Cartilage Tears (Menisci)
General information about cartilage tears (Menisci)
A really common sports injury is when the menisci is torn. The menisci are discs of cartilage that help protect the knee from blows. During normal knee movements the cartilages move with the knee acting as buffers. They can sometimes tear simultaneously with a sprain.
CAUSE OF CARTILAGE TEARS (MENISCI)
Sudden stopping and twisting movements are usually responsible for menisci to tear as in badminton or basket ball. When an abnormal force twists the bones of the knee against each other, this puts stress on the cartilage and causes it to tear or split.
If the knee swells immediately it usually means there is also a sprain. If swelling occurs later it maybe only the cartilage that is torn but this injury usually gives immediate pain. The knee will feel tender and painful towards the front. Occasionally fluid escapes from blood vessels into the surrounding area and the knee looks ‘puffy’. Also the knee may not be able to move at all and it is impossible to put any weight on it.
HEALING AND RECOVERY
The RICE procedure should be started but as swelling is usually the cause of internal damage it is important to seek medical advice, especially if the knee feels locked or stuck. This is a good indication that cartilage damage has occurred. If there has been no need for surgery it is possible that muscle power and mobility will return within about two weeks but it will be about three or four months before the knee will be ready for resuming sport. Recovery after surgery can vary immensely and sometimes can be much less than three months depending on the surgery. In each instance the injury must be fully healed before returning to any demanding sport or the risk of future injury is high.
It is important to gently start straightening the leg and follow with mobilizing exercises as soon as possible, as this will maintain knee stability. This should be followed by leg strengthening exercises which will help to protect the knee and finally activity exercises should be carried out to test the knee for full movement. At all times care must be taken to ensure that the knee is not over worked as pain and swelling may return.
LEG STRAIGHTENING EXERCISES
- Sitting on the floor put both legs in front of you and press the leg to be straightened down into the floor. Hold this for a few seconds and stop. Repeat this five or six times and repeat four times a day if you are back at work and sitting you can straighten the leg whilst sitting.
- Sitting on the floor again with leg straight and the knee locked. raise the leg about six inches from the ground and lower and repeat about ten times. Again repeat four times a day. This exercise can be built up to twenty raises four times a day and finally a weight added of no more than one kilogram making sure that the knee is locked as it is raised.
KNEE MOBILIZING EXERCISES
- Sit on something so that your legs don’t reach the floor and gently bend the injured leg several times.
- Support the injured leg on your other leg and bend this leg gently as far as it will bend without feeling uncomfortable.
- Lie on your back and hold your injured leg below your knee on the shin and gently pull your leg towards your chest. This will bend the knee a little further – Repeat these five or six times.
- Sit on a chair with you injured leg on the floor and move your foot to the left and to the right five times. You will feel the knee moving with the foot. Do this several times throughout the day.
After two days you can introduce the following exercise:
- Hold the top of a chair for support and gradually bend you knees until you are squatting. Repeat this four times making sure the weight is evenly balanced on both knees. Repeat three times a day.
LEG STRENGTHENING EXERCISES
- Sitting on a chair place a kilogram weight on you foot. Raise your leg and straighten and lower it slowly. Repeat this exercise with your other leg.
- Imitate a skiing motion and gradually work up to squats. Repeat this exercise with your other leg. Start the squats doing five and work up to ten. It is beneficial if you can perform the exercises twice daily.
- Standing with you back straight against a wall slide down the wall until you imitate a sitting position and hold this position for a count of ten. Repeat three times.
- Step-ups. – Do ten of these first leading with one leg and then change to lead with the other. Repeat twice a day.
ADVANCED LEG STRENGTHENING EXERCISES
- Repeat the step-up exercise but do twenty and use a two kilogram weight in each hand.
- Jump up and land carefully bending you knees. Do ten of these and repeat three times.
- Hop ten times on each leg and build up gradually to twenty on each leg.
- Run up and down stairs, about fifty at a time, again this is more beneficial if performed twice daily.
EXERCISES TO PREVENT FURTHER INJURY
- Sit on the floor and place the now healed leg straight out with the opposite foot tucked into the thigh. Reach toward the toes until the stretch is felt.
- Lying down face up put you hands on the shin of your leg and bring it towards your chest and you will feel the stretch.
- Lying down, again face up, cross the leg to be stretched over the other leg and again a stretching feeling will be felt.
- You can also stretch whilst standing, put the leg directly behind your other leg, and with your hands at your side slowly lean backwards, and you will feel the stretch in the thigh.
- Always warm up.
Protection and supporting the injury
Wear shoes that have good support or shoes that comfortably allow you to wear a brace inside. Avoid playing on uneven ground and slippery services. Always warm up before you participate in physical activity. This will increase the body and muscle temperature. The blood and oxygen will increase around the working muscles and also this lubricates the muscles, joints and connective tissues. This will help to prevent injury from sudden stretching.