Meniscus Tears – Everything You Need To Know
/in Podcast/by dmiddaughHey there El Paso! Welcome to the Stay Healthy El Paso Podcast. My name is Dr. David Middaugh, Physical Therapist, and I'm the owner of El Paso Manual Physical Therapy. I wanted to talk to you today about meniscus tears. We have had lots of clients in the clinic, over the past few weeks coming in with knee problems, and they specifically have meniscus involvement.
Now I'm going to use a bunch of different words, talking about the meniscus. I'll try my best to make sure I delineate the differences between them all. So when I say meniscal involvement, for example, that's just any problem related to the meniscus, because there are different types of ways that the meniscus can get injured, which we'll go into. But just follow me here. In case you are having trouble following all the different terms, don't worry, I'm trying to make this as simple as possible, for people that are not in the medical field and may not understand medical terms.
But I'll have to use a term every now and then just to make sure that I'm communicating clearly. I encourage you to go Google stuff and go look it up type in the word that I'm saying here, but like I said, I'm going to explain it as clearly as possible.
I'm going to tell you everything you need to know about meniscal tears. If you have one right now, you are going to probably find yourself in some of these symptoms I'm going to talk about, as well as some of the issues that are surrounding meniscal tears and treating them.
If you have never learned about a meniscal tear, let me just start with answering the question of what the meniscus is. I get asked this all the time. A meniscus is a chunk of cartilage that sits between your thigh bone and your shin bone. It's in your knee and you have two in each knee, you have a pair in each knee and the pair is differentiated by the inside one, and the outside one. In the medical field that’s called the medial meniscus. That's the inside one, and the lateral meniscus, that's the outside one.
The job of these two chunks of cartilage, in each of your knees, is to cushion the thigh bone on the shinbone, and make sure that movement happens. Normally in the knee, because if you ever look at the structure of the bones in the knee, they don't really sit on each other perfectly well. Well, the meniscus helps to fix that problem, it develops what's called congruency because the meniscus is cup shaped. They allow the end of the thigh bone to settle onto the top of the shin bone, the tibia.
The main job, like I said, is to cushion the femur onto the tibia, the thigh bone onto the shin bone, and of course what's above the thigh bone while the rest of your body your hips, your torso, head and arms. Because it's supposed to cushion it, it acts a lot like a disk in a spine. If you think of your spine or somebody's spine. There are chunks of cartilage between each of the bones in the spine, and their job is to absorb forces and cushion everything else above, and below it and allows certain movement to happen. So that's a meniscus.
The next question I usually get, from people coming in for treatment is, why does the meniscus tear? Why is my meniscus torn? How did it happen? Some people have an accident, maybe playing sports growing up, they were playing soccer or football or volleyball, basketball, one of those and they had a knee injury that went undiagnosed. They got better from it. They never felt like they had to go to the doctor. But they have never quite been the same from that injury there. They tend to avoid exercises that aggravate it. They just been babying it essentially for decades.
You do have some more extreme injuries where we are playing those same sports or something similar or car accidents or other accidents. People blow up their knee, they tear the meniscus, they tear the ACL, or other structures in the knee. They might end up having an operation afterwards because it was a massive injury. Those people can also end up with some meniscal injury later on in life.
There is another group of people that never had a sports injury growing up, never really had any injuries whatsoever. And then they get to middle age, they are in their 50s, 60s, maybe a little older than that, and they start having knee problems. They go to the doctor, get an MRI and find out that they have a meniscal tear. That's always a shocker for them because they are wonder how did they get this? They have never had any knee pain ever. They have never done anything that could have aggravated it, and they chalked it up to old age. They think well, I'm in my 60s now so I'm feeling older and this is what happens to old knees.
But let's talk about what really causes a meniscus tear. Those are just the perceptions that people have, the stories that people give here in the clinic. But when I look at a meniscal problem, somebody that is coming in and they are telling me about their knee problem, the way that the pain presents, I have to differentiate, is it more of an arthritis problem? Is it more of a meniscus problem, a ligament problem or some other cartilage in the knee? Because there is lots of cartilage in the knee.
There are other structures too, that that could be causing knee pain. Certain nerves can cause knee pain. There is actually a nerve that is called the saphenous nerve. It runs on the inside of your leg, and there is a massive branch off the saphenous nerve that lies right on top of the meniscus and could mask meniscus pain for some people. I have to be able to differentiate, is this a saphenous injury or a meniscus injury or is it both, and then decide how to treat that problem so that the person can get back to doing what they want to do.
