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Author Topic: Rehab schedule for meniscus tear? (no surgery)  (Read 122 times)

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Offline twolfe77

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Rehab schedule for meniscus tear? (no surgery)
« on: August 01, 2018, 10:43:20 PM »
Hello all,

I stumbled across this board and it appears to be a great resource.  I believe I tore my left medial meniscus 3 days ago playing soccer; my left foot stuck in the turn when I tried to move.  There was a cracking noise but the knee just felt a little sore, so I continued to play the game with no ill effects.  A few hours later the leg had really stiffened up and there was some pain in the medial area.

My doctor agrees that it's torn, but did not order an MRI (my god awful health insurance limits what I can do).

The knee is a bit stiff right now, but feels good overall.  There is no pain or swelling whatsoever (I don't know if that's good or bad or meaningless) and my leg is not buckling or locked at all.  Based on what I have learned so far, physical therapy seems like a good option for at least the first few weeks.  I'm 40 and very active and would be borderline suicidal if I had to give up sports, so I want to hang on to whatever cartilage I have unless there is a really good reason to part with it. 

My question is: what would be a good rehab schedule for someone with a meniscus tear who wants to avoid surgery?

I have compiled a lot of PT resources I have look over, but tentatively I was thinking something like:

Week 1: Nothing, just rest.
Week 2: Very light yoga, avoiding any pose that stresses the left knee or bends the knee more than 90 degrees.
Week 3: Exercise bike at the gym.
Week 4: Stretching targeting the calves, quads, and hamstrings.
Weeks 5-7: Continue with the above activities. 
Week 8:  Body weight lunges and squats.
Week 12: Weighted lunges and squats, jump roping.
Week 16:  Sprinting and resume sports.


I think that schedule will keep me busy but also is conservative enough where I am not unduly risking a re-tear.  But I'm all new to this and know little.  I'd really appreciate any insight for active people who've been through the rehab process already.  Did you pursue a more conservative rehab, or a more aggressive one?  Thanks!




Offline LisaWilliams38

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Re: Rehab schedule for meniscus tear? (no surgery)
« Reply #1 on: August 05, 2018, 05:38:58 AM »
It definitely sounds like a classic meniscus tear, and I agree you should take it easy to avoid further problems and give it time to calm down. Lots of ice these first couple of weeks too. Overall, your first 2 weeks of rest is wise (and yoga seems fairly restful considering you're avoiding a lot of the deeper bending poses---I'd avoid standing on that leg by itself for awhile though, to limit inflammation). I'd still be careful of doing anything with a deep bend (like you said), and definitely avoid too many stairs. I've had more issues from stairs/steps than I would have thought possible. :)

However,  I worry if you stick to only adding biking/stretching the 3rd/4th weeks, you're going to be losing muscle mass....and when it comes to meniscus tears and avoiding osteoarthritis/further knee problems/complications, you want your quads and hamstrings super strong. I do a lot of single yoga/Pilates poses/exercises to help with a lower back problem, but it's nothing heavy-duty nor a structured session, so I don't mean to say yoga isn't maintaining your strength---so take no offense. I'm just not sure how much pressure you'll be putting on that knee without knowing how heavy duty your yoga practice is. :)

If it was me, I'd look up open vs close-chained exercises, and stick to the open-chain ones, where your whole body isn't involved----basically you want to isolate your leg. Think lots of quad sets, weighted leg lifts, even a leg press or hamstring curl with lower weight than you would normally do, etc. Even with your stationary bike, make sure you have "some" resistance to maintain muscle. The main thing is NOT to lose muscle while you're resting. That can be done safely without aggravating things, though some people's ego can barely take it.  :P Your schedule listed above has you adding the closed-chained types of exercises in week 8, which is what a lot of us do following articular-cartilage repair surgery, so that sounds very reasonable. You might even get by with adding those things a couple of weeks earlier, depending on how your knee behaves. :)

For the record, I think you're wise to play it safe and try to avoid surgery for now. However, my BIG concern is if you get any locking, catching, or especially pain across the lower quad, right above the knee. Any of those suggest a mechanical problem inside the knee----usually part of the meniscus (or something!!) has broken off and is getting stuck in between other parts of the knee anatomy. I've had 2 meniscus tears that caused no problems, and a few that caused significant trauma because I waited until the mechanical problems were WAY past the point of no return. I have a standing oath with my surgeon to NOT wait anymore.....as it's caused severe articular cartilage damage in a short amount of time--with one knee to the point of borderline knee replacement.

