It’s a common question: ‘Will walking on a torn meniscus make it worse?’ Well, it may be cliche, but this will vary from case to case, as not all meniscus tears are equal.
Here, Six Physio's Ollie Errser delves into the detail. But first, let's first look at what the meniscus is and how it can be torn.
What is the meniscus?
Within each of your knees there are two C-shaped pieces of thick, rubbery cartilage that act as ‘shock absorbers’ between your shin (tibia) and thigh (femur) bones.
Unfortunately for us, these bits of cartilage have a pretty poor blood supply. What this means is that generally the meniscus isn’t great at healing by itself!
How do meniscus injuries happen?
Injury to the meniscus can be caused by different mechanisms. These can be worn down with natural ageing and degeneration, but in younger people meniscus tears are generally caused due to sudden twisting movements, especially when weight bearing.
This rotation or twisting of the knee can happen when changing direction while running, landing awkwardly from jumping, or while being tackled during a football game.
When people experience a torn meniscus, they’ll often report sudden pain, a ‘popping’ sensation, swelling and sometimes a feeling of being ‘blocked’ when trying to bend or straighten the knee.
With the swelling knee it may begin to feel stiff and have a feeling of pressure when bending or straightening, which can worsen over the following hours and days.
In some cases, people will be okay to weight bear and walk, in other cases you may not be able to put any weight through the leg. Some people even report the feeling of the leg buckling beneath them.
If you feel you may have sustained an injury like this, you should seek medical assessment and potentially further investigation.
Prior to seeing any professional, I’d advise abiding to the POLICE principles, which stand for: protect, optimal loading, ice, compression and elevation.
You can also take over-the-counter pain medication such as paracetamol and ibuprofen to relieve any of the discomfort post-injury.
Subsequently, your GP may prescribe stronger pain medication and/or stronger anti-inflammatories if they feel appropriate to manage the pain and swelling. As with all drugs, please read and follow the directions for use.
Diagnosis of a meniscal tear is through the use of either an X-ray or MRI, although we don’t necessarily need an MRI to treat a tear.
These images give us an idea on the type and severity of meniscal injury, and thus how to manage the tear, whether surgical or conservative.
The recovery time for a meniscus tear and how soon we can get back to full weight-bearing, walking and running will vary depending on the above.
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Types of meniscus tears
There are five main shapes or types of meniscus tears and we’ll briefly cover these (although tears often present in different ways depending on size, depth and location).
Vertical longitudinal tears
These run between fibres of meniscus, so are not always debilitating or painful. They’re common on the medial meniscus. Complete longitudinal tears can result in bucket handle tears and need surgical intervention.
Vertical radial tears
These run across fibres of meniscus and can affect shock absorption. They’re common in the lateral meniscus and may need surgical intervention.
Horizontal tears
These tears split the meniscus into upper and lower sections. These types of tears can split the meniscus leading it to ‘flip’ up into the joint space and cause locking or catching.
Generally these can be asymptomatic and managed conservatively unless catching or locking becomes more severe or frequent.
Oblique tears
Generally symptomatic and painful. These often catch in certain positions and can cause pain during knee flexion. They can require surgery.
Complex/degenerative tears
These occur with age, wear, and tear. They’re generally an accumulation of multiple small tears and not always symptomatic.
They’re often managed well within physio sessions, but advanced cases may require joint replacement.
Will walking on a torn meniscus make it worse?
Walking on a torn meniscus can vary in its effects depending on several factors, including the type and severity of the tear, an individual's pain tolerance, and their overall knee health.
Here's a closer look at how walking can affect a torn meniscus…
1. Pain and discomfort
Walking on a torn meniscus is likely to cause pain and discomfort. The degree of pain can range from mild to severe, depending on the extent of the tear.
In some cases, individuals may be able to bear weight on the affected knee, while in others, the pain may be too intense to walk comfortably.
2. Swelling
Walking on a torn meniscus can lead to increased swelling in the knee joint. Swelling is the body's natural response to injury and it can further restrict mobility and increase discomfort.
3. Limited range of motion
A torn meniscus can limit the range of motion in the knee joint. Walking with limited mobility can result in an altered gait, potentially causing further strain on the injured area and adjacent structures.
4. Potential for further damage
Walking on a torn meniscus does carry a risk of worsening the tear or causing additional damage.
Excessive stress on the already compromised meniscus can lead to more extensive tears, making the injury more complex to treat.
Of course, if you’re not at the start of your recovery journey, but have been working with a physio to heal, then walking may not be so risky. Refer to your physio’s advice on this.
Meniscus tear treatments
Choosing the appropriate treatment for a torn meniscus depends on the type and severity of the tear, as well as the individual's overall health, activity level and what they are hoping to return back to. Treatment options include:
1. Optimal loading
In many cases, rest is essential for allowing the torn meniscus to heal. This means reducing or eliminating activities that worsen the pain, which may include walking or weight-bearing activities.
We wouldn’t want you to do absolutely nothing for an endless period, though! This would result in losing muscle mass in your quadriceps and make a return to running more difficult.
2. Ice and elevation
Applying ice to the affected knee and elevating it can help reduce swelling and alleviate pain.
3. Physical therapy
Physical therapy can help strengthen the muscles around the knee joint, improve stability and enhance range of motion.
This is going to be a big part of the return to running/sport irrespective of whether you have surgery or not.
Juggling appropriate strengthening exercises in a controlled environment while not irritating the knee is huge.
You’d progress from working to achieve full range of movement through to getting your quad bulk and work capacity up, and then working on your maximal strength.
That would be followed up by adding in some hopping and jumping in preparation for a return to running.
4. Bracing
In some instances, a knee brace may be recommended to provide support and reduce strain on the torn meniscus.
5. Medication
Over-the-counter pain relievers and anti-inflammatory medications may be prescribed to manage pain and swelling.
6. Corticosteroid injections
In cases of significant pain and inflammation, a doctor may recommend corticosteroid injections into the knee joint.
7. Surgical intervention
For severe tears that do not respond to conservative treatments, surgery may be necessary.
Arthroscopic surgery is a minimally invasive procedure often used to repair or trim the torn meniscus.
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How to return to activity gradually
As the torn meniscus heals, a gradual return to activity may be appropriate. Physical therapy plays a significant role in this process, as it helps rebuild strength, stability, and range of motion in the knee joint.
During the recovery period, it's crucial to work closely with a healthcare professional who can provide guidance on when and how to reintroduce activities like walking, running, and sports.
Rushing the rehabilitation process or resuming normal activities too quickly can increase the risk of re-injury or prolonged recovery.
Generally a return to full function is more than achievable with the correct management and if in doubt, please seek medical advice and guidance!
If you think you’ve sustained a meniscus injury and are experiencing the symptoms mentioned above, then getting an opinion from a physiotherapist is a great place to start your rehabilitation. Six Physio has multiple clinics across London and you can find out more here.
Top image credit: Getty Images/Jan-Otto