Meniscus Injuries Part 3 - Manual Therapy & Exercise
- Dr. Brian Abelson DC
- Jun 18, 2024
- 8 min read
Updated: Aug 27, 2024
Manual Therapy and Exercise
The cornerstone of nonsurgical, conservative treatment for meniscus injuries is twofold: pain relief and functional improvement. While many find solace in these interventions, potentially sidestepping surgery, it's crucial to recognize that they might not fully mend a meniscus tear. The menisci's limited blood circulation often compromises their healing capacity. Moreover, in patients with pronounced osteoarthritis, the meniscus tear might be intertwined with arthritic changes rather than an isolated incident.
Article Index:
Objectives of Manual Therapy
The objectives of manual therapy and exercise for meniscus injuries include:
Restoring range of motion and flexibility.
Reducing pain and inflammation.
Enhancing muscle function, as research indicates that medial meniscus injuries can impact the strength of the quadriceps (especially the VMO), hamstrings, calf, and hip muscles. (1)
Preventing flexion and extension contractures. Flexion contractures are the most common type seen with meniscus injuries. If an individual cannot properly straighten their knee, they will struggle to increase knee strength or develop stability in the knee. (1)
Improving neuromuscular coordination.
Progressively increasing weight-bearing capacity. Gradual weight-bearing with increased joint stress is a vital component of effective meniscal repair.
Motion Specific Release
Motion Specific Release (MSR) is a treatment system developed by Dr. Brian Abelson. MSR integrates diverse therapeutic perspectives to resolve musculoskeletal conditions. It follows the EPIC paradigm and integrates orthopedic and neurological examination, fascial research, kinetic chain relationships, myofascial manipulation, fascial expansions, osseous adjusting, Traditional Chinese Medicine, and functional exercise programs.
Knee Release Protocol - Motion Specific Release
In the accompanying video, Dr. Abelson demonstrates an effective knee release protocol using Motion-Specific Release (MSR) techniques. These procedures address the localized area of pain and the broader kinetic chain, contributing to a more comprehensive treatment approach.
Increasing Knee Joint Mobility - 4 Point MSR Knee protocol
Effective Motion Specific Release knee mobility procedures are demonstrated in this video, which are extremely effective at addressing the body's entire kinetic chain. The femur, tibia, and patella, as well as a large number of muscles and ligaments, make up the complicated structure of the knee joint.
Fascial Expansion: The MSR Knee Pain Protocol
Utilizing fascial expansions in knee pain management merges contemporary insights into fascia, kinetic chain relationships, and acupuncture principles. This approach effectively treats meniscus injuries by improving joint function and reducing discomfort. The MSR protocol's focus on fascial health and biomechanics helps alleviate symptoms of meniscus injuries and enhance mobility, offering a holistic treatment that addresses underlying causes and promotes tissue repair.
Exercise
A study published in the British Medical Journal found that rehabilitative exercises were as effective as surgery for middle-aged patients with meniscal tears (9).
The following exercise recommendations are intended for those who do not require surgery or have been cleared by their surgeon to perform these exercises.
Initial Phase of Exercise:
Isometric exercises for the Quadriceps (especially the VMO): Electrical muscle stimulation can also help increase the VMO's contraction.
Range of motion exercises [passive and active if appropriate]: Begin with Wall Slides. Once the patient has achieved 110-115 degrees of knee flexion, Heel Slides can be introduced.
Stationary cycling - single-leg cycling using only the uninjured leg. This exercise helps maintain muscle strength and function while avoiding stress on the injured knee.
Intermediate Phase of Exercise
The objective of the Intermediate Phase is to return to full weight-bearing on the injured leg and to increase muscular endurance. Combining soft-tissue mobilization with exercise is essential to prevent scar tissue formation. During this stage, appropriate exercises would include open chain kinetic exercises such as:
Limited open chain resisted tubing exercises of the ankles, knee, and hip: These exercises help improve strength and range of motion in a controlled manner, minimizing stress on the injured knee.
Stationary cycling with no or only minimal tension: Stationary cycling can begin once the patient attains 115-120° of knee flexion. Ensure the patient's ROM is sufficient, as forcing the motion with inadequate ROM may increase pressure and irritate the knee.
One-leg stands, in which the patient alternates standing on one leg for approximately 20 to 30 seconds and shifts body weight back and forth, improve balance and weight-bearing tolerance but should only be performed if the patient can bear weight without significant discomfort.
Strengthening
During the rehabilitation of meniscus injuries, incorporating both open and closed-chain exercises is essential for optimal recovery. Here are some examples of each type, along with information about when to begin hamstring strengthening exercises:
Open Chain Exercises for Meniscus Injuries:
Seated leg extensions: Extend the injured leg from a bent to a straight position with a resistance band or machine.
Seated leg curls: Using a resistance band or machine, curl the injured leg towards the buttocks.
Straight leg raises: Lying on your back, lift the injured leg straight up while keeping the knee straight.
Closed Chain Exercises for Meniscus Injuries:
Wall squats: Lean against a wall with feet shoulder-width apart, then slowly slide down into a squat position, ensuring the knees do not extend past the toes.
Mini squats: Stand with feet shoulder-width apart and slowly lower into a shallow squat, keeping your knees in line with your toes.
Step-ups: Using a step or low platform, step up with the injured leg, followed by the uninjured leg, then step down in reverse order.
Strengthening exercises for the hamstring muscles can begin when the patient can flex the injured knee to at least 80-90°. This will ensure that the knee can handle the additional stress from the exercises.