But in a true injured meniscus, where there is a tear and there are problems with it, the structure of the meniscus is disrupted. A lot of these people can function without any problems. They may not even know that they have a meniscus tear.
Then there are some other people that have knee pain. They go get an MRI, they get checked out, and they are told that they don't have a meniscus tear. When we see them here in the clinic, they have knee pain, obviously, they may even have swelling and other problems that look a lot like a meniscus tear. But what I believe they actually have is an irritated meniscus, which you can't really pick up on an MRI or X-ray too well, and it's confounding for the medical field.
People don't know what to do with these types of patients that have knee pain, that doesn't show anything on any sort of imaging, any sort of MRI or X-ray. The way to think about a meniscus irritation is, just think of your skin, if you scratch your skin, not too hard, but hard enough to get it red, where you leave a red mark. That would be skin irritation. Your skin is just angry because you scratched it. That redness will go away within a few minutes, maybe at most, a few hours, maybe a day at most. It won't take long to recover from that before your skin will look normal again. But if you scratch yourself pretty hard and you break your skin, some blood comes out while you have an injury there, that needs to take some extra time to heal properly, and that's going to take you some more time.
In a true injury on your skin, you have to start the inflammation process, you have to send certain cells to the area, your bloods got to clot, you have to eventually form a scab, under the scab, over time, a scar will form the special cells to do that, that's called proliferation. And then over the course of a week or two, sometimes three, then the scab will fall off and you have a nice new little scar that formed to protect your skin and close it up. Now that's got to happen in just about every single tissue in the body. It just looks different depending on the tissue. That happens on bone, that happens on cartilage, on ligaments, on muscle, but obviously you don't see it because it's under your skin.
Whenever you look at your body, you are pretty much looking at skin everywhere. So, in a meniscus if you have a tear, it is really slow to heal, because cartilage is one of the slowest healing tissues in the body. I think in the meniscus, in my opinion, from my personal experience in treating people with this, this type of problem, it's the absolute second slowest, only second two discs in the spine. Discs in the spine can take a really long time to heal. But the good news about both discs and the meniscus inside the knee, the cartilage in the knee is that it does heal. If you put it in the right environment, you take the proper steps, it can heal. I've seen it happen many times and people are always super happy to reach that point.
The next question that you probably are wondering about, because you are thinking, well, do I have a meniscal problem or is it one of these other things you mentioned, arthritis, that weird saphenous nerve, other types of cartilage in the knee. Let me go the way that a meniscus tear feels in individuals. Whenever we spot them here I can, I can tell you exactly how they present. I categorize these people into three different types, mild, moderate, and severe meniscus tears.
In mild, there might be a little bit of swelling, these people tend to still be active, they get pain. Not every day, it's more so a couple times a week, and it tends to be associated when they are very active. A lot of these people are younger usually, they are in their 40s, sometimes 30s. You see some older people with it too. These are the people that are definitely in better shape and haven't had any injuries, and they tend to get a mild meniscus injury later in life. But they eill be running or playing sports. Being active with families. Some of them just like to go walk their dog and they will push their activity a little too much and that will set off their knee problem.
They will come in saying, I've been walking or jogging for years, and I started to train for this event where I had to do extra and then my knees started to swell up. But I gave it a day or two, the swelling went away, I felt fine again, and then I went back to do that exercise, and my knee swelled up again. And it's just concerning me because I'm getting older, and I want to be able to do this activity. I've never had any problem and I don't want to have to stop doing this exercise because it's keeping me in shape.
That's the typical mild presentation for a torn meniscus, or it could even be a meniscal irritation in these people. In fact, a lot of these people don't get MRIs. It's not that bad for them. Some of them barely get any attention from doctors though. They might go see him for a visit and then get sent straight over to physical therapy. They never actually get an MRI. Which is a good thing in my opinion, because if you have a tear, it leads you down a path that may not be the nicest. Ignorance might be bliss in this in this situation.
Plus, they get better once they come into the clinic and get treatment. They start improving, they don't feel like they need a MRI, or any sort of imaging, because they are happy with the results.
