Meniscus tears are common injuries among athletes, and if not treated properly can cause problems throughout your life. So here's everything you need to know about recovery times and, most importantly for triathletes, how and when you can resume exercise following a meniscus tear…
What is a meniscus tear?
Inside the knee joint between the tibia and femur, there is a medial and lateral layer of C-shaped cartilage known as the meniscus. This cartilage plays an important role in shock-absorption, load-bearing, force transmission and lubrication of the knee joint.
A tear in the meniscus can be caused by an acute injury when the knee joint is in a deep squat position or is subject to a forceful twisting movement during an accident or sporting activity.
It can also develop due to gradual degeneration, which happens when repetitive strain is placed on the meniscus from biomechanics, previous injury, muscle weakness or imbalance.
Tears in the meniscus can be classified in grades 1-3 based on the severity and location of the tear. This can be seen and diagnosed from an MRI scan.
Grades 1 and 2 are not considered to be serious and will be managed conservatively before considering alternative treatment. Grade 3 meniscal injuries are more severe and surgery may be advised immediately.
It is typically recommended that a patient tries conservative management first. The main symptoms people experience include pain along the joint line, popping, locking or clicking, giving-way and swelling.
Do I need surgery for a meniscus tear?
Some people require surgery after a meniscal tear and some do not. The factors which affect this are:
- Location and grade of tear
- Mechanism of injury
- Age and general health
- Activity level
- Severity of symptoms
- Functional goals
- Previous injuries or surgery
Whether or not surgery is advised is based on each individual case. A physiotherapy programme should be consistently followed for a period of three months before considering an injection or surgery. Recent research does not categorically prove which treatment is most beneficial.
It's important for patients to be aware that surgery has a number of negatives. These include: a higher likelihood of developing osteoarthritis, increased chance of future meniscus injuries, altered gait, muscle weakness and it is not guaranteed to improve pain or function in the short or long-term.
What’s the recovery time for a meniscus tear?
Recovery can take anywhere from 3-6 months. The time it takes to recover from a meniscus injury will differ from person to person. If seeing a physio you will be reassessed in each of your sessions and progressed accordingly.
If a patient hasn't had surgery they should rest from all sporting activities for at least 6-8 weeks following the injury. This is very important as from weeks 3-6 the tissue is in a stage of healing that involves a layer of ‘temporary tissue’ being laid down. This means that it is weaker and more susceptible to re-injury.
This tissue plays an important role in the laying down of new collagen fibres for the meniscus to recover.
The final stage of the healing process known as ‘wound remodelling’ can take months or years.
This involves converting scar tissue into stronger and more flexible collagen tissue. The time this recovery process will take is dependent on how committed the patient is to rehab, their healing time, age, diet, previous injuries.
Similarly, recovery from meniscus surgery can take anywhere from 6 weeks to 3 months. For the initial 3-6 weeks the patient will be advised to use crutches and be partially/non weight-bearing, and weeks 3-9 will focus on maintaining range of movement and then strengthening. A full return to sporting activity is expected once more than six months have passed.
How to help a meniscus tear heal faster
The good news is there are lots of things that can be done to help a meniscus recover faster and ‘better’. I use the word 'recover' as opposed to 'heal' as meniscal tears often remain even when the patient’s symptoms have gone and they have made a full recovery. This is due to a poor blood supply to areas of the meniscus.
A good blood supply is essential for the delivery of nutrients and removal of waste products which aids the inflammatory and remodelling process.
Despite this, by having the right rehabilitation programme from a physio that builds support around the meniscus and knee joint, recovery can still be achieved regardless of a tear still being present.
It's important to see a physiotherapist as soon as possible post-injury so you can be given individual advice.
When the injury initially occurs the first thing to do is RICE (rest, ice, compression and elevation) which aims to reduce the swelling as much as possible. Icing the knee should be done at least three times a day for 10-15 minutes, and if this provides relief can be continued throughout the recovery process.
A tubigrip can be used to compress the area slightly if swelling is an issue, which can be worn for two-hour periods throughout the day. Medication is also advised to help with pain relief and inflammation during the acute stage. Crutches can be helpful to take some load off the knee.
