Treating a Meniscus Injury

Some small meniscus tears have no symptoms at all and may disappear on their own. Other less severe or non-complex tears will subside with conservative treatments, especially if your knee is stable and doesn't lock. These tears are often located on the outer edges of your meniscus and have access to a lot of blood supply.

It is the blood in your body that heals and repairs damage to your tissue. By transporting oxygen and nutrients to the damaged tissue and flushing away dead cells, your blood helps your body to heal itself. Unfortunately, when an injury occurs you need to prevent further injury and rest the area to allow it to heal. By resting, you actually limit the flow of blood and slow the healing process. The trick is to slow tissue damage, reduce scar tissue, and generate blood flow to speed healing and prevent further damage.

Younger patients tend to have higher success rates with meniscus injuries than older individuals, as their conditions are generally a result of trauma to healthy tissue rather than degeneration over the years. Individuals with a discoid meniscus will often receive conservative treatments if they experience no major pain. However, surgery is often used if symptoms do not subside as they grow.

Step 1 – Cold Compression Therapy

When a tear first occurs and/or when it is irritated by overuse or re-injury, you experience swelling and inflammation in your knee. At this time, the best course of action is treating your meniscus with RICE (Rest, Ice, Compression and Elevation).

• Rest your knee and limit your activity; you may want to use crutches or a cane to prevent weight bearing on the joint.
• Ice your knee 2-3 times/day for approximately 15 - 20 minutes at a time (do not apply ice directly on your skin, rather wrap it in a cloth or towel or use a Knee Freezie Wrap) to reduce swelling and pain.
• Compress your knee by adding light pressure to minimize swelling (make sure the compression wrap is snug, but not too tight as it could cause numbness, tingling or more pain).
• Elevate your knee above chest level to relieve the pressure from swelling and allow fluid to drain from your injured area

Applying a cold compression wrap to your knee keeps swelling to a minimum and numbs pain while you rest and elevate your injured knee. It is important to reduce swelling because the buildup of fluid in the tissue interferes with proper blood flow. Once swelling is reduced, blood can flow easily and healing can begin. The Knee Freezie Wrap is a medical grade cold compression wrap that allows you to control the compression in an easy, non-messy and reusable wrap.

Step 2 – Ultrasound Therapy

As your meniscus tear begins to heal, scar tissue naturally builds up in the fibrocartilage. At this stage, using therapeutic ultrasound will soften scar tissue as it is created as well as breaking down any existing scar tissue.

Scar tissue develops as a result of injuries once acute inflammation begins to decrease. As your damaged knee tissues heal this dead, fibrotic tissue will develop instead of forming brand new healthy tissue. This tissue adheres to your meniscus and ligaments in your knee causing pain and preventing your joint from moving properly (this limits your range of motion, flexibility and strength). With less scar tissue, the normal elasticity in the meniscus will return making it healthier and less prone to re-injury. In addition, less scar tissue build up means less knee pain. Ultrasound can also administer therapeutic medicines deep into the body through a process called phonophoresis.

This therapy can be received using a MendMeShop Ultrasound Therapy System.

The treatment is safe, easy, painless, and generally requires between 5 ­ 10 minutes. It is based on a form of deep tissue therapy, which is generated through high frequency sound waves (that we can not hear). These waves send vibrations deep into your body and raise the temperature of your soft tissue. The waves are delivered through a hand held transducer and conductive gel that are used together in a slow, circular motion on your skin over the injured area.

Ultrasound therapy increases collagen and tissue elasticity and promotes circulation (blood flow) which brings oxygen and nutrients to your injured knee area. This cleans your tissue by getting rid of cell waste products and allows your meniscus injury to heal correctly. If not treated properly injured tissue can heal with a weakened state, which can lead to scar tissue or calcification. If used on an ongoing basis, ultrasound will help to improve your range of motion by breaking down any scar tissue that may form in the knee area. Ultrasound waves penetrate deep into your tissues, relax your muscles, decrease chronic inflammation and accelerate your recovery rate, so you can return to your daily activities as soon as possible.