One person in particular, we had a woman in her 50s come in, she's ran for years and years, three, four or five times a week she runs on a treadmill at home. She is not into competition or anything like that. She just runs for her own benefit. She does other exercises as well some aerobics type of exercises. But she started to have knee pain all of a sudden, during and after running. Then she was flared up for a week or two. Nothing that stopped her from doing what she wanted to do. But she had to think twice about getting back on the treadmill because she knew that she would flare up again.
After we address certain things in her hips and her muscles around her legs, we even had to go up into her back, and down into the foot as well. She got back to running and she didn't have any problems at all, it stopped the swelling, we got it back 100%. So that would be a case of a mild meniscus injury. The people that come in at that point, I think are super-duper smart because they are definitely getting ahead of the problem. Ideally don't want to wait until it's more moderate or severe. But I'm going to go into moderate and severe next.
If you find yourself in one of those categories, don't take it the wrong way. Our medical field is just crazy if you have any injuries. We'll talk about it just let's keep going here.
Let's get into the moderate part. If you have a moderate meniscal problem, you think you might have a torn meniscus, the way this is going to present, you are going to definitely have swelling, you are going to definitely have limits on your activity, the problems might present daily. These people to tend to complain about going up and down stairs, usually going downstairs is rougher than going upstairs, and they started having trouble sleeping at night. Because of the knee problem. They also tend to say that mornings are pretty rough. They don't like to wake up and get up out of bed in the morning because those first few steps, getting up out of bed to head over to the bathroom. The knee feels stiff, it doesn't want to move well, it might pop and click a lot. It takes 15 minutes, 20 minutes, and some people closer to an hour to kind of loosen up the knee and kind of get back to normal.
When it's at that point, these people typically have stopped exercising. They are concerned that they are getting unhealthier. They are putting on weight and that's feeding into the knee problem as well. A lot of times they've been seen a doctor already, they might have had some sort of treatment that just didn't work out for them. They might be using a brace or something like that, and we'll talk about what to use, and what not to use here in a second but just bear with me.
If you think that you have a moderate knee meniscal tear, it usually is still salvageable quite a bit, you can usually get in the 90s, as far as percentage improvement, if we are talking, zero to 100%, these people tend to get 95% better, 97% better. They tend to do really, really well, they might just have some very mild limitations that they might not even worry about. Most importantly, they don't need to have a surgery or some sort of invasive procedure, and they can stay healthy the rest of their lives.
Let's talk about a severe meniscal tear. These people will have all the symptoms of the moderate meniscal tear, the ones that just covered, their swelling will tend to be constant. Of course, going up and down stairs is a nightmare for them. They avoid it at all costs. I've had people come in and say I sold my two-story house because I could not go upstairs anymore. And I live in a one-story house now and I avoid stairs at all costs. I always use the elevator the escalator. These people tend to walk with a limp. They have changed their walking pattern over time. Some of them will use a cane, they tend to be older because this has happened over time.
One of the classic symptoms that severe meniscal tear will have is joint locking. What this looks like is their knee will get stuck. They will sit down, or go to get up, and of course you have to bend your knee during that process, and when they are about to transition either into sitting down or getting up, their knee will get stuck. They are sitting down, their knee won't want to bend all the way. Most people, when they sit in a kitchen chair, your knee will bend about 290 degrees, and it'll get stuck at 20 degrees or 30 degrees and they feel like they can't bend it to 90 degrees, it's painful, and it just feels stuck or locked. Usually they can shake it a certain way, kind of wiggle it around, and then it'll make a noise, it'll pop and unlock. Then they can bend their knee just fine.
Then the opposite will happen when they stand up, they will go to stand up and the knee will kind of stay bent. They usually have trouble balancing once they stand up, and they shake their leg around, and move it around, and then it'll pop, and then it'll go straight, and they can walk normal again. By normal i mean they are normal which is painful and with a limp and with swelling and all that. The thing behind this is that there are a flap of the meniscus that's impeding motion within the joints. That's why these people can shake it loose and twist and turn their knee and it'll move better.
But if it's that bad, you have a severe meniscal problem more than likely. Now, the way that the meniscus will feel in most people, as far as pain, is that they tend to have pain on the inside of their knee. If you were to reach down and you feel your kneecap and then slide your hand towards the inside of your knee, there are usually some bumpy spots there, depending on how much tissue you havegot, and that's where it tends to hurt for people.
Some people do have pain on the outside of the knee as well, and some people report pain on the back of their knee. There are something called a baker's cyst that can develop at the back of the knee. When you hear the word cyst people, I think the mind picture that most people get is like a bubble that needs to be taken out or drained. The way I think of this is the joint is just very swollen inside the knee, there are an active inflammation process happening, and extra fluid is being developed to deal with it.