Rest is crucial in the recovery process of a meniscus tear – which I know at times can be very frustrating! However, ignoring a tear and continuing to train will only prolong the process and will result in the injury not healing as well as it could. The more you rest at this stage the better the outcome.
Guided and individualised rehabilitation will help the meniscus heal as best it can. Your physiotherapist's aim is to get the patient back to their sporting activity as soon as possible and reduce the likelihood of the symptoms recurring.
They will create a programme of exercises which maintain the range of movement in the knee, and then will progress to building the strength of the surrounding muscles. This will be done gradually in a way not to aggravate pain.
Avoiding any movements that cause pain, and in particular rotational and load bearing exercises which place stress on the meniscus will aid the healing process.
As previously discussed, if a meniscus tear is not healing then an injection or surgery can potentially help.
Can I continue training while my meniscus tear heals?
During the acute phase of a meniscus tear you should rest and therefore stop all training. This allows the inflammation to reduce and healing to occur.
During this acute phase you will be given gentle range of movement exercises that do not aggravate any pain in the knee, with the aim to increase circulation, maintain mobility and reduce swelling.
Whether you have surgery or not you will be advised to rest from your training for at least for 8-12 weeks. However, that doesn’t mean the patient has to do nothing. By seeing a physio will be given an individualised rehab programme which will aim to build strength in the muscles surrounding the knee joint, work on balance, proprioception and then gradual load-bearing.
All exercise and mobility work will have the aim of reducing the load on the meniscus, and getting the patient back into training as soon and safely as possible.
This programme will take your individual training goals into account and will set out clearly when you will be able to return to your training.
Some examples of the aims and exercises your rehabilitation programme may include:
- Quad strengthening (and glute) – Straight leg raise, Wall slides, Squats, Side-steps, Hip abduction in standing and lying, Bridges
- Hamstring strengthening – Isometric hamstring curls, Stiff-legged deadlift
- Balance – Single leg stands, Bosu squats
- Mobility – Heel slides, Hamstring stretch in lying
- Plyometric/load increase – Leg press, Knee extensions, Squat Jump
In regards to triathlon, you will be able to return to cycling and swimming before running. Cycling is a non-weight bearing activity and so if you have no pain while doing it at 12 weeks you should be able to return to it and increase your intensity gradually.
When rehabbing my patients, I recommend starting with 10-15mins at a low intensity and seeing how their knee responds before increasing.
Similarly, if you have no pain by 12 weeks then you could slowly reintroduce swimming into your training programme. I advise to only do front crawl and not breaststroke as this involves twisting the knee.
Returning to running can take anywhere between 3-6 months. When advising a patient on returning to running I normally start with interval work (e.g. 2min walk, 2min jog, 30sec sprint x 2-3) to see how their knee responds before increasing it.
Before returning to running your programme will likely involve plyometric and some twisting exercises to load the knee gradually before beginning to run.
Your training programme and activity level during recovery will look very different from someone else's with the exact same injury, as it is very much dictated by your individual symptoms.
How do you know when your meniscus tear is healed?
The only way to know if your meniscus is healed is by having an MRI scan, without one it is difficult to know if a tear has resolved.
However, the best way to actually know if you have recovered from a meniscus injury is your symptoms, and if you are able to perform your exercises and training without pain or discomfort (during or after).
What happens if I ignore my torn meniscus?
If you decide to ignore your torn meniscus the pain could persist, worsen and will likely recur. Therefore if you decide to ‘push-through’ pain and continue to train it will undoubtedly affect your performance both immediately and in the future.
I use the term ‘short-term pain for long-term gain’ to encourage people to fully commit to their rehabilitation programme and not to ignore their injury! As I know that often we would rather ignore pain than rest and allow ourselves to recover.
At Six Physio, our motto is 'don’t treat, cure’, which is important in the case of meniscal injuries as it's important to look at why the injury may have occurred, and how it can be rehabbed in the best way possible to prevent it from impacting your training again.
Top image credit: Getty Images