Step 3 – Blood Flow Stimulation Therapy

After the acute (or severe) swelling is gone it is time to promote blood flow to speed healing and reduce further inflammation. Remember, the meniscus is cartilage and does not receive much blood flow naturally and when you rest your knee, you are not creating the natural blood flow your knee usually receives. With the use of Blood Flow Stimulation Therapy you can increase your body’s blood supply to the knee and healing power. In addition, the fresh blood flow whisks away dead cells and toxins (including lactic acid, commonly found in trigger points) that have built up from the injury leaving the area clean and better prepared for healing. Our Knee Inferno Wrap™ provides effective, non-invasive, non-addictive pain relief with no side effects.

During your recovery, you will probably have to modify and/or eliminate any activities that cause pain or discomfort in your knee area until your pain and inflammation settle. With these 3 easy therapies you will notice great knee improvement within a few wekks, with most meniscus patients seeing some improvement quickly. The more diligent you are with your treatment and rehabilitation, the faster you will see successful results. If you start using your knee before it has a chance to heal properly (even though it may feel better), you can end up doing a lot more damage than good!

Pain and Anti-Inflammatory Medication

NSAIDs - (Non-steroidal anti-inflammatory drugs) can be used if required to help manage your pain. The use of ultrasound in conjunction with NSAIDs can greatly improve the effect of this medication and can help to heal your meniscus injury quicker. However, NSAIDS aren't recommended for long term use, as they can cause gastrointestinal difficulties, trigger other side effects and even inhibit the body's natural ability to heal itself.

Some health professionals have also recommended natural supplements such as Glucosamine, MSM, Chondritin, or Hyaluronic Acid to help strengthen your injured tissue.

If pain and inflammation persist, you can see your physician to investigate cortisone/steroid injections or topical medications, which may help reduce swelling and inflammation. However, these should be used with caution and never in conjunction with ultrasound therapy.

Physical Therapy

Physical Therapy is a beneficial way to help decrease pain in the soft tissues, restore atrophied muscles and improve knee and leg strength and mobility. The type of physical therapy and the duration will be dependent on the extent of your meniscus injury.

Gentle massage around the injured knee area or small flexing or extending knee movements (if not painful) will also help increase blood flow, oxygen, nutrients, and will prevent stiffness.

Once your pain starts to diminish, a physiotherapist will set up an individualized knee and leg strengthening and stretching exercise program for you to perform at home or in the gym. This will be based on your needs and abilities, and will help you return to performing your normal routines. Individuals will often exercise or lift weights on their own to try and build up their strength; however in doing so, they can do more damage. It is extremely important to strengthen your muscles properly, as they may have weakened during the period of non-use. A trained therapist will help to ensure your rehabilitation process is effective. For best, long-term results use ultrasound in conjunction with physical therapy and an exercise program.

Rehabilitation for meniscus injuries that receive conservative treatments often adhere to the timeframe noted below, however they are specific to the individual:

• First 2-4 days - URICE, crutches and/or a cane for protective weight bearing while walking until swelling goes down.
  
• 2-4 weeks after - flexion/extension exercises for motion and strength (no rotation), ultrasound therapy and physical therapy.
  
• 4-6 weeks after - strengthening and stretching exercise program, ultrasound therapy and return to activities, if symptom free.

Evaluate how you use your knee in daily activities to determine if you can decrease stress on the injured tissue. This may involve changing your technique, using correct or supportive equipment (proper shoes, knee braces) and/or implementing ergonomically-sound structures to help you perform your tasks more effectively and safely (prevent you from squatting or bending your knee as much). Taking more frequent breaks during your work or activities can also alleviate stress on your knee joint. Speak with a professional in the specific activity or work setting to get the proper information.

Your progress will be observed for approximately 2 - 3 months; if no symptoms are experienced after this time, no surgery is generally required.