Knee Pain Meniscus Tear Treatment and Prevention

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Meniscus tear nemesis, now that may sound a little dramatic.  To some runners if not all, however, knee pain is considered just that. An enemy or a foe, the pain is an injury that can cause major problems in a jogger or runner’s life, for that matter anyone.  The knee is one of the most vulnerable parts of the body and most commonly injured.  Regular doctor visits and emergency room situation statistics attests to this fact.

Like all parts of the body, the knees have their unique function.  Let’s apply a simile or comparison to understand their significance.  A hinge or connector allows the door to move.  Without the hinge, the door is useless you can say.   Well that is what the knees are to the body; hinge joints or connectors that allow mobility. The knee is responsible for angular movement (flexion) and extension of the leg and is the human body’s largest hinge joint.

Compare the knee also to an intersection in which components come together. Your thighbone (femur), shinbone (tibia), and knee cap (patella) all come together at the knee joint and thereby forms the leg.  Other parts of the knee’s complex anatomy are tendons, ligaments, bursa sacs as well as the articular and meniscus cartilage.  The bursa sacs are small fluid filled sacs that cushion the bones and tendons/ligaments/muscles so as not to cause friction. They aid mobility as well.

At some point you will likely experience knee joint pain.   Slight or severe, chronic or temporary knee pain can limit daily activity.   Whatever the case, you should not ignore it.  Let’s take an in-depth look.

What is a Meniscus Tear?

Knee pain is a type of knee injury and as mentioned a very common one.  It is among a varied list of common injuries to the knee caused by high energy trauma from sports-related activities, falls, and motor vehicle crashes.   Runner’s knee is a type of knee pain experienced not just by runners but those who do a lot of walking, bending, and jumping.    It is a pain or ache around the knee cap and is the result of having several kinds of knee problems Patella femoral pain syndrome is the medical term for runner’s knee.  The symptoms and causes of knee pain can help us further deduce what it is exactly.

Symptoms

Symptoms are determined best by a physical examination.  Symptoms primarily depend upon location and severity with swelling, stiffness, and heat sensation with redness of knee in and around the knee as the most noticeable.   Other symptoms include weakness, inability to extend, bend or flex the knee, and unusual sounds (popping, grinding, crunching, etc.).

When do you need to see a doctor?  When there is:

  • Noticeable deformity
  • Significant swelling and redness
  • Body temperature increase (fever) in and around the knee
  • Knee gives out or feels like it is going to give out

All pain initially is the body’s healing response which comes in the form of inflammation.  Prolonged inflammation can lead to something else.  Use proper judgment.  Even if the pain symptom is slight and you feel you should go to the doctor, go.   Better safe than sorry.

Causes

Jogging or running for a long period of time will certainly make you susceptible to knee pain.    Improper footwear and continuous contact with hard surfaces contribute as well.   The main causes however are from injury and disease. The injuries are due to damage or trauma to the bones and knee ligaments. Injuries can be categorized as follows:

  • Fractures –Susceptible to the patella, but can occur in various parts of the femur and tibia as well
  • Dislocation (Patella Dislocation, e.g.) – Partial or complete out of alignment of the bones in the knee takes place due to bone structure abnormalities.
  • Anterior Cruciate Ligament (ACL) Injuries – Ligament tears due to incorrect landing and jumping, changing directions quickly.
  • Posterior Cruciate Ligament (PCL) Injuries –Injured or torn ligaments from frontal blows to the knee, while in a bent position. Positioning makes tear partial and healing process more rapid.
  • Collateral and Lateral Ligament Injuries – Ligament tearing due to rapid and sudden pushing of the knee sideways. Lateral injuries are blows from the back causing the knee to be pushed outward.
  • – Tearing of the meniscus cartilage due to sudden twisting.  Located between the thighbone and shinbone. Two wedge-shaped, the meniscus cartilage serves as a cushion and shock absorber.

You may have experience some or all of these if you have participated in contact sports like football or hockey.  Running is a kind of contact sport in which the impact is with the ground. The lower body (legs, knees, and feet) are constantly pounding the ground.  ACL, PCL, and CLI injuries would be less of a risk for runners.  Knee pain from fractures, dislocations and tears of the meniscus is more applicable due to falls and certain disease propensity.