Best Meniscus Exercises
The following video give demonstrates some of the common exercises that we prescribe to patients who have had a meniscus injury
Conclusion
In conclusion, the cornerstone of nonsurgical, conservative treatment for meniscus injuries lies in a dual approach: alleviating pain and enhancing functional capabilities. While manual therapy and targeted exercises are highly effective in relieving and improving knee function, they may not fully heal a meniscus tear due to the menisci's limited blood supply. Additionally, in patients with advanced osteoarthritis, meniscus tears are often compounded by arthritic changes, necessitating a nuanced approach to treatment.
Conservative treatments can significantly aid recovery by restoring range of motion, reducing inflammation, and improving muscle strength and coordination. Techniques such as Motion Specific Release and a structured exercise regimen are vital in achieving these goals. Whether through manual therapy or carefully tailored exercises, the aim is to promote healing, enhance mobility, and improve the patient's quality of life.
References
A.M.J.S. Vervest, et : Effectiveness of physiotherapy after meniscectomy; knee surg,sports traumatol, arthrosc (1999) 7: 360-364
Arnoczky SP, Warren RF. Microvasculature of the human meniscus. Am J Sports Med. 1982;10:90–5.
B. R. Mohan and Harminder S. Gosal Reliability of clinical diagnosis in meniscal tears
Hare KB1,2Stefan Lohmander L1,3,4Kise NJ5Risberg MA6Roos EM1Middle-aged patients with an MRI-verified medial meniscal tear report symptoms commonly associated with knee osteoarthritis. Acta Orthop.
Hoshino A, Wallace WA. Impact-absorbing properties of the human knee. J Bone Jt Surg Br. 1987;69:807–11.
Karachalios T, Hantes M, Zibis AH, Zachos V, Karantanas AH, Malizos KN. Diagnostic accuracy of a new clinical test (the Thessaly test) for early detection of meniscal tears. J Bone Joint Surg Am. 2005;87(5):955-962.
Konan S, Rayan F, Haddad FS. Do physical diagnostic tests accurately detect meniscal tears?. Knee Surgery, Sports Traumatology, Arthroscopy 2009; 17:806-811
McDermott ID, Amis AA. The consequences of meniscectomy.J Bone Joint Surg Br. 2006;88:1549–1556.
Nina Jullum Kise, May Arna Risberg, Silje Stensrud, Jonas Ranstam, Lars Engebretsen, Ewa M RoosBMJ 2016; i3740 DOI:10.1136/bmj.i3740
Sweigart MA, Athanasiou KA. Toward tissue engineering of the knee meniscus. Tissue Eng. 2001;7:111–29.
The O'Donoghue triad revisited. Combined knee injuries involving anterior cruciate and medial collateral ligament tears". Am J Sports Med. (5): 474–7
Tuxoe JI, Teir M, Winge S, et al.: The medial patellofemoral ligament: A dissection study. Knee Surg Sports Traumatol Arthrosc 10:138–140, 2002.
THE POPLITEUS MUSCLE AND THE LATERAL MENISCUS, The Bone and Joint Journal, https://doi.org/10.1302/0301-620X.32B1.93
Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up BMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i3740
Yeh PC, Starkey C, Lombardo S, Vitti G, Kharrazi FD. Epidemiology of Isolated Meniscal Injury and Its Effect on Performance in Athletes From the National Basketball Association. Am J Sports Med. 2011 Nov 30.
Arendt EA, ed. Orthopaedic Knowledge Update: Sports Medicine 2. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1999.
Magee, D. J. (2014). Orthopedic Physical Assessment. St. Louis: Elsevier Saunders.
Dutton, M. (2012). Dutton's Orthopaedic Examination, Evaluation, and Intervention. New York: McGraw-Hill Medical.
Gomoll, A. H., Katz, J. N., & Warner, J. J. (2013). Surgical Management of Meniscal Injuries. Journal of Orthopaedic & Sports Physical Therapy, 43(10), 736-747.
Fox, A. J., Bedi, A., & Rodeo, S. A. (2012). The Basic Science of Human Knee Menisci. Sports Health: A Multidisciplinary Approach, 4(4), 340-351.
Bolog, N., & Andreisek, G. (2018). Imaging of the Knee Menisci. Seminars in Musculoskeletal Radiology, 22(3), 277-291.
Roemer, F. W., Kwoh, C. K., Hannon, M. J., Hunter, D. J., & Eckstein, F. (2015). Partial meniscectomy is associated with increased risk of incident radiographic osteoarthritis and worsening cartilage damage in the following year. European Radiology, 25(1), 2-10.
Kim, S., & Bosque, J. (2016). Joint Line Tenderness and McMurray Tests for the Detection of Meniscal Lesions: What is Their Real Diagnostic Value? The Journal of Physical Therapy Science, 28(6), 2000-2003.
Khan, M., & Miller, B. S. (2013). Meniscal Injuries: Management and Surgical Techniques. Journal of Knee Surgery, 26(5), 341-352.
Yim, J. H., Seon, J. K., & Song, E. K. (2013). A Comparative Study of Meniscectomy and Nonoperative Treatment for Degenerative Horizontal Tears of the Medial Meniscus. The American Journal of Sports Medicine, 41(7), 1565-1570.
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DR. BRIAN ABELSON, DC. - The Author
With over 30 years of clinical practice and experience in treating over 25,000 patients with a success rate of over 90%, Dr. Abelson created the powerful and effective Motion Specific Release (MSR) Treatment Systems.
As an internationally best-selling author, he aims to educate and share techniques to benefit the broader healthcare community.
A perpetual student himself, Dr. Abelson continually integrates leading-edge techniques into the MSR programs, with a strong emphasis on multidisciplinary care. His work constantly emphasizes patient-centred care and advancing treatment methods. His practice, Kinetic Health, is located in Calgary, Alberta, Canada.
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