Sometimes, I think the body is trying to build some cushion inside the knee as well. So, it's generating fluid, and it's a genetic thing. In my opinion, I think some people are just predisposed to react that way to different types of the injuries including a meniscal tear. That Baker cysts is a problem, because they will have trouble bending their knee and it's unsightly for some people. If they get really big, they just get really concerned with it. But the problem needs to be addressed, the meniscus problem needs to be addressed, and usually the baker cysts will reduce or become less of issue.
The medial meniscus, the inside knee meniscus is the one that tends to get affected more often. But you do see the lateral meniscus problem happen to a lot of people as well, and there are ways to test both here in the clinic. But regardless of which one is affected, the treatment options are typically the same, and we are going to go into all that here in a second. But what you'll see with a meniscus problem is, there are usually other knee problems happening at the same time. You'll typically see some knee arthritis developing, it's called osteoarthritis. There are usually some cartilage problems in the back of the kneecap, on the front of the femur, the thigh bone, and there could be some ligament problems as well.
There are some major ligaments inside the knee. I'll just go over them really quick. One of the top four are called the ACL, PCL, MCL and LCL. And these are structures that connect the bones to each other and hold the bones together. These four ligaments, their job is to make sure that the thigh bone stays attached to the shin bone. If they get elongated or torn, then that can cause stability problems in the knees. The connection between the two bones won't be as stable as it should be, which can cause the meniscus to get irritated because the meniscus will take some weird forces.
Let's talk about what happens to an untreated meniscus tear. We got lots of clients coming in here, of course they are getting treatment and some of them delay a long time on getting treatment, and the symptoms kind of worsen. And then we have the ones like I was telling you about earlier, where they come in when it's mild, and they haven't had any major limitations yet, and they haven't had a chance with all this other stuff to develop. But what tends to happen in people with untreated meniscus tears, of course, the meniscus problem gets worse over time. They move from mild to moderate to severe, and with all the problems that develop they will progress through arthritis way faster than normal.
About arthritis, arthritis is happening, and everybody constantly think of it as aging just like you get gray hairs and wrinkles on the outside of your body. The thought process osteoarthritis is that you get it on the inside of your body as well, and you age on the inside of your body as well, and it looks like osteoarthritis, so the joints change a bit. You might get different little structural changes in other tissues as well. For some people, they start developing small bone spurs. They start developing the cartilage might thin out, they get spots on their cartilage, the joint surfaces looking even, and it might not actually be painful at all.
In older people, I think, I'll have to dig up the research again, but it's in the 90s. I think once you are over 80 years old, it's like 93% chance that you are going to have some sort of arthritic change, or disc herniation in your back. I haven't seen the research on knees, but the rates go up. Of course, when you are younger, you still have a chance of having all that stuff happening, but it is painless and a lot of people. But if you have a meniscus tear, and you have other issues on top of that, like loose ligaments or cartilage issues in the kneecap, and you havebeen moving inappropriately for a while, you haven't been exercising like you probably should be, because this knee problem is slowing you down. Then it's going to allow for a faster progression.
Just think of it like your overall health. If you don't take care of your health, you are going to probably not live as long as somebody who does take care of their health. Your joints are the same way. If you don't take care of your joints, they are not going to last as long as if you do take care of them. People with meniscus problems in their knee, they tend to eventually develop hip problems. They can develop hip arthritis, they can get pain in the hip joint itself or around the hip joint. They will also get lower back problems. A lot of times we get ankle and foot issues as well. The foot changes the strength in their foot is usually affected and that can cause toe problems like hammer toes, bunions, other issues with the foot that that can be prevented.
Loss of arches in people that leave this untreated for a long time meniscus problem and then the arthritis gets out of hand, they will eventually likely get an knee replacement because the knee problem will continue to get worse. Of course, once they have that locking, like you get in severe meniscal tear that completely changes the mechanics, people really slow down. They don't want to move as much because of the locking and that makes arthritis progress way faster. If years go by, decades go by, then it's just a matter of time before they start getting told by their doctor that they need a knee replacement.
