Now let’s get into the signs and symptoms of a meniscus tear.
This is the third article on the topic of meniscus tears. If you missed the last two, you can check them out at the end of this article.
Signs and Symptoms of a Meniscus Tear
Similar to other knee injuries, a meniscus injury is manifested by acute or abrupt pain in the joint-line of the involved knee. All signs of inflammation, which include redness, warmth, pain, swelling, and function loss, may be observed and noted by the physician during physical examination.
A client with a meniscal tear may experience and report the following signs and symptoms:
Pain – After an acute injury, pain in the joint line of the affected knee is usually reported. Acute trauma is not a prerequisite to develop meniscal tears. Some patients may not even recall or describe the injury event. For non-traumatic cases, the pain may be intermittent and limited to the affected knee.
Tenderness on The Joint Line – This symptom is found in 77 to 86% of patients diagnosed with meniscal tears, classifying it as an accurate clinical sign of meniscal injuries (Baker, 2011).
Joint Swelling – Some patients may experience swelling in the involved joint line, occurring as a delayed symptom. Others may not display this symptom all. Research revealed that 50% of patients with meniscus tears presented with knee joint swelling (Baker, 2011).
Tear of medial meniscus
Swelling that occurs minutes after an acute injury is highly indicative of a meniscus tear resulting from a tear associated with hemarthrosis, a condition where bleeding occurs in the joint space.
Immediate swelling with bleeding typically occurs in the outer one-third of the meniscus. In the 1993 study by Stanitski and colleagues, it was found that 47% of adult patients with hemarthrosis had a tear in the ACL (Bhagia, 2012). The same study also revealed that 47% of the affected patients had meniscal tears (Bhagia, 2012).
Locking of the Knee – Locking is a frequent symptom of meniscal tears. The knee of a client with a meniscus injury may freeze or get stuck in one position as it being bent or straightened, causing inability to straighten out the knee. Locking is more likely to occur with a displaced tear, where the torn fragment is trapped within the knee joint. Swelling may mimic the sign of locking. The physician may observe for clicks or snaps after unlocking the joint to distinguish locking from joint swelling.
Giving Away Sensation in the Knee – This symptom occurs when the detached fragment is temporarily lodged in the joint. A patient may report feeling wobbly without warning. Giving away sensation in the knee may occur immediately or 2 to 3 days after the inciting injury.
Abnormal Range of Motion of the Knee – Meniscal injuries may cause difficulty with straightening of the knee. When the knee is fully bent, as in squatting, pain may be reported. The pain may be so severe that the client is unable to perform or complete the movement. Deviations and compensatory patterns during walking are also observed.
Diagnosing Meniscal Injuries
A meniscal injury can be accurately diagnosed through a detailed subjective history, physical examination, performance of certain maneuvers, and diagnostic tests.
Taking the History of Your Meniscus Injury
Your physician will first obtain a detailed history, focusing on the mechanism of the injury, which includes timing of the injury. Trauma is not necessary to cause meniscal tears. There are cases where you may not recall or be able to describe the symptom leading event.
Physical Meniscus Injury Examination
A complete physical examination is conducted by your physician. During evaluation, the lower spine, hip and thigh of the affected leg, and the patellofemoral joint will be examined. Joint line tenderness, swelling, and range of motion of the affected knee will be checked.
A part of a complete physical examination is the performance of certain provocative maneuvers. These maneuvers elicit the signs and symptoms of a meniscus injury by causing impingement of the torn meniscus.
Your physician may perform the following provocative maneuvers:
McMurray Test – In the presence of a tear, this maneuver elicits knee pain or reproduces a click.
Steinmann Test – Pain is elicited when the shin bone is rotated with the patient sitting and the knee bent to 90-degrees. A medial meniscus is possibly torn if the client complains of pain as the shin bone as it is rotated going away from the center of the body. A torn lateral meniscus is suspected if pain is reported as the shin bone is being rotated toward the center of the body.
