you contract your quadriceps and straighten up slowly.

    It is very important that you understand and perform this part of the program correctly. In order to improve strength, a considerable dynamic load is placed on the thigh muscles. This is the same type of load placed on the knee during many forms of physical activity. It is a unique type of exercise since the work is being done by the muscle as it is lengthening (stretching) rather than shortening (contracting).

    3) Progression

    There are two phases to the progression; build up and maintenance.

    Build Up

    Begin by performing 3 sets of 20 repetitions of the slow squats (do 20 squats, wait a minute or two, then do 20 more, recover and then do the third set of 20).

    Continue this daily, after 5 days start fast drop squats using the same format of 3 sets of 20 repetitions. Next, add weight, using dumbbells, hand weights or bags loaded with cans or sand. Use your bathroom scale to adjust the weight in the bags. A backpack can also be used to hold weight, but should be worn on your front so that you can hold onto it with your arms (this makes it more comfortable when you do the quick squats).

    Drop Squat 30 Day Build Up

    3 sets of 20 repetitions daily

    Slow………………………………………5 days

    Fast drop, slow up…………………………5 days

    Fast drop, slow up 5 lbs in each hand……..5 days

    Fast drop, slow up 10 lbs in each hand……5 days

    Fast drop, slow up 15 lbs in each hand……5 days

    Fast drop, slow up 20 lbs in each hand……5 days

    Maintenance

    Once you have reached the 20 pound level for 5 days, switch over to the maintenance program (using the same weight, but doing it every other day). Then, continue with the maintenance program as part of your regular exercise routine. It is important to work at maintaining the strength and endurance gained during the build up phase, otherwise your knee pain will likely return.

    Drop Squat Program Maintenance

    Decrease to 2-3 times per week at the 20 lb level.

    Sample Program

    The above is an example of a typical program which uses the build up and maintenance phases already described. The program should be periodically supervised by your Physician or Physiotherapist.

    Modification to the depth of the drop or the amount of weight should be made depending on the type of your knee pain and your body size. The sample program can be modified easily by using less repetitions or weight. It is a good idea to keep a log of your progress.

    It is important to incorporate stretching into your program. When doing so, try to hold your stretches for 20 to 60 seconds. Do not bounce during a stretch since the muscle will respond more positively to a stretch which is held for a longer period.

    Stretching

    20-60 seconds of a gentle hold

    No bouncing

    No pain

    The routine should consist of a warm-up stretch, the squats, a cool-down stretch and icing of the knee if painful.

    Routine

    Stretch

    Do squats

    Stretch

    Ice if painful

    (Ice 10 min, remove ice to rewarm, ice 10 min)

    Are there any Precautions or Considerations?

    It is quite common for your knees to not feel much better during the build up part of the program. This may be frustrating, because you feel that the program isn’t doing anything.

    But, feeling the same while you are increasing the weight means that you are actually making progress.

    It is very important to pace yourself through the program, increasing the intensity of the exercises only if the pain is not worsening. If you experience increased pain, reduce the weight to where you were comfortable before and stay at that level for a few days. For example, if you were using 10 pounds in each hand and the pain worsened when you tried 15 pounds, reduce to 10 pounds for a few days, and then increase the weight again. If this does not help, it is important that you contact you Physician or Physiotherapist.

    When may I Return to Activity?

    As long as you can progress through the program, keep playing your sports. If however you experience flare-ups as you increase the intensity of the drop squat program, you will have to decrease the activities which irritate your knees. The program takes priority because your knees will likely not get better until they are strong.