If it's that bad, if they've had joint locking for a long time and in their knee doesn't even move and have all the motion that is supposed to have a knee replacement a fantastic option for those people. The only concern I had is how are you going to move after that. You have to make sure you take care of your leg health, and get your activity back so that you can keep your body healthy, and make sure you don't have to have another knee replacement in a matter of time.
Now we are heading into the final part of this podcast here, we are going to talk about what treatment options there are for a meniscus tear. We will also go through the entire list of things that I see people do, and probably all the options that you are thinking of as well. I'm happy to entertain more if you leave us a comment on this podcast or get in touch with us. Let us know what other options are out there, I want to get a comprehensive list going.
Prior to getting any sort of medical treatment, we often see people trying home remedies.
The top things that people try, which is the easiest one, is just giving it time. They just rest it, they avoid moving a whole lot. They will avoid walking more than they need to, just to rest their knee. This is a very short-term solution, especially if you got an irritated meniscus it's going to feel better with off time. It absolutely will usually feel better because you are not standing on it, you are not putting weight through it, you are not using the meniscus like it's supposed to, so it has a chance to heal.
The problem is, if you haven't fixed the underlying problems that got to the meniscus tear, the meniscus problem in the first place. As soon as you get up to move again and you get active again, because you are feeling better, you are going to flare up again, we see people do that all the time. That's why they have the often symptoms where they say, Well, sometimes it flares up, and then a couple weeks later, I'm okay. Then another two or three months after that, it flares up again, and then it goes away. And then it flares up and it goes away. And eventually after going through this cycle enough times the pain gets worse and it stays more constant, or you don't get as much relief from the rest, because the original root problem hasn't been addressed.
The other things people will try at home, will be over the counter medications. Things like Ibuprofen, Tylenol, and Naproxen. There are a bunch of different medications you can get at the pharmacy over the counter. A lot of people try anti-inflammatory medications. The idea is to reduce the inflammation in the meniscus so that it can help with healing, and it's a pain reliever as well.
This is good for most people in the short term, they do get some relief. But after a while the drugs can become dangerous and this is not a good long-term solution. Ibuprofen is known to affect the lining of stomachs instantly, and for most people they can tolerate it pretty well, but I think the cutoff is six to eight weeks. If you are using ibuprofen consistently around the clock. After six to eight weeks the rate of people having major stomach problems, they get a hole in their stomach lining that spikes tremendously, which can lead to internal bleeding, which for a lot of people, they they need to go to the hospital for that. In some severe cases there is deaths that occur, especially in older populations, which is the people that tend to get these knee problems anyway.
If you are at home right now and you have been taking ibuprofen for a while, I strongly suggest you find an alternative, or take a break, or talk to your doctor about it and see what other options you have. Make sure you start to build a long-term plan to treat this miniscule problem because over the counter pain medication is not a long term plan.
Other things that people try are pain creams, you got your BenGay, Icy Hot, Biofreeze the rub that stuff all over their knee, and that tends to work pretty well in the short term as well. It's a pain reliever, it's not fixing the root problem, which we'll talk about here in a second.
The other the last most common thing that we see is people try knee braces. They will go to the store and buy a sleeve that slides over their foot and ankle and comes all the way up to their knee. These sleeves usually have a little opening for the kneecap to tell you where to line it up and leave some space for the kneecap. Some of these braces will be a little more heavy-duty, where they have metal brackets that are on the inside or the outside of the knee. A lot of people report that they have relief with these knee braces.
If you haven't tried a knee brace yet, and you are looking at trying to just get some relief, go for the knee brace that's definitely a way to get off the pain medication, if you havebeen using pain medication for a long time. It still is not going to solve the long-term problem, but I love the knee brace because it's not that dangerous for you to use. It's a safe way to get some instant relief, and most people report a little less swelling, they can sleep a little better at night.
But it only lasts so long because the problem is, knee braces tend to make your muscles weaker. Your body is smart, it can sense stability coming from the outside. The muscles will get lazy and you start to atrophy or lose muscle over time. A knee brace is just a short-term solution, you have to figure out a way to eventually not have to rely on the knee brace.
The other thing about knee braces is their main job, especially the heavy-duty ones, the ones with the brackets, their main job is to stabilize the knee and if you don't have a ligament problem, then it's not going to make a huge difference for your meniscus problem. You might need to get that checked out by an expert to know if you have more of a ligament problem, or meniscus problem, and get proper advice on how to use the knee brace. Because what I see a lot of people do, that come in where they need brace. I ask them this question I say, well, who gave you the knee brace first of all? Was it just on your own that you got that, or did somebody recommend that you use one? Was it a medical professional? And then what's your long-term plan for this knee brace because, if you are in your 50s or 60s, wearing a knee brace right now, I would not want you to be wearing a knee brace into your 70s and 80s or beyond, you eventually need to get out of that thing, but you need to have a plan.
