Clicking in the knee could be from a meniscus or for the patellofemoral (knee cap) joint
The meniscal tear is a common injury. It can affect athletes who play individuals and team sports. It’s also common in people who have jobs that require lots of squatting, such as plumbers or coal miners. Your physical therapist can help you manage the injury and, if surgery is required, can help you prepare for the procedure and recover your strength and movement afterward.
What is a Meniscal Tear?
The meniscus is a rubbery, C-shaped piece of cartilage that cushions your knee. Each of your knees has 2 menisci (plural of meniscus); one on the inner (medial) part of the knee, and the other on the outer (lateral) part. Together they act to absorb shock and stabilize the knee joint.A meniscal tear typically is caused by twisting or turning quickly on a bent knee, often with the foot planted on the ground. Although meniscal tears are common in those who play contact sports, anyone at any age can tear a meniscus. When people talk about having torn cartilage in their knee, they usually are talking about a meniscal tear.
Signs and Symptoms of a Meniscus Tear
When you tear a meniscus, you might:
- Feel a sharp, intense pain in the knee area
- Feel a “pop” or a tearing sensation
- Have difficulty walking because of pain or a “catching” sensation
- Have difficult straightening the knee
- Experience swelling within the first 24 hours of injury
How Is a Meniscus Tear Diagnosed?
Your physical therapist will:
- Conduct a thorough evaluation that includes a detailed review of your injury, your symptoms, and your health history
- Perform special tests to measure the range of motion (amount of movement) in your knee and determine which specific movements and positions increase your symptoms
- Use a series of tests that apply pressure to the meniscus to determine whether it appears to be damaged
The results of these tests may indicate the need for further diagnostic tests—such as ultrasound or magnetic resonance imaging—or a referral to an orthopedic surgeon for consultation.
How Can a Physical Therapist Help treat a Meniscus Tear?
Your doctor may diagnose a torn meniscus, but meniscal injuries can often be managed without surgery. A short course of treatment provided by a physical therapist can help determine whether your knee will recover without surgery. The physical therapist plays an important role by controlling pain and swelling and by restoring full strength and mobility to your knee.To control pain and swelling, your physical therapist may use ice and compression and will likely instruct you in the use of these treatments at home. Swelling is an important “guide” during your rehabilitation and can indicate when you are doing too much. Let your physical therapist know if you have an increase in swelling so that your program or activity level can be modified.Your physical therapist may use a treatment called neuromuscular electrical stimulation (NMES) to help improve your strength. Your therapist also will design special exercises to maintain your strength during recovery and help restore full movement to the knee. You will be given a home program of exercises that are specific to your condition.As you recover, your therapist will advise you on ways to maintain your fitness and activity level and will help you decide when you are ready to return to full activity.
If You Need Meniscus Surgery
Patients with more serious meniscal tears, or those that don’t respond to a course of physical therapy, may need surgery. Surgically removing the torn cartilage (a procedure called a menisectomy) usually is a simple procedure that requires a brief course of physical therapy treatment. Most people are able to return to their previous level of activity, including sports, in fewer than 2 months.
Following a simple menisectomy, your rehabilitation will likely be similar to that for nonsurgical injuries. Your physical therapist might use ice and compression to control pain and swelling and will show you how to use these treatments at home. Your therapist’s focus will be on helping you get back your strength and movement through special exercises performed in the clinic and at home. Generally, you will need to use crutches or a cane, but only until you can walk without pain or a limp.
Sometimes the surgeon will decide that the torn meniscus can be repaired, instead of removed. Research studies show that if a meniscal repair is possible, the long-term outcome is better than removal because the repair can reduce the risk of arthritis later in life.
Rehabilitation following a meniscal repair is slower and more extensive than with removal because the repaired tissue must be protected while it is healing. The type of surgical technique performed, the extent of your injury, and the preferences of the surgeon often determine how quickly you will be able to put weight on the leg, stop using crutches, and return to your previous activities.
After a meniscal repair, your physical therapist will help you control pain and swelling, help restore your strength, and help you regain full motion to the knee as soon as it is safe to do so. You’ll have a program of exercises to do at home, and this program will be advanced as you improve. A brace may be used to help protect the repaired meniscus during the recovery phase. These braces usually allow you to fully straighten the knee but will limit your ability to bend it all the way, in order to prevent stress to the repair.
Returning to Activity
Whether your torn meniscus recovered on its own or required surgery, your physical therapist will play an important role in helping you return to your previous activities. Your therapist will help you learn to walk without a limp and go up and down stairs with ease.
If you have a physically demanding job or lifestyle
, your therapist can help you return to these activities and improve how you do them.
If you are an athlete
, you may need a more extensive course of rehabilitation. Your therapist will help you fully restore your strength, endurance, flexibility, and coordination to help maximize your return to sports and prevent reinjury. Return to sports varies greatly from one person to the next and depends upon the extent of the injury, the specific surgical procedure, the preference of the surgeon, and the type of sport. Your therapist will consider these factors when progressing your rehabilitation program and will work closely with your surgeon to help decide when it is safe for you to return to sports and other activities.