Diseases that are a contributing factor are tendinitis, bursitis, arthritis and its different types -osteoarthritis (age-related, degenerative), rheumatoid (inflamed and thickened joints) and post traumatic (serious knee injuries like fractures, etc.). Inflammation in the bursa sacs causes knee bursitis and in the tendons patellar tendinitis develops.  Less familiar or well known, to some, are:

  • Knee effusion – swelling due to excessive synovial fluid in and around the knee joint (a.ka. water on the knee)
  • Baker’s cysts – cysts sacs in the back of the knee caused by excessive fluid development
  • Osgood-schlatter – inflammation in the knee cap (common adolescent disease)
  • Plica syndrome – irritation in the synovial (plica) membrane of knee joint
  • Osteochondritis dissecans – bone degeneration beneath the cartilage caused by blood flow disruption

Hip and foot problems or pain can be the root as well.  Altering your gait to alleviate the pain can cause stress and eventual pain in the knee.  Floating cartilage due to bone breakage (loose bodies) in the joint space is another.  These are referred to as mechanical problems because they pertain to mobility.

Risk Factors

Risk factors pretty much boil down to some common characteristics or denominators:

  • Age
  • Gender
  • Weight
  • Family history

As we age, our body undergoes many changes.  There are the aches and pains, the soreness.   For the knee there is cartilage degeneration, ligament muscle changes (less elasticity, flexibility), and decreased bone density.   These changes begin at age 50 and up.

Gender makes a difference.  Women are more prone to certain ailments and injuries due to body structure.  Responses are different even to treatment.  Excessive weight takes a toll on the knees.  Excessive pressure causes wear, tear and plenty of pain.    Although you don’t want to be ruled by your genetics (family history), the reality is it has to be taken into consideration. These hereditary characteristics that put you at high risk for diseases like arthritis and osteoarthritis.  They also are determined by lifestyle.

Diagnosis

Knee pain can be temporary.  Chronic pain indicates a problem, possibly the onset of disease like osteoarthritis of the knee.  Either way, diagnosis is necessary.  Prevention, cure, and management are possible with the aid of the following diagnostic image tests.

  • X-ray: Detects fractures, joint degeneration. Use of iodine or barium provides greater imagery.
  • Bone Density Test: Measures calcium and minerals in the bones which indicates density or strength. Determines risk of fractures and osteoporosis.
  • Computerized Tomography (CT) Scan: Fractures, other bone problems, loose bodies.  X-rays different angles of the body through cross sectional imaging.
  • Ultrasound: Soft tissue problems and diagnosis via sound wave imaging in real time.
  • Magnetic Resonance Imaging (MRI): Soft tissue (ligaments, tendons, cartilage, muscles) diagnosis via 3-imaging through radio waves and magnets.
  • Anthroscopy: Joints examined with a small fiberoptic camera. Incision is made in the knee.  Special fluid injected for camera to visualize part. Procedure also a form of invasive surgery in which minor problems can be repaired immediately.

Lab work is useful also.  Calcium, vitamin D, and serum alkaline phosphatase (SAP) levels can be checked during routine blood work.  Tissue removal from the knee joint through biopsies and arthrocentsis is a form of diagnosis.  Urine analysis detects bone markers which diagnoses absorption.

Treatment

It is a matter of opinion or what you feel is best for you.  There is traditional (conventional, Western medical treatment) and nontraditional treatment. Choice of treatment depends upon the situation or level of injury.   A wide range of traditional options exists that include medication, injections, and of course surgery.  You have aspirin and other over-the-counter (OTC) pain relievers.  There are nonsteroidal anti-inflammatory drugs (NSAIDs) like diclofenac, ibuprofen, indometacin, and naproxen.  Pain relievers like Panadol and Tylenol or acetaminophens are mild and reduce fever as well.

Acid injections like corticosteroid and hyaluronic to the affected area can provide immediate relief.  Surgery is the last resort when the situation is severe and debilitating.  A less-invasive procedure is an osteotomy which reduces or removes problematic bones (spurs, etc.).  Bone fusion or arthrodesis is an option.  Prior or after these treatments/procedures you can wear a knee brace for support and healing.