Apley Test – A client has a positive test when pain is elicited at the medial or lateral side of the knee joint as force is applied through the heel with the leg in internal or external rotation.
Diagnostic tests for a Meniscus Tear
If a meniscus injury is suspected, the physician may first order plain radiography to rule out arthritis and fractures.
To confirm the diagnosis, a magnetic resonance imaging (MRI) test is ordered. This diagnostic test is widely recognized as the standard imaging study for suspected meniscus pathologies (Baker, 2011). MRI is more reliable in capturing sharp and clear images of the soft tissues in the knee joint.
Arthroscopy may also be a reliable tool for meniscal tear diagnosis if it is performed by a skilled arthroscopist (Baker, 2011). Research showed that arthroscopy is nearly 100% specific and sensitive in diagnosing meniscal tears (Baker, 2011).
Types of Meniscus Tears
Meniscus tears are not all the same. Identifying the type of meniscal tear through MRI scanning is important during the diagnosis. Your treatment plan is also based on the type of tear you have sustained. Some tears may be treated conservatively. Other tears may be resolved through surgery.
There are Seven Types of Meniscus Tears:
Frayed Tear – A meniscus with frayed and jagged fronds on its sharp edges may be a sign of degeneration. If the inner meniscal rim is involved, the risk for further injuries and complications is not likely. If the whole meniscus demonstrates frayed fronds, the meniscus may collapse in ragged motion. A meniscus with severe degeneration is impaired to carry out its shock-absorber function. Arthritis of the knee is a likely consequence.
Radial Tear – In a radial tear, tearing occurs across the lateral rim of the meniscus. Tearing occurs from the edge of the meniscus, going inwards. In this type, the inner part of the meniscus may not completely heal due to inadequate supply of blood.
Parrot-Beak Tear – If an oblique radial tear is left untreated, it can lead to a parrot-beak tear. As an oblique radial heals, the tear may assume a rounded beak-shaped appearance.
Circumferential Tear – In this type, the tear may run along the length of the cartilage.
Bucket-Handle Tear – A tear running across the length of the meniscus may cause detachment of one of its sections from the shin bone, leading to the formation of a flap that resembles a bucket handle. A bucket-handle tear is more likely to cause complete straightening of the knee, locking, and pain. This type of tear is more susceptible to sustaining more damage.
Horizontal Cleavage Tear – Classified as a rare type of tear, a horizontal cleavage tear is manifested by a horizontal split found in the body of the meniscus. This tear is usually first sustained after a minor injury and then followed by degeneration.
Flap Tear – This type of tear is manifested by a horizontal split in the middle of the meniscus. The formed flap may flip over occasionally, leading to the symptoms associated with meniscal injuries.
There you go, the end of part 3.
If you would like to see the exercise program that I use for meniscus tears, you can check it out here:
Rick Kaselj, MS
If you liked the above, you might find these posts helpful:
As a freshman track athlete in high school, I had aspirations of making my varsity letter.
How cool would that be as a freshman to receive your varsity letter?
I was a skinny sprinter/jumper and my best shot at making varsity was going to be the long jump. I was the fourth jumper at the time, but quickly moved to the third jumper. Hang in there with me, I’m getting to my point.
We were at a relay meet, where there were long jump teams comprised of three jumpers. I was the third jumper for this meet. I was doing build ups with our number two jumper. This kid was built the opposite of me: short, muscular, and had these quads that made him look like quadzilla.
He was doing his build-up in front of me when he lets out a scream like he’d been shot, grasps his hamstring, and he goes down. He is done for the rest of the season because of a pulled hamstring, I move up to #2 jumper, and I made my varsity letter. Yeah me.
A Good Ratio to Prevent Hamstring Pulls
Fast forward some 20+ years and I’m a speed coach training athletes such as my old teammate to be fast. When it comes to strengthening an athlete for speed, the consensus from a lot of speed experts I’ve learned from is that the hamstrings are the weak link.
