Knee pain is one of the most common orthopaedic injuries that I see in older adults. The two most common injuries are knee osteoarthritis or issues with the meniscus in the knee. Both are often degenerative in nature. Knee pain can be extremely debilitating, affecting everything from walking around the mall to be able to perform a sport.
Meniscus injury is not a reason to stop working out!
Here’s what you or your coach need to consider when you are having pain from a meniscus issue in the knee.
The Meniscus: when things can go wrong
The meniscus is a C-shaped piece of cartilage in the knee that is about 70-75% water (1). It’s between the two bones in the knee joint and helps to allow the bones to glide smoothly past one another.
There are a couple of things that put the knee at risk to degenerate as we age. As we get older, we lose some of the water content in the meniscus. Think of it as decreasing the amount of cushioning available to the knee. This decrease can create more friction and lead to tears or degeneration of the joint. The wear and tear associated with this can be worse if we are not moving properly. For example, getting up out of chair or squatting with our knees caving in creates more force on the inside of the knee. This extra force can cause medial meniscus issues or pain on the inside portion of the knee.
Meniscus issues, especially as we get older, don’t tend to have a pin pointed incident. Often pain in the knee comes on gradually over time with repetitive strains to the knee. Think of it like when you’re rubbing your hands together. At first, it’s fine but as you keep sliding your hands past one another, discomfort accumulates until you begin having pain in the hands. The same is true of the meniscus. Degenerative issues are not about one moment in time but rather years of moving that eventually hit a threshold point where the body breaks down and you get pain.
So what can I do about a meniscus tear?
A meniscus tear can be treated either operatively or non-operatively. Your doctor or rehabilitation specialist will be your best resource to explore your options based on your specific circumstances.
Surgeons tend to favour younger persons for surgical management and older adults for non-surgical management. Research has also shown that persons can perform equally well with both treatment streams and there isn’t the risk of complications with non-surgical options (2). The first goal of any intervention is to manage pain. This may be by avoiding the movements that make the pain worse, pain medications or heat/ice for pain management.
Next step is to get the range of motion or movement in the knee back. If you have stiffness in the knee, often times people begin compensating which can lead to issues coming up to the hip or to the other side of the body. Restoring normal movement patterns is the next important piece. Ensuring that you are moving so that you don’t continue to put extra stresses on the meniscus will be important not only for pain now but to prevent pain from coming back later.
Trying to move around or exercise with pain from the meniscus in the knee can be very frustrating. Here are some things to keep in mind:
1. Squatting below parallel (or 90 degrees) will be painful so avoid it: Box squats to parallel or squatting to a box for a cue on depth is what I use with my athletes to ensure they aren’t reinitiating a sore knee
2. Ease off running: Often times the repetitive stress from running can make the knee pain worse. The impact can place more stress on the meniscus. Try to avoid running until the pain has gone away, especially on hard concrete
3. Avoid jumping or high impact: The impact of running, jumping or doing other plyometrics can be painful on the knee. Also if there is some issues with how your alignment, adding a dynamic component will just make that alignment worse.
4. Slowly reintroduce activities: Pain is your guide. As your body recovers from injury and you’re feeling less pain, begin increasing activity and volume while continually monitoring for rebound pain.
If in doubt, check with a physiotherapist. Physiotherapy can act as your guide to help get you back on track!
1. Howell R, Kumar NS, Patel N, Tom J. Degenerative meniscus: pathogenesis, diagnosis, and treatment option. World J Orthop. 2014. 18(5): 597- 602.
2. Mezhov V, Teichfahl AJ, Strasser R, Wluka AE, Cicuttini FM. Meniscal pathology – the evidence for treatment. Arthritis Res There. 2014. 16(2): 206.