The last step in your plan cannot be I'm going to be in this knee brace the rest of my life. Those knee braces are uncomfortable, they slide down, they get stinky, you have to wash those things everyday probably, especially in the summertime, and they just don't allow for normal movement. Ideally, you want to be without the knee brace as soon as possible, but you have to get to a point where you can wean yourself off and be able to do your everyday functions without a knee brace.
Okay, let's talk pain medications, prescription strength pain medications. Let's say you have gone to the doctor for this knee problem, they will usually recommend some sort of prescription strength pain medication. There are a ton of different types out there. It depends on which doctor you see, what their specialty is, and what their background is. They will recommend all kinds of pain medications, and these are all short sighted, for the most part, they are just doing their best to help you out with the pain that you are dealing with right now.
Understand that medications do not make your muscles stronger, they do not make your cartilage healthier, or your ligaments healthier, or your meniscus healthier as far as the actual structure. In fact, a lot of these anti-inflammatory medications, they are stopping the first stage in healing. Inflammation is actually a normal thing. That's why our bodies do it. It's the very first stage in healing, and it needs to occur in order for proper healing to happen.
If you are relying on anti-inflammatory medications, like some doctors will prescribe a steroid pack which limits inflammation. It's an anti-inflammatory medication, it is stopping the healing process in your entire body, and that's why they can't give you too much of it, because they know the long term effects of it, but it may provide you some quick relief, which most people are looking for that are visiting the doctor.
That might be a good thing for you, especially if you need to just kind of get through the week or get through the month. Or you don't want to be mean or grumpy with people because of your knee problem because that tends to happen, and you just want people to sleep at night, you are losing a lot of sleep. There are definitely some benefits to using some high-power pain medications, but they cannot be your long-term solution. You cannot rely on those for the long term, you are only going to get worse in your meniscus problem.
The next way the doctors will help out with medications is they will give you injection medication. The most common injection that people get is a cortisone injection into the knee, sometimes they'll do two or three all at once. It just depends on the doctor and how they do it. That is pain medication injected directly into the joints space, or the space where the meniscus is. They tend to be pretty effective in reducing pain. A lot of people have this sensation where they feel instantly better, after the injection site heals, maybe a day or two.
They might need a few days to recover from the injection, but then they feel massive relief. They feel like they can walk again, be active again, do all the things that they want to do. But you have to keep in mind, if you just got an injection, or you have had one not too long ago, or you are going to go get one soon. You have to keep in mind that it is not healing your meniscus. In fact, it's preventing your meniscus from healing. It's just masking the pain and you have got to make a plan to fix this meniscus for the long term so that you are not relying on injections for the long term, or other pain medications.
They will limit you on how many injections you can get per year, especially these cortisone injections. Because the doctors are very aware of the research, insurance companies are very aware of the research. If you get more than three or four per year, I think that's usually the limit. I'm not a physician, I'm a physical therapist, if I'm off, if you are in the medical field, or you know about all these limitations, and you are like, this guy doesn't know what he's talking about. You are probably right. I don't keep up with that part of the medical field. I keep up with my specialty very well.
I'm giving you the information that I hear from doctors and what I learned going through school, and what I keep up with here and there. The laws change, and the best practices change over time, and that's completely normal. But what I hear clients saying is, they limited me to three, they limited me to four. I'm like, good, you shouldn't get more than that because it's going to mess up your meniscus in the long term or other similar structures. So, you cannot rely on those cortisone injections.
Other things that people will get injected is PRP that stands for Platelet Rich Plasma. This is part of the newer, I think they call it functional medicine or it's non-medicinal, and it's supposed to be the natural stuff. They are injecting you with platelet rich plasma, they have to take some blood from you. They put it in a centrifuge, one of those things that spins really fast, and they pull up the plasma from your blood and it's got tons of platelets in it. Which is a sum of certain structures that are in your blood, and they inject that into your knee and the idea is that it helps your knee cartilage heal faster. I've seen mixed results with people getting these. I've heard some people say that it definitely helped out their pain, and then other people say didn't do a thing.