Can a Meniscus Tear be Prevented?
There is little research at this time to support exercise or other interventions such as bracing for prevention of meniscal injuries. But we do know that you can make choices to help improve your overall fitness and help keep your knees as strong and as healthy as possible:
- Regular exercise helps strengthen the muscles that support your knees.
- Staying physically active helps prepare your body for the demands of a sport or strenuous activity.
- Although accidents are difficult to prevent, avoiding twisting or turning quickly while your foot is planted may help prevent meniscal tears.
If you already have knee problems, your physical therapist can help you develop a fitness program that takes your knees into account. Some exercises are better than others for those with a history of knee pain. Many exercises can be modified to fit your specific needs. For example, when performing exercises that include squatting, it’s important to make sure that your knee stays directly over your foot and doesn’t twist or bend excessively.
Patellofemoral pain syndrome (PFPS) is 1 of the most common types of knee pain, particularly among athletes, active teenagers, older adults, and people who do physical labor. Patellofemoral pain affects more women than men and accounts for 20%-25% of all reported knee pain.
What is Patellofemoral Pain or Anterior Knee Pain?
Patellofemoral pain syndrome refers to pain at the front of the knee, in and around the kneecap. (The kneecap, or patella, is the triangle-shaped bone at the front of the knee joint. The pain usually is accompanied by tenderness along the edges of the patella.Current research indicates that PFPS is an “overuse syndrome,” which means that it may result from repetitive or excessive use of the knee. Other contributing causes may include:
- Weakness, tightness, or stiffness in the muscles around the knee
- An abnormality in the way the lower leg lines up with the hip, knee, and foot
These conditions can interfere with the ability of the patella to glide smoothly on the femur (the bone that connects the knee to the thigh) during movement. The friction between the under-surface of the patella and the femur causes the pain and irritation commonly seen in PFPS.
PFPS often occurs in people who are physically active or who have suddenly increased their level of activity, especially when that activity involves repeated knee motion, running, stair climbing, squatting, or repeated carrying of heavy loads. If you are older, you might have age-related changes that cause the cartilage on the under-surface of the patella to wear out. The result is pain and difficulty completing even the simplest daily tasks without pain.
Usually, patellofemoral pain is worse when you walk up or down hills or stairs and on uneven surfaces. This pain tends to increase with activity and improve with rest. You also may:
- Feel pain after sitting for long periods of time with the knee bent
- Occasionally hear or feel a “cracking” or “popping” when you bend or straighten your kne
How Is Patellofemoral Knee Pain Diagnosed?
Your physical therapist will review your health history, perform a thorough examination, and conduct a series of tests to evaluate the knee. Physical therapists use tests such as the patellar apprehension test, the Q-angle test, the patella alta test, and Clarke’s sign (patellar grind test) to determine whether the patellofemoral joint is the source of pain.
In addition, your therapist may observe the alignment of your feet, analyze your walking and running patterns, and test the strength of your hip and thigh muscles to find out whether there is a weakness or imbalance that might be contributing to your pain. Finally, your therapist will check the flexibility of the muscles in your leg, paying close attention to those that attach at the knee.
Generally, x-rays are not needed to diagnose PFPS.
How Can a Physical Therapist Help Treat Patellofemoral Knee Pain or Anterior Knee Pain?
After a comprehensive evaluation, your therapist will analyze the findings and prescribe an exercise and rehabilitation program just for you. Your program may include:
- Strengthening exercises targeted at the hip (specifically the abductor and rotator muscles of the buttock and thigh), the knee (specifically the quadriceps femoris muscle, which is located on the front of your thigh and straightens your knee), and the ankle
- Stretching exercises for the muscles of the hip, knee, and ankle
- Taping of the patella to reduce pain and retrain muscles to work efficiently
- Exercises for improving your performance of activities that have become difficult for you
If the alignment and position of your foot and arch appear to be contributing to your knee pain, your physical therapist may fit you with a special shoe insert called an orthosis. The orthosis can decrease the stress to your knee caused by excessive rotation or impact during walking and running.
If your pain is persistent, your physical therapist may:
- Have you try a lightweight brace
- Use pain-reducing treatments such as electrical stimulation
- Recommend that you apply ice or heat at home for relief
Your physical therapist will work with you to help you stay active and maintain your fitness level. You may need to modify your activity level or change your training activities until you recover; your therapist will show you how to do activities and exercises that will not increase your pain. Most important, your therapist can make recommendations to help prevent PFPS from returning.
Can Patellafemoral Knee Pain be Prevented?
PFPS is much easier to treat if it is caught early. Report the first signs of knee pain to your physical therapist. Early treatment by a physical therapist may help stop the underlying problem before it gets worse. Your physical therapist also can help you adjust your daily activities and teach you exercises to do at home to strengthen your muscles and bones and help prevent PFPS from recurring.