Walking With Meniscus Tear: Tips From A Physical Therapist

What precisely is a meniscus tear?

In both your right and left knees, you have 2 menisci (so 4 menisci in total).

These are crescent-shaped pieces of cartilage.

There is one more towards the inside of the knee (medial meniscus) and one more towards the outside (lateral meniscus).

Sometimes these menisci get damaged. It’s actually quite common, as it’s the second most common knee injury (Akkawi 2021). In this case, we’re talking about a meniscal lesion.

There are 2 main types of meniscal lesions:

• traumatic lesions: resulting from a shock, a twist of the knee, a fall;
• degenerative lesions: natural wear and tear over time, especially after 40 years.

And there are different forms of lesions, including meniscus tears. This means that a part of the meniscus is torn, partially ruptured: not across its entire width.

In contrast to a total meniscus rupture, where the meniscus is torn across its entire width.

Meniscus tears can be caused by trauma or simple wear and tear.

How to know if you have a torn or ruptured meniscus?

The symptoms and signs of a meniscal tear are similar to many other knee injuries.

Symptoms

Symptoms of a meniscal tear include:

• Knee pain: inside, outside, or anywhere around the knee.
• This pain often increases when you use your knee while walking or exercising.
• Your knee is swollen, red, and warm (inflammation).
• You feel like your knee is locking or catching sometimes, especially when you bend and extend it.
• You hear crackling noises when you move your knee joint.
• You have difficulty fully bending or straightening the knee.

You may experience one or more of these symptoms. However, even if you have all of them, it’s not certain that it’s a meniscal problem.

So how do you know if it’s a meniscal tear and not something else?

The symptoms I’ve described are also present in other relatively common knee pathologies:

• Patellar syndrome,
• Iliotibial band syndrome,
• Anterior cruciate ligament rupture,
• “Knee tendonitis,”
• Femoro-tibial knee arthritis (osteoarthritis), etc.

That’s why after discussing it with your doctor, they may have prescribed an X-ray. This X-ray helps rule out some other causes.

But to see the menisci, another type of imaging is needed: MRI is the most appropriate imaging for making the diagnosis.

Source: Raj 2023

Does walking worsen the meniscal tear or the pain?

The person who diagnosed your meniscal tear may have prescribed “rest” so that the meniscus heals on its own. And that your pain and swelling (= inflammation) decrease.

Whether you have been operated on for your meniscus or have been directed towards conservative treatment (= without surgery).

But I have observed in my patients that it is not easy to know what is meant by rest.

Rest does not mean “doing nothing.” You still have the possibility to walk (even without crutches) by leaning on the leg where you have a meniscal tear.

This will not worsen the tear.

You need to find the right balance of physical activity. For example, it is not the time to start running or Nordic walking if you have never done it before.

But if you are used to walking several times a week, you are not necessarily obliged to completely stop your walking sessions. You need to find a frequency, duration, and intensity that allows you to relieve pain.

Some people manage it on their own, and that’s great! Others seek advice from their physiotherapist or another professional.

Also, know that muscle strengthening exercises are the recommended first-line treatment for a meniscal tear by some research teams.

It is not certain that this significantly improves the problem compared to doing nothing, but it has been observed that 3 sessions per week for 10 weeks of quadriceps strengthening (the thigh muscle) did not worsen the tear or the symptoms (Luvsannyam 2022).

It is therefore reasonable to think that walking (which is less demanding for the meniscus than quadriceps strengthening) does not worsen a meniscal tear. Whether you have been operated on or not!

Why doesn’t walking aggravate the meniscal tear?

When you walk, your body weight is distributed over the various elements of the knee. But not everything is on the meniscus: other structures are there too!

Walking generally does not involve sudden movements or excessive stress on the knee joint. And therefore, not on the meniscus either!

How to walk with a meniscal tear?

There is no need to modify your way of walking when you have a meniscal tear. There is no “right” way of walking that would limit stress on the meniscus.

If you are too bothered by pain when walking, you can of course use crutches or other walking aids. This will allow you to put less weight on the damaged knee, and therefore likely experience less pain.

The only thing you may need to adjust is the intensity and amount of walking you do. You may need to reduce it a bit, but without stopping altogether!

Can you live a long time without problems with a meniscal tear?

Of course! Meniscal injuries such as tears are very common (even if we hear little about them).

Among those over 40, 28% of people who undergo knee MRI have a meniscal tear (Kaneko 2020)! That’s almost 1 in 3 people.

So yes, you can certainly live a long time without problems with a meniscal tear. In fact, in some people, it is said that this tear is asymptomatic: it is seen on MRI but the person has no pain or discomfort!

Can a meniscal tear heal on its own?

Yes, here’s the good news: many people no longer experience discomfort or pain without undergoing surgery to repair the meniscus.

Here are the 4 types of treatments proposed in case of a meniscal tear, from most frequent to least frequent:

1. Conservative treatment: you simply adjust your level of physical activity to relieve symptoms for a few weeks. You may also implement specific non-drug or drug treatments to relieve pain if necessary.
2. Meniscal repair via knee arthroscopy (or reconstruction): success rate of over 90% in a two-year follow-up, long-term failure rates between 23% and 30%.
3. Partial meniscectomy via arthroscopy: only the damaged, irreparable part of the meniscus is removed. The effectiveness is not superior to that of a placebo surgery.
4. Total meniscectomy: the entire meniscus is removed. This procedure is becoming less common because it has been found to increase the risk of knee osteoarthritis.

Source: Luvsanyaam 2022

Meniscal tears can be classified according to their anatomical zone:

• Red zone, vascularized: blood can bring necessary elements here for healing, allowing the torn area to repair naturally.
• White zone (avascular): this zone is less rich in blood vessels, so healing may be more difficult.

Tears in the red zone may have a better chance of spontaneous healing, “without doing anything”: the damaged meniscus tissue repairs itself thanks to the blood that comes into the area and brings substances that allow tissue to heal.

In the case of a tear in the white zone, spontaneous healing is more difficult. However, it is still possible over time to no longer experience pain and discomfort, even with an “imperfect” meniscus, without surgical intervention.

Can you exercise and run with a meniscal tear?

Running places more stress on the knee (and therefore the meniscus). That’s why sometimes running is “forbidden” for people with a meniscal injury (tear or otherwise).

However, there are also people who practice running without any particular problem and who unknowingly have a meniscal tear (which is discovered one day “by chance” during an MRI of the knee for another issue).

That’s why in my approach, running is not necessarily absolutely contraindicated. It’s up to you to weigh the pros and cons.

And perhaps reintroduce running in a more gradual and gentle manner. For example, by limiting running sessions on very unstable terrain that place even more stress on the meniscus: downhill forest runs, trail running outings.

The same reasoning applies to sports that place a lot of stress on the knee, especially in flexion and torsion: football, combat sports, lower limb strength training with load-bearing, etc.

Again, physiotherapists are among the professionals who can help you resume running with or after a meniscal tear, if you feel the need for supervision.