Keep in mind some of us heal VERY quickly though, and you may be back to fighting form in no time. Others, like myself, take forever to heal and just rack up the complications left and right, no matter what we do. I'd say genetics play a huge role here. :)  As for aggressive vs conservative rehab, that's up to your body and how it responds. You WILL know if you're overdoing it. I can't do aggressive rehab post-op, even though I build muscle quickly and am all in at 110% effort. I simply swell too easily and it takes forever for my swelling to go down and achieve full range of motion. For my more complex surgeries, I ended up with severe rebound swelling anytime we tried to add closed-chain exercises involving multiple body parts. We just added 3-4 more weeks of open-chained stuff, increasing the weight each week, then FINALLY keeping the swelling down enough to add small amounts of closed-chain exercises, and only 1-2 new ones a week. Totally frustrating for me, as I'm a gym-rat, but I've paid the price for doing too much, too soon. So yeah--your body will tell you!!!

Almost forgot---the MRI. You may be better off without it anyway. My OS says they're only correct about half the time for meniscus tears. I had the fancy MRI with contrast (arthrogram) in April, and I go to the imaging center my surgeon sends all of the pro-athletes to. That MRI missed THREE meniscus tears. It did see my severe articular cartilage defect, but it placed it ABOVE the knee (on the bottom of the femur), when in reality, it was BELOW the knee, on top of my tibia (all of this was discovered/confirmed from surgery in May). My OS says the MRI is half the story, the office exam is 40%, and only surgery can provide the final 10% when you're at a loss and not getting better after all else fails. So yeah---you probably saved yourself a ton of money anyway!!   ;)  I HAVE had other MRIs be spot-on with meniscus tears and articular defects though, but then again, this wasn't the first MRI to MISS something that was discovered surgically 2-3 weeks later. It really can be a toss-up.

I wish you the best and hope things improve soon.

--Lisa
« Last Edit: August 10, 2018, 07:03:14 AM by LisaWilliams38 »
'98 R plica
'99 L resect discoid meniscus
'01 L  meniscus tear
'02 R  meniscus tear
'10, R meniscus tears, Bursectomy
'13, R 3 meniscus tears, Grd 3 Biocartilage fil
'15 R Oct-ACI harvest,
'15 R Dec-ACI implant
'16 R Mar-lysis of adhesions
'16 R Mar-MUA
'18 L 3 menis tears, Grade 4 Biocartilage fill

Offline twolfe77

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Re: Rehab schedule for meniscus tear? (no surgery)
« Reply #2 on: August 09, 2018, 03:15:33 AM »
Thank you for such a detailed response, Lisa- I appreciate the insight from a "vet" of meniscus tears.  I'll be sure to push myself to a reasonable extent on weightlifting.

It's very strange about MRIs!  I would have thought those were almost 100% accurate, but my doc said they can show both false positives and false negatives when it comes to meniscus tears. Weird.

Thanks again!

Offline LisaWilliams38

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Re: Rehab schedule for meniscus tear? (no surgery)
« Reply #3 on: August 10, 2018, 07:14:01 AM »
I'm always happy to help, as I wish someone had been there to guide me in the early years. I should have left one of my right and left meniscus tears alone and just rehabbed longer. The right one has always given me a lot of grief though, so I'm not sure it would have mattered.

I managed 16 years before the left knee fell apart since it's last meniscus repair in 2001----but I really regret the first scope on that knee too. All in all, hindsight is 20/20, but I wonder if I could have gotten myself closer to 50 before seriously considering a replacement on the right knee.

I'm only 46 and trying to but a few more years if I can---assuming nothing else happens in the interim (ha)!!!  ;D I just wish I had known THEN what we do now about not surgically repairing EVERY meniscus tear that comes along.

Best of luck to you!!!

--Lisa
'98 R plica
'99 L resect discoid meniscus
'01 L  meniscus tear
'02 R  meniscus tear
'10, R meniscus tears, Bursectomy
'13, R 3 meniscus tears, Grd 3 Biocartilage fil
'15 R Oct-ACI harvest,
'15 R Dec-ACI implant
'16 R Mar-lysis of adhesions
'16 R Mar-MUA
'18 L 3 menis tears, Grade 4 Biocartilage fill