“I recently tore the meniscus in my left knee as diagnosed by MRI. It aches especially if I walk a lot. Driving a manual car didn’t help but I now have an automatic. It doesn’t lock up and I can walk on it but it tends to ache the next day. I can have surgery but I am slightly reluctant as it is an option. I desperately miss my running and wondered if you have any ideas for me to work around this?”
Running Fitness Magazine, March 2015
Meniscal tears are indeed becoming more of an issue these days for runners than they used to be, possibly because the average age of a runner is on the increase. In sports like football and rugby, acute tears can occur as a result of sudden twists of the knee on a planted foot but with runners the tears are more commonly chronic in nature, i.e. the result of minor tears accumulated throughout life (which may cause no symptoms) tending to heal less as we get older and starting to cause problems.
MRI’s are designed to confirm a diagnosis but should not be used in isolation to decide if surgery is needed. The symptoms, specific manual tests and individual’s case history are used to advise. Without examining you myself I can obviously not say for sure, but the fact that your knee is not locking up is a good sign that that the tear may not be severe enough to warrant an operation. The symptoms of minor to moderate tears can often be resolved within 2-3 weeks through suitable activity modification, standard RICE protocol (Rest, Ice, Compression, Elevation) and most importantly rehab.Meniscus Tears in Runners - Surgery may not always be necessary. Click To Tweet
It is important to remember that rest does not necessarily mean total inactivity. Recovery from injury requires a gradual progression of whatever level of loading (weight bearing) is possible without causing over a 3 out of 10 pain. As I have written before, pain should not be interpreted as a sign that more damage is being done. Pain is a message of perceived threat not actual damage, so during the rehabilitation of an injury mild warning pains should not be feared and indeed expected now and again if you are progressing your exercises properly.
Once symptoms have been resolved, it is imperative that a regular strength & conditioning program is put into place to reduce the chances of the problem reoccurring. This is particularly important for older runners, and by that I mean over 35 years. The menisci of the knee are made of fibrocartilage, a mixture of fibrous tissue (for flexibility and toughness) and cartilaginous tissue (for elasticity). Blood flow is significantly less towards the inside of the menisci and significantly decreases with age. By adulthood the central meniscus is avascular (very limited / no blood supply) meaning that healing rates are low. Research shows the average age of runners with a meniscal issue is 43 years old, with males being twice as likely to experience a tear.
In conclusion, in the case of meniscal tears, surgery may not always be needed. The human body is an incredibly resilient, robust organism IF you put the work in. Stay robust… do your strength & conditioning!