OK… I am finally back at my meniscus blog…delays due to having a blast dancing at the Calgary Salsa Congress. The next Calgary Salsa Congress is April 2012 - and if you are in town…then be sure to go to this. The workshops and performances from around the world are amazing. But now, to the matter at hand…your meniscus injury.
What to do when a meniscus injury has occurred?
You should seek medical attention immediately if you show indications of a meniscus tear as it is extremely important to determine the severity of the injury. The severity of your injury will determine the type of strategy that must be implemented to rehabilitate your meniscus tear. It is important to stop all further activities that may cause further damage to the knee until you have completed this assessment.
Upon initial onset of the meniscus injury – RICE IT!
No matter what the severity of the injury is, at the initial onset of a meniscus tear, follow the RICE (rest, ice, compression, and elevation ) procedure.
- Rest - Avoid putting excess stress on the knee. If necessary, use crutches, and a neoprene brace that keeps the knee locked in extension.
- Ice – Apply ice to the knee for 20-30 minutes, every 2-3 hours, until the swelling is reduced.
- Compression - An elastic tensor bandage on your knee may also help to reduce swelling and can be used in conjunction with the ice.
- Elevation - Elevating your knee helps to reduce swelling. Place your knee on a blanket or pillow.
REST
Depending on the severity of the injury it may be necessary to rest your knee completely for several weeks in order to fully recover. Keeping the injured knee in a locked position, in full extension, will take about 50% of the compressive load off the knee.
Initially, you should avoid any activities that involve flexion of the knee. The act of flexing your knee creates tension in the popliteus and semimembranosus muscles. These structures connect into the meniscus, resulting on increased stress in this area.
Resting the injured leg does NOT mean avoiding all physical activity. Exercising your lower extremity on the non-injured leg will help to maintain overall muscle mass. By exercising the opposite leg, there will be some neurological crossover, which helps keep the muscles on the injured side from atrophying. Electrical stimulation, such as inferential current, can also aid in preventing muscle atrophy of the injured leg, and do so without additional stress on the meniscus.
Manual Therapy
Once you have the go-ahead from your physician, you should start manual therapy and exercise as soon as possible. Waiting too long to start treatment will only prolong a meniscus injury.
There was an interesting study that was done in 1988 by Timm about the effectiveness of combining rehabilitative exercises with arthroscopic knee surgery. Those patients who received no rehabilitative exercises showed a zero success rate in recovery (did not recover). Those individuals who received a comprehensive rehabilitation program showed a 92% success rate. This study was conducted on over 5000 subjects.
Manual therapy can help to prevent what is referred to as a flexion or extension contracture. This refers to the inability of the knee to fully straighten or bend due to pain, stiffness, and adhesion formation. A flexion contracture is the most common type of contracture. If an individual is not able to properly straighten their knee, then they will have difficulty in increasing strength or developing stability in the knee.
Types of Therapy
There several forms of therapy that can help to speed the healing process, with the most effective being Active Release Techniques, Graston Technique, massage therapy, fascial manipulation, and joint mobilization. During each stage of recovery from the injury, the patient can greatly benefit from these procedures to maintain active range-of-motion and speed the healing process.
Active Release is a great way to speed the healing process, as well as prevent meniscus injuries (by removing adhesions and impingements in the area). Active Release treatments often involve removal or release of numerous soft-tissue restrictions above, below, or in direct contact with the meniscus. For example, as we mentioned in our earlier blog, the popliteal muscle and the semimembranosis muscle both attach to the meniscus. Active Release Techniques can remove restrictions in these structures, thereby improving meniscus function.
You can locate practitioners trained in Active Release Techniques at www.activerelease.com. When checking over qualifications, make sure you select a practitioner who is certified in working with lower extremity protocols. Of course, if you are in Calgary, Alberta - please come see us at Kinetic Health.
Graston Techniques uses specially designed stainless steel instruments to specifically detect and remove soft-tissue fibrosis caused by chronic inflammation. This technique was originally developed to be used on athletes.
With menisci injuries, Graston Technique (GT) proves quite beneficial since:
- GT increases the rate and amount of blood flow to the injured area. Since the menisus generally have decreased blood flow, any increase in circulatory function is helpful in the healing process.
- GT re-initiates the healing process in many areas where fibrotic scar tissue has formed. It does this by increasing cellular activity in the injured region, especially that of fibroblasts and mast cells.
You can find trained practitioners in Graston at www.grastontechnique.com and at our clinic in Calgary – Kinetic Health.
Massage therapy can be very beneficial when treating a meniscus injury. Massage therapy helps to preventing flexion and extension contractures of the knee. In addition massage therapy can be an effective approach for managing pain.
Make sure you look for therapists that are educated and trained to accurately assess and treat meniscus injuries. It is important to remember that not all massage therapist receive the same level of training. Check the credentials of the selected massage therapist. Some massage therapists may also have received additional training in Active Release Techniques and will combine this treatment with their standard massage techniques.
Treating Menisci Injuries – see the next installment of this blog for more information about how you can treat menisci injuries with exercise. For more information about other types of knee injuries, visit the following sites:
Meniscus tear are common injuries of knee could caused in the sports and daily routine workouts or simple works and needs early treatment.
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