Replacing the knee with an artificial joint is last the resort.  The surgical procedure is an arthoplasty, commonly known as knee replacement or total knee replacement.  Introduced in 1968, the procedure has improved with a high success rate due to advanced surgical materials and techniques.   Primary candidates are persons between the ages of 50-80.  Severity of injuries and individual case needs, despite age, makes it open to people of all ages.  It is a four step procedure which entails:

  1. Bone preparation – removal of damaged cartilage and bones from the femur and tibia
  2. Metal implant(s) positioning – metal components cemented (press-fit) in place of damaged cartilage
  3. Patella (knee cap) Resurfacing – cutting the patella and resurfacing it with a plastic button, optional procedure
  4. Spacer Insertion – placed between metal components for a smooth surface (gliding mobility

Medical or conventional options have their level of risk.  For this reason nontraditional treatment has become a popular as a course of action.  These options are also known as alternative (use instead of) and complimentary/integrative (used along with which conventional therapies). They are:

  • Physical Therapies: Acupuncture, acupressure (Japanese massage), and reflexology. Injuries cause energy imbalance and lack of blood flow in the body.  These therapies restore balance via muscle and joint manipulation.  Water or aquatic therapy is an option also.  Water’s buoyancy, especially in heated pools, has less stress impact on the inflamed joints and bones. Jet pools enhance water exercises. The recovery process using aquatic therapy is slow; however, water resistance improves strength and mobility.

  • Hot and Cold Therapy: Applying hot or cold compresses, heat, and ice to relax the muscles, reduce pain and swelling. There is an art to it – heat relaxes while cold reduces pain and swelling.

  • Dietary Supplements: Glucosamine and chondroitin are by products of shellfish and shark cartilage. Views on effectiveness are mixed. Expensive, tablets have become popular pain reliever for osteoarthritis sufferers.   Chondroitin is also lab made and combined with mineral salt. There is the organic sulfur-containing compound MSM (methylsulfo-nylmethane) or the “miracle supplement.”  Effective because it is biologically active sulfur which can act as a pain reliever, tissue restorer, and immune booster.
  • Herbal Supplements: Willow bark, ginger, cinnamon, and arnica are anti inflammatory and pain relieving herbs. They can be taken in capsule, tablet, liquid, or powder form.  All are natural with low toxicity and very little side effects, with the exception of arnica.  Best used in a highly diluted homeopathic or skin salve/ointment form, due to high toxicity and liver damage capacities.   Less toxic homeopathic supplements are Causticum, Calcarea Fluorica (Calc-f), and Rhus-t. Herbal ointments or salves made with ginger, cinnamon, mastic, and sesame oil is a popular pain relieving remedy.

Immediate treatment for knee pain can be summed up with the popular acronym RICE – rest, ice, compression and elevation.  Believe or not, despite the pain, if you have your mobility then exercise helps with low impact exercises like swimming and jogging.   Less activity weakens the knees. Aforementioned aquatic therapy is considered low impact and includes jogging and aerobics in the water.    Suggested exercises that you can do at home or in the gym:

  • Straight Leg Raises – strengthens quadriceps and knee muscles
  • Hamstring Curls – good for back thigh muscles, add weights to increase resistance
  • Prone Straight Leg Raises – tightens hamstring muscles
  • Wall Squats – advanced exercise for knee strengthening
  • Calf Raises – overall leg strengthener
  • Step-Ups – up and down movement improves bending agility
  • Side Leg Raises – angular flexibility and toning
  • Leg Presses – pushing resistance builds strength and agility

Let’s not forget stretching.  Stretching improves flexibility or elasticity of the muscles.  Other benefits:

  • Enhances physical fitness
  • Increases mobility
  • Reduces muscular soreness, tightness, and risk of injury
  • Relaxes the body and mind

Common stretches good for the body and the knee are the lunging hip flexor, figure four, standing hamstring, and the calf stretch.   Try these also to reduce knee and hip tension and loosen up the quads and abductors.

