How to treat a meniscal tear: A guide for runners

Recovery time for a meniscal tear

Recovery from meniscal injuries can take between 4 – 24 weeks if you start effective treatment early and you manage it well.

Minor to moderate meniscal tears, both acute (from traumatic injuries) and degenerative (from wear and tear), can heal with conservative treatment.

The more severe your symptoms and having other injuries like anterior cruciate ligament injuries with your meniscal tear, will increase your healing time.

What are the treatment options for a meniscal tear?

A conservative rehabilitation program for your knee that includes rest, ice, medication and a structured exercise program is often enough to heal a meniscal tear on its own.

If conservative treatment doesn’t improve your symptoms within three months, your tear may require surgical treatment.

Do all meniscal tears require surgery?

No, treatment of a meniscal tear depends on:

• Symptoms
• Age
• Activity levels
• Location and type

Age, symptoms, activity levels

Meniscal tears may cause mild to severe symptoms at first. For people over 40 years old, once the initial injury settles down if your symptoms don’t interfere with daily activities, surgery is not recommended. Non-surgical treatment is preferred.

The younger you are, the less wear and tear there is in your knee joints, and the better your body heals from surgery. Surgery is a valid option if you’re young, have no other ligament injuries and your meniscal tear is from an acute injury.

Location of meniscal tears

In our previous article about the meniscus, we explained that meniscal tears need a good blood supply to heal. The meniscus has areas with a good blood flow (along the outside edge) and areas with no blood supply at all (central area).

If your tear is in a ‘no blood supply’ zone, it will likely not heal and it can’t be repaired with surgery. However, studies have shown that you can have a fully functional, pain-free knee even if you have a meniscus tear that hasn’t healed.

It is always best to see if your knee can improve with a conservative treatment plan, but if your symptoms are bad and stop you from living your daily life, the damaged part will usually need to be removed.

Most minor to moderate tears respond well to a structured rehabilitation program. A program like this helps support and protect your meniscus, and in turn may improve your symptoms.

Type of meniscal tears

There are several different types of meniscus tears. Examples include horizontal, longitudinal, radial, bucket handle, flap and degenerative tears. They can occur in the different blood supply zones.

The most frequently found meniscal tear is the radial tear. Bucket handle tears can lock your knee joint. These tears usually need surgery because it’s the only way to free up your knee movement and stop it from locking.

What is the fastest way to heal meniscal tears without surgery?

The best way to heal your meniscus without surgery is by following a progressive exercise-based rehabilitation program. It gets inflammation under control, kickstarts the healing process and gradually builds the strength in your legs and body to take the load off your meniscus now, and in the future. You can find a detailed example below.

We know! Runners need to run. The Exakt Health app was designed to help injured runners get back to running safely, stronger, and sooner! Our specially tailored meniscal tear recovery program divides your rehabilitation into 6 stages. Each stage builds onto the next, making sure you maintain the progress you’ve gained and keep getting stronger until you’re back to your normal training levels.

Start with your meniscal tear rehab today

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The Exakt Health 6-Stage meniscal tear rehabilitation program

Stage 1: Acute Stage

During the acute stage of meniscus tear recovery, your rehab aims are to:

• Allow your injury to settle – the PRICE regime works well for this.
• Regain range of motion in your knee.
• Activate and maintain the strength in the muscles that support your knee.
• Start building strength and control in your core and muscles that control your leg.

Examples of stage 1 meniscus tear exercises

Leg slides can reduce swelling and improve the range of motion in your knee. Active knee extension over a rolled up towel both activates your quads and helps your knee to straighten out. The app also includes core and hip exercises that don’t put any strain on your knee.

What to avoid

• Walking long distances
• Deep squatting or kneeling
• Twisting around with planted feet
• Hopping and jumping
• Running

You can progress to the next rehab stage when:

• You can walk short distances around the house without much pain; and
• You can comfortably bend your knee past a right angle (90 degrees).

Stage 2: Sub-Acute Stage

This recovery stage will help build your strength and your meniscus’ loadbearing capacity in low-load positions that don’t require a lot of control.

Rehab aims

• Start loading the knee joint in a controlled way.
• Continue building strength and control in your core.
• Maintain cardiovascular fitness through activities that don’t load the knee e.g. cycling or swimming with a pool buoy between your legs.
• Limit your walking to what you can do pain-free

Examples of stage 2 meniscal tear exercises

Gentle squats, where you limit the range of motion to what you can do pain free, are usually a good choice. Balancing exercises (starting on a stable base) should be included as they develop your control. The app is programmed to suggest stable, low load exercises and slowly progress them as your knee recovers.

Activities to avoid

• Avoid walking on uneven ground.
• All the activities listed in stage 1

You’re ready to progress when you can:

• Walk 30 minutes at a slow pace without pain or discomfort; and
• You can do squats with light weights; and
• You can do basic balancing exercises without pain.

Stage 3: Remodelling stage

As your meniscus recovers, it’s important to slowly increase the forces through your knee and challenge its control through more complex exercises.

Rehab aims:

• To build strength and control in positions that resemble the running action – these usually place a higher load through your knee and are more challenging to control.
• Continue building core strength and control.
• Slowly build your walking endurance and pace without pushing into pain.
• Cross train to maintain your cardiovascular fitness.

Examples of stage 3 meniscus tear exercises

Lunges and step-up exercises fall under this category.

Activities to avoid

• Hopping/jumping
• Running

When to progress

• When you can walk for 30 minutes at a brisk pace; and
• You can perform the exercises (like lunges and step-ups) that the app has prescribed without pain and with good control.

Stage 4: Return-to-running

Rehab aims

• Ease into running with a run/walk program.
• Continue building your leg strength and control through high load exercises that resemble the running action.
• Maintain your cardiovascular fitness through cross training.

Examples of stage 4 exercises

A typical exercise for this stage is the single leg squat, but the walk/run program is actually the most important component. This type of program allows your meniscus to get used to the impact of running while limiting the risk of overworking it. The app uses your feedback after each session to help you decide when to progress the walk/run program and when you should rather pause and repeat a session a few times.

Activities to avoid

• Running on uneven ground

When to progress

If you’ve been following the app’s run/walk program, you’ll be ready to progress to the next stage in your recovery when you can jog continuously for 20 minutes.

Stage 5: Build easy run endurance

The main focus during this stage is to rebuild your previous slow running endurance. It’s usually best to only increase your running volume by about 10% per week.

Strength training

As your running volume increases, your strength training sessions should reduce to twice a week to allow enough recovery time. The focus is now on maintaining the strength that you’ve built in the previous stages and should include exercises that work all the main muscle groups in the body. The app’s program includes maintenance strength and flexibility workouts.

Activities to avoid

• High-intensity running sessions (tempo runs, hill sessions, sprints etc.)

When to progress

You can progress to the final stage of your recovery once you’re able to do your pre-injury volume of weekly running at an easy pace.

Stage 6: Build running intensity and speed

Your meniscus should now have the strength to withstand higher-intensity running sessions. It’s usually best to start by adding just one per week. Continue your regular strength training sessions.

Start the meniscus tear injury rehab plan

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Now that you have a good idea of what happens in each stage of an effective meniscal tear treatment plan, all you have to do is get started.

Have fun and good luck!