A meniscus lesion is an injury to one or both cartilage discs, which are located inside our knee joint as shock absorbers. In addition to shock absorption, the menisci have the function of adapting the joint surfaces of the thigh and shin to each other in order to enable the best possible sliding function of the joint surfaces. The menisci are made of cartilage and, especially in their interior, have a poorer blood supply than muscle tissue or connective tissue.
The healing of poorly perfused structures takes longer. The inner meniscus is fused with the joint capsule of the knee and is more frequently injured than the outer meniscus. In acutely injured knees and in chronic meniscal lesions during reactive inflammation, the knee should only be gently mobilized.
The movement improves blood supply to the joint structures and promotes healing. After an operation, movement in the knee may be medically restricted. This limitation must be taken into account during the mobilization exercises.
In a conservative treatment of a meniscus lesion, depending on the wound healing status (early phase, see below), the knee joint is treated with a special device. Late early phase: training to below the pain threshold, late phase: also at the pain threshold). The knee is particularly well mobile in 2 directions of movement – in flexion and extension.
1. exercise 2. exercise 3. exercise 4. exercise .
- At first the knee should be warmed up with as large and wide movements as possible. Both directions of movement are trained.
For example, the foot can be placed on a ball or a lying bottle to reduce the resistance. Now the knee can be rolled forward to practice stretching, as if on a rail, and pulled tight, rolled up to improve flexion. It is important that during the exercise both buttocks are equally loaded in the seat.
In this way, evasive mechanisms can be avoided. Both directions of movement should be carried out consciously and in a controlled manner, so that the stretching is also carried out consciously with the final degree as possible.
- For stretching, the so-called heel swing is a good choice. Here the patient is in a long seat.
The exercise can be performed on one side or simultaneously with both legs. At first the stretched leg is stretched very long. The hollow of the knee is pressed towards the support, the foot is sharpened.
The heel should now be fixed in this position and should not move during the whole exercise. Now the knee is bent and the foot is pulled up. The angle between the back of the foot and the lower leg is thus reduced while the heel remains firmly in place.
To mobilize the extension of the knee joint, the foot is stretched again and the hollow of the knee is pressed firmly into the support (if the extension is still limited, a towel roll can be placed under the knee as a tactile resistance).
- Also for the extension (stretching) of the knee, is the so-called hammer exercise. From the same starting position, the patient tries to lift his heel minimally from the support by stretching the knee. A pillow or towel under the knee joint can also be helpful here.
The hollow of the knee is pressed to the floor, the foot is tightened and the heel is lifted slightly from the surface. The exercise is done in quick alternation of tension and relaxation, so that the heel taps the floor like a hammer.
- The flexion (flexion) can be trained well with the exercise described above, in which case the focus should be on rolling the foot up. In everyday life, cycling can also be regarded as knee mobilization, since a large range of motion can be practiced with little stress.
Stretching exercises should always take place at the end.
Therefore, it is not advisable to stretch in the acute phase or in the case of existing medically induced movement restrictions. The final stretching or bending of the knee during stretching puts more strain on the menisci and can be painful. Stretching exercises should therefore be used with care.
However, they can play a major role in the late phase of treatment. If the patient has muscular imbalances and this results in overstraining the meniscus, shortened muscles should be stretched. The hip and ankle joints also play a role here, as they also influence the load on the knee joint.
The stretching should be selected according to the findings. Often, the rear thigh muscles are shortened.Back thigh (ischiocrural muscles) Front thigh muscles (quadriceps) Further exercises can be found in the article Stretching exercises and physiotherapy for meniscus lesions
- For this purpose, the stretched leg can be pulled upwards from the supine position with the hands on the thigh. The stretch should be held for about 20 seconds and can then be performed on the other side.
It is important that the head and cervical spine remain relaxed on the floor during the entire exercise.
- If the anterior thigh muscles are shortened (e.g. quadriceps femoris muscle), this can be stretched from a standing position. The affected side is angled, the patient grasps the lower leg above his ankle joint and pulls the heel towards the buttocks. This provokes the posterior parts of the menisci.
The exercise should only be performed when no joint pain is present. However, pulling on the front thigh or just below the knee joint is to be expected as a normal stretching pain.
Strengthening exercises are particularly important in meniscal lesions. The muscular support of the joint plays an enormous role in therapy and in the prevention of osteoarthritis.
The muscle groups should be trained in isolation, but also in their function in the so-called closed chain, i.e. when standing under the load of one’s own body weight. 1. exercise (knee extensor) 2. exercise (knee flexor) Strengthening exercises are performed slowly and in a controlled manner. 12 repetitions are sufficient.
After a break of approx. 30-60 sec. another set can be performed.
The exercise can be repeated 3-4 times in total and should be performed on both sides. Quality before quantity. 3rd exercise More strengthening exercises can be found in the articles Physiotherapy exercises knee and exercises knee pain.
