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. Given the menisci's limited blood circulation, their healing capacity is often compromised. 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 are vital components 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 areas such as 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 this video Dr. Abelson demonstrates an effective knee release protocol using Motion Specific Release (MSR) techniques in the accompanying video. 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.
Note: MSR protocols should only be performed by certified MSR practitioners, and are not for practice by the general public. The videos we provide are strictly used for demonstration purposes only!
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 be used to help increase contraction of the VMO.
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. It is essential to combine soft-tissue mobilization with exercise 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 where the patient alternates standing on one leg for approximately 20 to 30 seconds, then shifts body weight back and forth: This exercise improves 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: With a resistance band or machine, extend the injured leg from a bent to a straight position.
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 is capable of handling 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, understanding and managing meniscus injuries require a comprehensive approach that includes recognizing symptoms, performing a thorough physical examination, and utilizing appropriate diagnostic imaging when needed. Conservative treatments, such as manual therapy and exercise, can be highly effective in addressing pain, improving function, and promoting recovery for many patients. The rehabilitation process should incorporate a combination of open and closed chain exercises, tailored to the individual's needs and progress.
It's crucial to consult with a medical professional or physical therapist throughout the recovery journey to ensure appropriate care and to minimize the risk of further damage. By following these guidelines and recommendations, many patients can successfully overcome meniscus injuries and return to an active, pain-free lifestyle.
DR. BRIAN ABELSON DC. - The Author
Dr. Abelson's approach in musculoskeletal health care reflects a deep commitment to evidence-based practices and continuous learning. In his work at Kinetic Health in Calgary, Alberta, he focuses on integrating the latest research with a compassionate understanding of each patient's unique needs. As the developer of the Motion Specific Release (MSR) Treatment Systems, he views his role as both a practitioner and an educator, dedicated to sharing knowledge and techniques that can benefit the wider healthcare community. His ongoing efforts in teaching and practice aim to contribute positively to the field of musculoskeletal health, with a constant emphasis on patient-centered care and the collective advancement of treatment methods.
Revolutionize Your Practice with Motion Specific Release (MSR)!
MSR, a cutting-edge treatment system, uniquely fuses varied therapeutic perspectives to resolve musculoskeletal conditions effectively.
Attend our courses to equip yourself with innovative soft-tissue and osseous techniques that seamlessly integrate into your clinical practice and empower your patients by relieving their pain and restoring function. Our curriculum marries medical science with creative therapeutic approaches and provides a comprehensive understanding of musculoskeletal diagnosis and treatment methods.
Our system offers a blend of orthopedic and neurological assessments, myofascial interventions, osseous manipulations, acupressure techniques, kinetic chain explorations, and functional exercise plans.
With MSR, your practice will flourish, achieve remarkable clinical outcomes, and see patient referrals skyrocket. Step into the future of treatment with MSR courses and membership!
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.
Disclaimer:
The content on the MSR website, including articles and embedded videos, serves educational and informational purposes only. It is not a substitute for professional medical advice; only certified MSR practitioners should practice these techniques. By accessing this content, you assume full responsibility for your use of the information, acknowledging that the authors and contributors are not liable for any damages or claims that may arise.
This website does not establish a physician-patient relationship. If you have a medical concern, consult an appropriately licensed healthcare provider. Users under the age of 18 are not permitted to use the site. The MSR website may also feature links to third-party sites; however, we bear no responsibility for the content or practices of these external websites.
By using the MSR website, you agree to indemnify and hold the authors and contributors harmless from any claims, including legal fees, arising from your use of the site or violating these terms. This disclaimer constitutes part of the understanding between you and the website's authors regarding the use of the MSR website. For more information, read the full disclaimer and policies in this website.