The majority of your leg exercises and movements strengthen the quadriceps a heck of a lot more than the hamstrings. I myself, thought that just doing squats and lunges one winter, I would really strengthen my legs for intramural softball. I didn’t do any specific hamstring work. My first hit sprinting down first base, I tweaked my hamstring.
Lesson learned. You have to include hamstring specific exercises or activity to strengthen them.
Most athletes I see come in with their hamstrings about 50% as strong as their quadriceps, maybe even worse. To maximize speed development, experts would love to see it at a 1:1 ratio, but believe if you get to 75% – 80% then that still helps improve your speed AND is good for injury prevention.
Yes, I said injury prevention.
Females and ACL Tears
So, as we start working with more athletes on speed, we start seeing a fair share of athletes (mostly female) that have torn their ACL’s. We don’t do the rehab, but as soon as they are cleared from rehab, they come to us to get them back to being the athletes that they were.
I’m sure you have had your fair share of ACL athletes as well.
One of my good buddies was an ATC and he decided to do some research on the subject about what we could do to try and prevent those ACL tears from happening. He basically created a report that to this day I am still selling copies of, discussing the reasons why these incidences keep happening, especially in females.
A few of the highlights of Why Females Get More ACL Tears:
A lot of females have blown their ACL’s during their menstruation cycle: their period. This, as a professional, I can’t give help for.
Female’s ACL’s may be smaller in diameter than males, thus not be able to provide as much support to the joint.
Female athletes tend to have much weaker hamstring strength than male athletes. Thus, they can’t activate them as quickly to provide assistance during rapid movement.
Whoa, wait a minute. Did I just mention hamstring strength again?
Working Your Hamstrings to Prevent ACL Injuries
Yes, I did. A good percentage of ACL injuries are non-contact. They were acquired by landing from a jump, cutting, or pivoting. Because of the weak hamstrings, when they do those movements there is a ton of added strain to the ACL for support. The athlete wants to move rapidly, but the ACL says “nope, not today.”
Now get this. The experts say ideally they would love to have a 1:1 ratio between the hamstring strength and the quads, but because there are only 3 hamstring muscles compared to 4 quadriceps muscles, if they can get the hamstring strength to 75% – 80% of the quads that would be the goal.
Yep, you read that correctly, 75% – 80%, which is the same percentage that you are shooting for when you are trying to develop speed. Consequently, if you are working on speed, then you are also reducing the chances of you tearing your ACL.
When you get that strength up, you will be more balanced and your muscles will be firing correctly. Thus, you can reduce the chances of getting other muscle strains. I haven’t had a muscle pull or strain in my legs since that softball incident and that has been over 14 years. And I still run pretty fast.
Once that strength is up, we can then start really developing your speed and quickness. Your landing on your plyometric jumps will be better because all the muscles will be firing to stabilize and support. When we do agility drills where you are cutting from one direction to the next, the muscles in your legs will be firing better, giving you more stability. Thus, when you start to utilize them in your games, you will be faster, better prepared, and your body hopefully will have less chance of getting injured.
To help improve your hamstring strength, I have provided two videos of exercises I like. One is the glute ham raise and the other is manual hamstring curl (or manual glute ham raise). This is in case you don’t have access to a glute ham raise.
The Best Machine to Improve Speed
If You Don’t Have the Machine Above, A Great Alternative
Obviously, there is more to the process of both speed training and injury prevention. But I think if you start with improving the hamstring strength, then the other facets of those processes will become easier to attain.
Adam Kessler is a Certified Strength and Conditioning Specialist (CSCS) and a USAW Sport Performance coach that helps athletes learn how to run faster and improve athletic performance.
Athletes of all levels – professional, collegiate, high school, and younger – have used his Run Faster Method to improve their speed and accomplish the sport goals that they desired. He has a speed blog for speed and sport tips at http://howtorunfasternow.com.
This will be a nice start to a very busy few weeks of travel and teaching. I am also teaching in Vancouver, San Diego and Edmonton.