Kneeling Quad Stretch

  1. Kneel on one knee.
  2. Place opposite foot in front of you. Make sure it is flat.
  3. Grab your back foot and pull towards buttocks.
  4. Switch sides and repeat, 3 or 4 times

Quad Stretch

  1. Lie on your side, lifting up on your elbow with bottom leg stretched out
  2. Bend knee of top leg.
  3. Grab top foot with your hand, pulling toward your buttocks.
  4. Keep your hips stable so as not to rock while pulling
  5. Switch sides and repeat, 2 or 3 times.

Side Lunge

  1. Stretch or lunge out to one side with one knee bent and the opposite leg straight.
  2. Make sure feet are flat as possible.
  3. Place your fingertips on the floor for balance.
  4. Switch sides and repeat, 2 or 3 times.

Prevention

Cure is better than treatment but prevention is exceedingly better than cure for any type of injury or malady.   Nutrition, weight management, and exercise can be a part of the treatment process but are even better in preventive measures.   Conclusive studies have shown that prevalent chronic diseases (cancer, diabetes, possibly, Alzheimer’s, arthritis, etc.) can be drastically alleviated with proper nutrition/healthy dietary and holistic lifestyle (mental, spiritual, etc.) changes.

Nutrition comes from the food we eat which provides nourishment and energy.  The main nutrients are protein, carbohydrates, fat, fibers, vitamins and minerals, and water.  Foods that are good for knee health are cruciferous vegetables like broccoli, Brussels sprouts and cabbage.  Fruits high in vitamin C like strawberries, tart cherries, blueberries, red raspberries, and watermelon.

Whether you consider it a fruit or a vegetable, avocados are a good source of carotenoid lutein and vitamin E, anti-inflammatory agents.  Foods rich in vitamin K, C, and D build and strengthen the bones and muscles.  Of course the vital mineral calcium is needed.  It is most effective when combined with the mineral, magnesium along with Vitamins D and K – a synergistic relationship.   You have dairy products high in these minerals and vitamins as well green leafy vegetables. Garlic, onions, and leeks limit cartilage-damaging enzymes and are anti-inflammatory.

Resolvins and protectins are anti-inflammatory molecules found in Omega – 3 fatty acids, a known combatant against osteoarthritis.  Omega-3 enriched foods include fish, fish oils, soy bean oil, safflower, and cold pressed oils like olive oil, avocado, walnut, and flax seed.  Avocado Soybean Unsaponifiables (ASU) is a natural oil supplement or vegetable abstract containing one-third avocado oil and two-thirds soybean oil.  It slows osteoarthritis progression and is anti-inflammatory.

Beans (red, kidney and pinto) and whole grains like brown rice, oat meal, and whole-grain cereals (barley, millet, and quinoa) are good because they lower C-reactive protein (CRP) levels in the blood.  High levels of CRP cause inflammation.  Incorporate nuts (almonds, walnuts, pine nuts, pistachios) and green tea in the anti-osteoarthritis dietary regimen as well.

Weight management is vital.   Most of us associate weight management with losing weight or dieting.    It’s really about acquiring a healthy lifestyle, balancing a healthy diet with exercise. Bombarding your mind with the weight on the scale isn’t going to help much.  Excessive stress on the knees from being overweight causes pain.  Not getting enough nutrients from being underweight is not good for knee strength either.  Overweight or underweight, you are still at risk. A healthy body weight is determined by body mass index (BMI) and waist size.   Once you know your body weight, you are on your way.

The exercises, talked about in the treatment section, are of course preventive.   We mentioned traditional and nontraditional treatment approaches with nontraditional based on Eastern medicine (Chinese, etc.).    Well there is the Chinese movement art called Tai Chi.   The meditative, flowing movements tones the muscles and joints, improves alignment and body awareness.  Friction is used to stimulate circulation, blood and energy flow.   Movement stimulates cellular turnover and nutrition absorption. Let’s take a look at a technique.