- Isolated strengthening exercises are, for example, leg extension for the quadriceps femoris muscle, the knee extensor. From the seat (preferably with legs hanging freely), the lower leg can be stretched upwards and held there briefly. The exercise can be made more difficult with the help of Thera bands or weight cuffs.
It is important that during the stretching both buttocks are equally loaded and the thigh does not lose contact with the support. The hollow of the knee should be pressed into the support at the same time.
- The knee flexion can be trained in the prone position, but even better from the quadruped position. Here the hands are placed under the shoulder and the knees are placed under the hips on the pad (possibly with a soft pad if pain occurs).
The back forms a straight line parallel to the floor, the gaze is directed diagonally downwards, the cervical spine is relaxed. Now the affected leg can be lifted off the floor and stretched straight backwards (in extension of the spine). From this position, the heel can now be tightened and stretched again.
Therabands or weights can also make the exercise more difficult.
- The king’s discipline is the knee bend. Here the knee is loaded with the own body weight. The patient stands about hip-wide with slightly bent knees.
The body weight is evenly distributed over both feet. Now the patient lowers his buttocks backwards as if he wanted to sit on a stool which is standing far behind him. The knee joints remain above the ankle joints and do not point beyond the tips of the feet.
The kneecap looks forward over the feet and does not deviate inward or outward. The weight is more on the heels than on the forefoot. The lower leg stands vertically in space.
The buttocks can be lowered until the thigh is approximately parallel to the floor. Afterwards, you brace yourself with the exhalation back into an upright position. The knees stretch, but do not overstretch, i.e. they remain minimally bent.
This keeps tension on the muscles and the joint is not overstretched. Weights or Thera bands can be added to increase the exercise if it can be performed safely.
Coordination exercises are a particularly important part of the treatment of meniscus lesion. The menisci play an important role in stabilizing the knee by reporting the joint position of the knee to the brain (proprioception).
This ability can be trained again after a meniscus lesion through reaction training and balance exercises. This can be done with all kinds of exercises.However, the execution of the exercises should always be mastered correctly. For coordination exercises, self-control with a mirror is recommended.
- In addition to the knee bend (see above) or the lunge (one leg in front, one leg about 2 arm lengths behind, both feet facing forward, the front knee remains behind the ankle, the pelvis is slightly lowered so that the rear knee is just above the ground), the one-legged stance is also a good starting position in increasing difficulty for exercises.
- By setting different resistance levels, the therapist can improve the responsiveness and response of the patient’s muscles. At home such a pull can be imitated by a Theraband, which is attached to the outside or inside of the knee. Distractions such as throwing and catching a ball can also train the responsiveness of the muscles.
If the exercises are mastered on solid ground, the patient can perform them on a shaky or yielding surface (at home a pillow, or a thickly folded blanket, balance pads). Initially, it is sufficient to simply hold the various positions on the surface securely. Later, distractions can make the exercise more difficult.
Grab something from the floor and lift it up. Lay something from right to left. Quick pendulum movements with the arms, with the lower extremity stable.
There is a variety of exercises that the therapist should tailor to the patient. Difficulty highlights are jumping exercises. These should only be performed when the leg can be safely stabilized muscularly in its axis.
Meniscus lesion initially results in reduced mobility in the knee joint.
The surrounding structures are no longer shifted against each other, and adhesions and tensions can occur, which can be released by massage exercises. In addition to light massage grips on the thigh, the direct joint environment should also be massaged. 1 Exercise 2 Exercise 3 Exercise 4 Exercise and connective tissue massages.
- To do this, the patient can grasp a slight fold with both hands with the fingertips and move it. This is often slightly painful, especially on the inner edge of the knee. The entire knee region can be treated in this way.
- In case of pain points, the patient can perform slight circular movements to relieve them.
The bone should never be “massaged”, this can lead to irritation of the periosteum!
- The hollow of the knee can also be painfully stuck together. The patient can stroke with the fingertips through the hollow of the knee to loosen the connective tissue. Heat application can be used to emphasize the massage exercises in a relaxing way.
- After the meniscus lesion, self-massage with a fascial roller can also be pleasant.
Here the patient rolls over a hard foam roller with the load of his body weight or an extremity and can treat pain points or perform a fascial massage on his own.
A meniscus lesion can be treated conservatively (immobilization followed by physiotherapy) or surgically. The operation is usually performed arthroscopically (minimally invasive). The injured meniscus can be partially or completely removed.
Injured regions of the joint surface are usually also treated. Even meniscus sutures can be performed arthroscopically. In some cases an open operation can also be performed.
In this case the joint is opened by a slight incision and the meniscus can be removed or sutured. This treatment option is usually chosen in cases of concomitant injuries to the capsule or ligaments. After the operation, the doctor can arrange for the knee to be immobilised, usually the knee joint is then secured in a splint. In the course of healing, the mobility is gradually released and can then be regained therapeutically. In addition to restoring mobility, the strengthening of the stabilizing musculature and the improvement of coordination are increasingly important in the course of therapy.