Before I left, I needed to clean up my email box and answer a few questions.
Let me share a few of the questions that I got.
Well, before I get to the first question, make sure to watch Jedd Johnson’s video on some of the tactics he used for his elbow and forearm pain:
Should I Get Your Program?
Hello. I don’t know if you remember me but a while ago I messaged you about piriformis syndrome. I wasn’t diagnosed with that yet but I should get an MRI approval tomorrow. After a long walk I lay down and my leg starts twitching where my glutes are at. I have sciatica but no back pain. Should I wait for my approval for the MRI to purchase the piriformis program?
More important then getting my program, is you need to start doing something to help with your injury.
AR, I am not picking on you. I have just seen it so many times, someone waiting for an MRI for a rotator cuff injury before they do anything. They get the MRI, the doctors says it is not surgical and all that time has passed when the person could have been working on making their injury better, but they waited for the MRI.
It is important to get an accurate diagnosis by a physical assessment and diagnositic tests, but an important question to ask you doctor is, “Will a positive result change if what I do is not surgical?”
In many situations, the answer is “No.”
Getting a diagnosis provides a foundation for what exercises to do and not to do. Plus it will rule out anything more serious. Getting input from other health and fitness professionals can help with the solution, but the biggest thing is to do something for your injury now.
If you look at disability management research, it shows that the longer one waits to get treatment, the longer their injury will be around. In my opinion, treatment is not going to appointments but doing stuff you can at home and the gym.
All I can say is, get a diagnosis, find out what you should do and start taking action. We all want someone to fix us but the person that is the best at fixing your injury is yourself.
Sorry, I Don’t Speak Physio
I am a rugby trainer. Where I come from we are not that advanced in sports medicine. My rugby team, who is about to start their season in a week, has a couple of players with knee injuries (suspected ACL tears and partial tears).
Most of these players will never play rugby after this year so the physio has advised good strengthening, and getting them to play with strapping.
Would you be able to help out with developing programs for these players, or would any of your resources on knee injuries be useful? If so could you advise which one?
I am a conditioning coach and not a physio so will not understand too many medical terms. Would you have any easy to use program that I can do for my players with ACL injuries?
The program is focused on athletes and active individuals, plus many of the exercises focus on ACL prevention and recovery. I have it set up as an ebook and easy to watch videos. I have kept things easy to understand and not technical.
I would suggest giving the program a go.
If you need any other help when it comes to setting up a program for your players, I am more than happy to help.
Have a great season, B.
How to Get More Referrals?
Good Afternoon Rick,
I’ve been networking with different health professionals starting this year. However, I’ve had trouble establishing relationships with Physiotherapy Clinics effectively. Do you have any quick words of wisdom you can pass on to me? And as well, I had someone ask me, “Why would people refer clients to Kinesiologists instead of a Physiotherapist?” I partially answered the person’s question but I didn’t fully answer it because I am still quite new in this field. Besides the obvious, would you able to shed more light on this?
Thanks for the email.
Building relationships with physical therapy clinics is no different than any relationship. It involves giving, helping and time.
MS, I want to reply to the “Why should I refer to a physical therapist compared to a Kinesiologist?”
I would focus on the skills and talents that you have that are unique.
For me, I don’t say that I do personal training, exercise rehabilitation, ergonomics, disability management, functional capacity evaluation, etc.
I focus on the fact that “I help people with injuries with exercises. I can meet you at my gym, your gym or your home, whichever is convenient for you.”
How do you differ from a physical therapist: “I work with people that are finished with physical therapy and are working themselves back into the gym or back into sport. I work with the physical therapist and build on what she has done when it relates to your injury. Plus I help people in the gym focus on exercises that will help their injuries and not make it worse.”
I hope this makes sense, MS.
Listen to the two interviews, they will help a lot. Plus focus on the things you are really good at.
Fixing Elbow Pain
Here is Jedd chatting about the Fixing Elbow Pain program that we put together.
