Medial Meniscus Rehab

Below is an example of a rehabilitation program suitable for both conservative treatment and following surgery for a partial removal of the meniscus.

Knee rehabilitationThe following is for information purposes only. We recommend seeking professional advice before beginning rehabilitation. The cartilage meniscus rehabilitation program is split into 4 phases with a guide to when these phases should begin although timescales following injury may vary as each injury and patient will be different.

Phase 1

Duration: 0 to 1 week post injury

Cold knee wrapThe aim of the first phase is to reduce swelling, maintain the ability to straighten the knee and be able to bend the knee to just over 90 degrees.

Treatment

Ice or cold therapy can be applied for 15 minutes every couple of hours if possible to reduce swelling. Do no apply ice directly to the skin but use a wet tea towel or specialist cold therapy knee wrap which can provide both cold and compression to help reduce pain and swelling.

A compression bandage or knee support worn all the time can also help reduce swelling. In the first 24 to 48 hours when complete rest is advised a simple elastic knee sleeve is fine. Later as the athlete starts to walk then most physiotherapists will recommend a hinged knee brace or at least a strong stabilizing brace to protect the medial knee ligament and cartilage.

A physiotherapist or similar may use electrotherapy including ultrasound and tens to help disperse swelling and ease pain.

Exercises

Heel slidesSimple range of motion can begin within the limits of pain. Knee flexion and extension with the aim of maintaining range of motion to the injured knee. Isometric or static quadriceps exercises can begin. Double leg calf raises, hip abduction and extension and resistance band hamstring exercises can also be done on a daily basis. If pain allows use an exercise cycle to maintain aerobic fitness. Aim to walk normally with full weight bearing on the injured leg.

Phase 2

Duration: Between 1 and 2 weeks post injury

Ultrasound on the kneeThe aim of phase 2 is eliminate swelling on the knee and achieve full, normal range of motion in the joint.

Treatment

Continue with cold therapy applying ice 2 or 3 times a day. Wear a knee support to protect the joint and help reduce swelling. Your therapist may continue with electrotherapy with ultrasound applied around the joint to help eliminate any swelling still present.

Exercises

Squat exercisesContinue with flexion and extension knee range of motion exercises to regain full range of motion in the joint. Isometric quadriceps contractions can continue. Begin to do squats and lunges but only very shallow if pain allows. One quarter normal depth is sufficient to start with. Leg press machine exercises can begin with both legs initially moving onto single leg exercises.

Other exercises which can begin include step ups, hip bridges, hip abduction and extension with resistance bands, single leg calf raises and wobble balance board drills. Continue with exercise cycling if it is not painful, walking normally without a limp and if possible light swimming but only very gently with the leg kick.

Phase 3

Duration: Between 2 and 3 weeks post injury

The aim of phase 3 of a meniscus tear rehabilitation program is to ensure full range of movement in the knee, regain normal strength with the ability to perform a full squat and start to return to running and normal training.

Treatment

Treatment at this stage should be minimal. There should be no need to apply ice or wear a compression bandage for swelling. Some athletes may feel more secure wearing a stabilizing or hinged knee brace to protect the joint when exercising. Sports massage to the muscles surrounding the knee may help with rehabilitation.

Exercises

Exercises should be similar to phase 2 but increasing the number of repetitions, sets and load. Shallow squats and lunges, step ups, bridges, hip abduction, hip adduction, single leg calf raises and balance exercises should all be incorporated into the exercise plan and performed daily.

The athlete should be capable of running, swimming, road cycling and begin to perform more sports specific exercises which involve changing direction, backwards running, jumping, hopping and kicking. It is probably better at this stage to do cross train using a mix of activities to get maximum aerobic benefit without over loading the cartilage in the joint.

Phase 4

Duration: Between 3 and 5 weeks post injury

The aim of phase 4 is to ensure full strength, range of movement and muscle endurance returning to sports training and limited matchplay or competition.

Treatment

Treatment again will be minimal. There should be no requirement for cold therapy or compression. The athlete should aim to train without the use of a knee support.

Exercises

By now the athlete should be returning to normal sports specific training. Start doing part of the training session and gradually build up to completing full sports specific training sessions. When returning to match play this should be restricted to start with for example playing 20 mins of a soccer match first to see if there is any reaction afterwards or the following day before building up to full match play. Be aware that the aim is not to get back playing your first game or competition as soon as possible but the second and third.