Friction Technique to the Patella

  1. Sit in a chair and stretch out leg.
  2. Take the edges of your hand and cup around both sides of the knee.
  3. Move hands up and down vigorously rubbing around the knee cap/patella. Applying friction.
  4. Lock your knee.
  5. Grab with one hand (cupped) the patella and shake; back and forth, up and down. Continuing to apply friction.
  6. Apply friction to the outside and on top of the knee also.
  7. Gently bend knee afterwards.
  8. Knee can be elevated as well (small stool, bed, etc.)
  9. Avoid leaning your back as much as possible.

The goal is not to loosen the knee but to relieve stiffness and pain.  Tai Chai does not encourage rotation movements for the knee.   Hips and ankles are meant to rotate, not the knee.   Recall the knee joint/door simile?  Hinges don’t rotate.  When the hinges are out of order, you have to apply some lubricant or oil.  Friction is like the oil needed for the knee joint hinge.

Remember also the hold and cold theory.  If the knee is swollen then reduce the swelling/ inflammation with ice before applying the technique.   If you are outside and not able to sit down then you can stand and do the technique.  You can lean, but make sure your knee is locked.

False Positives

False positives or wrong diagnosis can occur with knee pain.  It depends on the type of injury but appears to be most applicable regarding MRI diagnosis of meniscus and ACL tears.   Most importantly, there are concerns regarding accuracy as the sole determinant for a type of treatment, especially surgery.   MRI’s can diagnose a tear that actually is not present. For more accuracy, they should be conducted six weeks after onset of pain because healing can take place naturally over a period time without surgery.   It boils down to a “vs.” paradigm, diagnostic findings versus clinical findings.   Clinical findings are based on symptoms and physical examination of the patient.   If you have questions about the diagnosis, especially pertaining to surgery recommendations, then by all means get a second opinion.

Conclusion

A runner or not, you are going to experience knee pain at some point.  When it happens monitor it.  See a doctor at the onset if you feel you need to.    If it can be relieved with hot and cold therapy or some of the aforementioned natural/non invasive treatments and preventive measures then go that route prior to a doctor’s visit.   Should pain persist then by all means get it diagnosed and even with that, combine it with the proper clinical diagnosis.     Just remember the options are limitless due to the vast amount of technology and information available.  Cure the pain but most importantly try to prevent it.   Whichever the case, don’t let knee pain stop you.   Happy running life!

Sources and Disclaimer

In addition to the linked sources, below you will find the additional sources used for the health claims made in this article below.  They were compiled from online posts and scientific studies published by medical professionals and websites.  Although the research can be substantiated, the main purpose is only to inform. This article is not intended as a sole source of medical advice.   Please seek medial consultation for a proper diagnosis.

Sources

  1. Payal Kohli and Bruce D Levy, Resolvins and protectins: mediating solutions to inflammation, Article, Jun 12, 2017
  2. Donald C. Pompan. , Reassessing the Role of MRI in the Evaluation of Knee Pain, Article, Jun 12, 2017
  3. Staff Writer, Avocado Soybean Unsaponifiables (ASU), Arthritis.org, Jun 12, 2017
  4. Staff Writer, 12 Best Foods For Arthritis, Arthritis.org, Jun 12, 2017
  5. Staff Writer, Natural Home Remedies for Knee Pain, Article, Jun 11, 2017
  6. Staff Writer, Glucosamine and Chondroitin - Topic Overview, Article, Jun 11, 2017
  7. Ryan, Andrews, Nutrition for bone health: Calcium, vitamin D, and other strategies to prevent osteoporosis, Precision Nutrition, Jun 11, 2017
  8. Staff Writer, 8 Knee Exercises to Help Prevent More Injuries, Article, Jun 11, 2017
  9. Staff Writer, Complementary, Alternative, or Integrative Health: What’s In a Name?, 9. National Center for Complimentary and Integrative Health, Jun 11, 2017
  10. Mayo Clinic Staff, Knee Pain Diagnosis and Treatment, Mayo Clinic, Jun 11, 2017
  11. John Miller, What is Meniscus?, Physio Works Online Medical Database, Jun 11, 2017
  12. 13. S Gupta, R Sharma, A Sachar, Y Saini, N Saini. , Comparison Of Clinical Examination, MRI And Arthroscopy In Knee Injuries., Article, Jun 11, 2017