This is what Jedd was talking about:
Just note that today is the last day of release discount for Fixing Elbow Pain. If you want to check it out, you can here.
How flexibility can help you with your knee pain during squatting
A different kind of lunge that decreases knee pain
Vicious cycle of knee pain
Importance of using a mirror for feedback on your technique
Master your lunge and squat exercises with no weight and added weight
As I discussed in the interview, one of the things you need to address when it comes to knee pain during squatting are muscle imbalances. I go into detail about this in Muscle Imbalances Revealed.
I am having a tough time keeping up with all the kind words about Muscle Imbalances Revealed. Here are a few more that I just got:
“Addressing muscular imbalances is of paramount importance when training athletes. Muscle Imbalances Revealed provides the background, assessments, training strategies, and specific exercises to restore balance across the lower extremities, lumbopelvic area, and shoulders, and therefore equips you with the knowledge you need to help prevent the most common sports-related injuries. Even better, you can benefit from all the content from the comfort of your home.”
Kevin Neeld Hockey Strength and Conditioning Coach KevinNeeld.com
“I am glad I had the opportunity to review Muscle Imbalances Revealed by Rick Kaselj. These are DVDs that you should NEVER let out of your education library. We all know how good DVDs just “disappear” all of a sudden. I am not only writing this review from the eyes of a fitness & sports performance coach but also a person that has suffered from knee and lower back injuries from my days in the US ARMY.
Muscle Imbalances Revealed is an indispensable resource for coaches and fitness trainers with an “all-star cast” of some of the best rehab and post rehab exercise specialists in this business. It’s not a perfect world and eventually your athletes or fat loss clients will get an injury you need to work with and around. This program has enlightened me and added a new toolbox to help my clients in a more effective way, and improve my own performance and past injuries I sustained while in the ARMY. Muscle Imbalances Revealed is a comprehensive and easy to follow program that I wish was around years ago. Not getting this program is leaving you unprepared for inevitable injuries that you or your clients may receive.”
Nii Wilson New York City USAW-Sports Performance Coach/ Underground Strength Coach Certified NiiWilson.com
“One of the keys to my success as a personal trainer has been my ability to work with and around the nagging aches and injuries of people from 35-55, the very demographic that has the time, money, and demonstrated needs for our services.
The information you’ll gain in MIR is exactly what you need most to differentiate yourself from generic “just-make-em-tired-and-sweaty” trainers. Rick and the crew have done an outstanding job, and Bill Hartman continues to defend his title as “the Smartest Man in Fitness.”
If you want to elevate your skills and, therefore, your income, you need these DVDS. You owe it to your clients and to yourself to be the best you can be.”
Stephen Holt “One of America’s Greatest Trainers” – Men’s Fitness 2003 ACE Personal Trainer of the Year BabyBoomerFitnessAuthority.com
Okay, before going.
I remembered that I did an interview with Shawna a few months back where she talked about knee pain.
I thought it would be helpful if I sent it to you.
I am missing the ACL in my right knee (tore it in a horse accident & never repaired).
I have full range of motion, but when I run or do too many deep knee bends (i.e. to clean or to pick up something) I get pain in that knee and have to rest it until the pain goes away (could be weeks).
Will your product help me strengthen my knee so I can avoid this?
I am female, 57 and would like to be able to run more and do more hiking on rough terrain, as well as normal chores.
Yes, Knee Injury Solution will help you.
The components of the program that will help you are:
Component #4 – Exercises to Improve Your Walking and Decrease Pain During Walking
These exercises will help strengthen your knees and prevent future knee injuries with quick, easy and simple exercises that you can do at home.
This will be great for helping you with hiking and as you progress, you can perform the exercise onto an unstable surface like a balance board to help you with hiking on rough terrain.
Component #1 – 9 Exercises a Day Keeps Knee Pain Away
These exercises help improve the stability in your knee in all directions and loosen up your hip so it puts less stress on your knee.
This will work great to get you back to running. It will slowly strengthen your knee and build stability around your knee for running.