The other thing that people get injected with is, and this is less popular, but it's up and coming are stem cells. You might have done some research because maybe you have a meniscus tear. You have known it for a while. You had an MRI a while back, and maybe you have been dodging surgeons, because they've been wanting to do an operation on you, and you are thinking of alternative solutions. I'm sure stem cells has probably crossed your mind once or twice. It's still controversial, the source of where they get the stem cells is very controversial. I won't go into that. Even the efficacy or the likelihood to be helpful for you, is mixed.
I have had some clients, that said that they had stem cells injected, and said that it made a big difference. And I have had others that said they had it injected, and saw only minor difference, or no difference. It's so new that we don't know much about it. Right now, there isn't much research. Not many people are doing it, and that that's all we know about it right now.
What I can tell you regarding all these injections is, they are not fixing the strength of the muscles, which usually needs to be addressed. They are not dealing with joint mobility, how well the joint moves, the quality of motion, the way that you move overall, the way that you walk and move. But that's something we fix here in physical therapy, which I'll talk more about in a second. There are still a lot of root problems that are not being addressed with these injections, and I think that's why people get mixed results because they get some relief instantly. But they continue to be weak and continue to not move well, and that sets them up to have the pain return. It's not a good long-term solution to the problem.
Okay, two more things. We are to talk surgery next. A lot of people get a surgery to fix their meniscus, they will do a meniscectomy, often a partial meniscectomy, which means that they take out a piece of the meniscus, usually a flap or a torn chunk. The idea is that the tissue is not going to heal, so they cut it out, get it out of the way. Because the assumption is that that is what's causing the pain. But what we know about the meniscus, as far as its ability to generate pain, the outer edges of the meniscus, where tears are less likely to happen. The outer edges are where you have the most nerve endings and where it's likely to be more painful. The inner edges are where you have much fewer nerve endings and that's where the tears tend to happen. It's a little controversial right now doing these partial meniscectomies, because there are actually a few studies coming out of England.
England, they have a national health care system, where it's run by the government, it's socialistic versus here in the US it's capitalistic. But as a result of them being of England being a national health care system, the government is very into figuring out what works and what doesn't, because they want to save costs. So, what they are what they are doing is something called placebo, partial meniscectomy.
What is happening is, they are getting people that have known meniscal injuries, they get them through MRIs, they get their MRIs done, and they find them meniscal tears, and they are putting them into these studies where they split them in half. Half the group goes into where they get normal surgery done. They are the normal partial meniscectomy be done, and then the other group goes into the placebo, partial meniscectomy. Both groups have surgeries. There are interesting words in the studies, they say they even move the knee the same way in the placebo, they have the same tools, they put them under anesthesia, the same people are there, they take the same amount of time to try to account for every variable possible to make it exactly like a normal surgery. But the one difference is that they do not actually cut the chunk of the meniscus out that they were looking at cutting out.
They leave the torn meniscus alone. Then they close them all up, and after the course of six months, up to a year, what they found was that there was no difference in improvement between both groups. Both groups improved a bit, but not one group improve more than the other. Now they are thinking well, is this meniscus surgery even doing anything? Now they haven't done studies like that in the US, but I think it'll be interesting if they ever do.
For those people that have meniscus surgeries, what I would consider if this surgery even needed? Is that the best place to go? You open yourself up to a bunch of risks possibly, if you ever have a surgery, there is a chance for infection. You have all kinds of risks, and for some people, it is the best thing. I'll even tell some clients that this this is pretty bad, I can't help you with this, you need to go talk to a surgeon, ad I'll be straightforward and honest. But for a lot of cases, coming in a lot of people with meniscus problems, I'd say you know, 9 out of 10. What I'll tell them is I can help you out, and if it's real severe, I'll say well, let's give it a month with treatment., and if you are improving some, maybe you'll be happy with that level of improvement, we'll have a good idea for how much you can improve. Because you might be okay with getting 70% better if that's your max because at least you can walk around and do your normal things. 100% improvement may not be realistic for you, even if you had a surgery, who knows.
If you are out there and you have already had a meniscectomy, a partial meniscectomy, and it didn't improve, and you are one of those cases, unfortunately. Or if you are thinking about getting a meniscus surgery, or you are just learning about this for the first time, and you even know there was a meniscus surgery out there. Let me tell you about the outcomes of this.
