Treating and Preventing Meniscus Injuries - Part 5

Exercise

If the injury is not severe enough to warrant surgery therapy can usually begin almost immediately. If surgery is warranted, exercises can usually begin within a short period of time [depending on your surgeon’s advice].

Initially, patients with meniscus injury tend to do better with non-weight-bearing activities that do not cause compression. Especially in cases of more severe injury it is important to progress to weight-bearing functional activities.

If you’ve had a posterior meniscus injury you should keep your knees ranges of motion limited while performing exercise. This will help to ensure that further injury does not take place. It is also important to avoid any rotational movements of the knee, especially in weight-bearing positions.

In cases of surgery it may be necessary to avoid any type of flexion exercise for up to two months. Exercises that include twisting activities or squats may need to be avoided for up to 3 to 6 months. Depending upon the degree of injury it may also be necessary to limit athletic activity for 4 to 6 months after surgery.

The following exercise recommendations are only general in nature for individuals who do not need surgery, or have been cleared by their surgeon to perform these exercises.

Initial Phase of Exercise

The objectives during this phase are to decrease swelling [RICE], prevent further injury [bracing may be necessary], prevent muscle atrophy and maintain overall strength. During this initial phase which is can be several weeks depending on the degree of injury, four weeks if post operative, further injury must be prevented. During this stage appropriate exercises would include:

1. Isometric exercises for the Quadriceps (especially the VMO)
2. Range of motion exercises [passive and active if appropriate]
3. Stationary cycling - single leg cycling only using the uninjured leg

Intermediate stage of exercise (Patient can now flex and extend knee)

The objective of this stage is to return to full weight bearing on the injured leg and to increase muscular endurance. It is important to combine soft tissue mobilization with exercise to avoid scar tissue formation. During this stage appropriate exercises would include opened chain kinetic exercises such as:

1. Limited open chain resisted tubing exercises of the ankles knee and hip.
2. Stationary cycling with no or only minimal tension.
3. One leg stands - in this exercise you alternate standing on one leg for approximately 20 to 30 seconds, shifting your weight back and forth. This can only be done if you are able to tolerate weight-bearing.
4. An upper extremity weight training program
5. Deep water running program
6. Stretches should include the: Quadriceps, hamstrings, hip rotators, iliotibial band, and calf muscles.

As the patient progresses Open Kinetic and Closed Kinetic Chain resisted exercises can be used.

Advanced stage of exercise (Patient now has full range of motion)

1. Begin running at 50 to 60% of effort.
2. Step ups, onto box.
3. Jumping and hopping exercises. These exercises must be performed completely pain-free.
4. Eventually exercises should simulate activities performed by the sport or activity the individual wishes to return to,
5. Balance and stability training on a gym ball can be used at this stage.

Conclusion:

In many cases meniscus injuries can be prevented. Active Release Techniques has been proven to be a viable option in removing meniscus entrapment’s before the actual tear occurs. Once an actual injury has occurred manual therapy and exercise should be implemented as soon as possible. Therapy must always consider key kinetic chain relationships to prevent an ongoing cycle of injuries. In addition to therapy exercise is essential without the correct rehabilitative strategy the probability of ongoing injury is almost 100%.

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