Component #1 – 10 Minutes to Strong Knees
With these group of exercises, you focus on strengthening your knees. The exercises can be done with a little equipment or even no equipment. I have videos of the exercises and a handout you can print out and follow the exercises.
These exercises will help strengthen the knee so bending down will be easier.
D, I hope this helps.
Have a spectacular day!
Rick Kaselj, MS
If you are looking for resources to help you with knee pain or injuries:
While putting my presentation together, I wanted to share with you a few of the cool things I found while taking a look at the research while preparing for the presentation.
Is Physical Activity Bad for Knee Joint Health?
There is the eternal debate if physical activity is good or bad for the knees. The researchers looked at things from the point of view of: physical activity is encouraged in school, but is this increase in physical activity leading to osteoarthritis?
What They Looked At:
They went back and looked at a lot of the research that was created on physical activity and knee health.
What They Found:
Strong evidence that physical activity lead to tibiofemoral osteophytes (bony outgrowth covered by fibrocartilage).
Strong evidence that there was no decrease in knee cartilage based on radiological joint space narrowing.
This research challenges the belief that if we get our kids to exercise in school, we are increasing their risk of getting osteoarthritis.
We need to get kids moving because the benefits of doing so are much greater than just improved knee joint health.
Where to get more information: Urquhart DM, Tobing JF, Hanna FS, Berry P, Wluka AE, Ding C, Cicuttini FM. (2011). What is the effect of physical activity on the knee joint? A systematic review. Med Sci Sports Exerc. 2011 Mar;43(3):432-42.
How to Target the Gluteus Maximus Better During the Lunge
What They Looked At:
They looked to see if trunk position (upper body) had an effect on the muscles in the lower body during lunging. They got a group of 10 to perform an upright, trunk forward (hip flexion) and trunk back (hip extension) lunge.
What They Found:
Something About Gluteus Maximus – Performing the lunge with the trunk forward (hip flexion) lead to greater gluteus maximus activation.
We talked about the lunge earlier this week in this blog post, where the researchers showed that females have greater gluteus maximus activity when performing a lunge compared to men. If you need to get more muscle activation for gluteus maximus in your clients, then look at getting them to move the trunk forward.
Where to get more information: Farrokhi S, Pollard CD, Souza RB, Chen YJ, Reischl S, Powers CM. (2008). Trunk position influences the kinematics, kinetics, and muscle activity of the lead lower extremity during the forward lunge exercise. J Orthop Sports Phys Ther. 2008 Jul;38(7):403-9. Epub 2008 Apr 15.
How to Prevent Cartilage Damage and Osteoarthritis in the Knee
This was more of an opinion on preventing cartilage damage and osteoarthritis in the knee.
It does show how one injury can lead to another injury which is an important thing to remember.
They had some interesting observations:
Articular cartilage has a difficult time healing and often times progresses to osteoarthritis.
Athletes are at greater risk of getting osteoarthritis compared to the non-athlete.
Those with osteoarthritis often times report joint pain, decrease range of motion and joint stiffness.
The diagnosis of osteoarthritis is confirmed by the symptoms and the radiological findings (narrowing joint space, osteophyte formation and subchondral sclerosis).
There is no strong link between symptoms and what is found in radiographic findings. This is a common theme with most injuries.
Risk factors for osteoarthritis are excessive musculoskeletal loading (at work or in sports), obesity (based on high body mass index), previous knee injury, female gender and muscle weakness around the knee (quadriceps, hamstring).
Cartilage injuries are often seen in young to middle-aged active athletes.
Cartilage injuries often predisposes someone to osteoarthritis.
Where to get more information: Takeda H, Nakagawa T, Nakamura K, Engebretsen L. (2011). Prevention and management of knee osteoarthritis and knee cartilage injury in sports. Br J Sports Med. 2011 Feb 25. [Epub ahead of print]
Well that is it. Thanks for reading and let me know what you think by leaving a comment.
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