A lot of people will improve, they get better, but then over time, they tend to regress, they get worse again. What we know for sure in the research is people that get meniscus surgeries are more likely to have osteoarthritis develop quicker in their knee. I think it's for obvious reasons. There is a chunk of your meniscus missing. So, the knee joint just doesn't move normally again, and it's going to age faster. It's really a short-term solution in my opinion to get a knee surgery, it might be the best decision for you depending on your situation. You have to weigh all those problems with you all those all those risks, all the factors to make the best decision moving forward.
But what the surgery is not fixing. Let's talk about that. Next is your strength, your joint mobility, the way that you move, the how you sit, how you stand. There are a lot of things that we look at here in physical therapy. Here at the clinic, we go into extreme detail about what you are doing, that led up to this meniscus injury. Because that's the question that needs to be answered. If we can fix the problems that led up to this meniscus injury, then you have an excellent shot at recovering for the long term. Even if you have had a surgery, you are going to have a surgery. It allows you to stop using the pain medications. avoid having to get injections. Stop having to worry about your knee all the time, you can get your sleep back, you can be able to go up and down steps just fine.
I'll tell you a story. We recently had a woman who came in for her hip. She actually had a hip surgery that didn't go too well but was having knee problems, and it looked like a moderate meniscus injury. In figuring out what was going on with her hip, and what we found in her was that her glute muscles are very weak. She just was not using them well. And it's counterintuitive because she's got a big butt. You would think she's got lots of glute muscle, and she has some pretty good strength, but she just wasn't using it well, and the strength that she had wasn't enough for the activities that she was doing. She was on her feet quite a bit, walking around every day for her job.
She doesn't have adequate strength to do what she needs to be doing throughout the day. And then she also isn't walking the best, so we had to figure out how to teach her. We taught her how to walk better way to figure out the problems there. We taught her how to strengthen her glutes better, and how to progress and to what level to progress to, and it's been amazing to see the benefits, we are five weeks in, now this week's upcoming is a sixth visit.
She is already sleeping better. She's walking much better. She stopped relying on insoles. She used to get insoles all the time. She feels like she doesn't need them anymore. The number one thing that we talked about recently though was, she's got a two-story home, and she was saying that she has to grab the rails to pull herself up with her arms to take weight off her legs, her hip and her knees. Because it was hurting so much. That was the first visit that I saw her. She flies up those steps now and can go down the steps with little to no pain, and she's still got tons of improvement to make.
This woman is set on getting back into the gym and doing the treadmill, being able to jog, being able to lift weights, and I think she's going to be very capable doing it. We just got to go a little farther and her progress to get to that that level.
So that's the root problem that we are fixing in here, we have got to find out where you are weak, where you are strong, there are usually something called a muscle imbalance happening. Muscles on one side of the body will be relatively strong, and on the other side of the body, they will be relatively weak. That stuff you can't pick up on an MRI. You can't see it on an X-ray, physicians aren’t trained to fix that or even identify it.
I think some doctors will have an idea of that happening, but they are not sure what to do with it because their specialty is medications, surgery, injections, those kinds of things. And that's cool. You need that sometimes. But if you are looking at fixing your movement, your strength, getting that long term, natural cure, because you take that with you, you can only get medication for so long and injections, and you ideally don't want to have more than one surgery. You are going to get one, you want to be going back for surgery all the time, doctors won't even let you do that.
You want to have fixes that you have control over, and that's what we teach here. It's heavy in education. We teach you what to do, and how to do it, when to ramp it up, or when to ramp it down, how to read your body, how to know what's normal, and what's not normal as far as sensations, and what you should be doing. We coach people through that process so that they can get to the point where they feel super confident that they are doing the right things, and that it's only helping their knee and not harming their knee.
There you go, guys. We talked about everything there is about meniscal problems. We covered what it is, what the meniscus is itself. How does a meniscus tear? What does it feel like to have a meniscal injury? We went over the mild, moderate and severe levels of meniscal tears, and what happens to an untreated meniscal tear. Of course, more issues are going to happen up in the hip and down in the foot. Then also the treatment options. We covered everything from what people try at home, and then what you can get done using the medical field, and what's going to help you for the short term, and what's going to help you for the long term. I hope this podcast was helpful for you. If you know of somebody that's got a meniscal injury, please share this with them. I want everybody to have the best information possible so that they can make the best decision about their own health moving forward. And I hope you have a wonderful day. Have a great day. Buh bye.
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