Our March 22, 2016 post described a 2015 study indicating physical therapy was as effective as spinal decompression surgery to treat low back pain caused by spinal stenosis. In a similar 2013 study published in the New England Journal of Medicine physical therapy without surgery was found to be as effective as surgery followed by physical therapy to treat meniscus tears in people at least 45 years old. These are generally called degenerative meniscus tears.
There is a meniscus in the inner half of each knee and one in the outer half of each knee. These “menisci” are actually wedge shaped and improve the mechanical stability of your knee by acting like wheel chocks to keep the rounded ends of your femur, your thigh bone, from slipping of the flat top of your tibia, your lower leg bone. Your knee depends on the strength of surrounding muscles and normal movement of your hip, ankle and foot joints to act as shock absorbers. Without these shock absorbers a normal meniscus will quickly deteriorate and cause knee pain.
Tears develop in a meniscus for many reasons. For example weak muscles or poor flexibility combined with overuse can cause a tear. The tear forms bumps and pot holes that can interfere with smooth motion of the knee. Excess force concentrates on the knee joint surfaces causing an inflammatory response resulting in knee joint swelling and knee pain. Swelling and pain limit muscle activation causing weakness. Abnormal movement patterns develop resulting in stiffness of the knee and adjacent joints. This creates a self-reinforcing cycle of increased knee joint force, more stiffness of the knee and surrounding joints and greater knee pain and overall knee joint deterioration.
Surgery or physical therapy can not correct a degenerative meniscus tear or restore normal joint surfaces to clear up knee pain. Physical therapy works by restoring knee joint muscle strength and flexibility of the surrounding muscles and joints. The improved muscle strength allows the muscles to act like shock absorbers and to decrease stress on the knee. The improved flexibility allows the adjacent joints to also act as shock absorbers decreasing knee joint force. The decreased force on the knee joint clears up the knee pain.
This is another example of the importance of consulting a physical therapist for orthopedic injuries. Getting physical therapy first will allow you to avoid the risk, time and cost of an unnecessary medical testing and treatment. In the case of a degenerative meniscus tear you can avoid surgery and take care of your knee pain.
Christopher DiPasquale, PhD, PT, OCS, SCS, CHT is a physical therapist at Performance Physical Therapy & Sports Medicine with offices in Hebron and Colchester, Connecticut. He is board certified by the American Board of Physical Therapy Specialties in Orthopedic Physical Therapy and Sports Physical Therapy and a Certified Hand Therapist by the Hand Therapy Certification Committee.