Meniscus Tears in Runners
Updated: Nov 10, 2022
When most people think of a meniscus tear, they picture the very sudden or acute onset from a sharp pivot on the soccer field or a misstep on the trail. However, meniscus tears can also be degenerative in nature. Degenerative meniscus tears are what we most often see in runners, as there is a high demand on the meniscus for shock absorption and stabilization in the knee over long hours of time on feet.
It is worth noting that if you took an MRI of anyone's knee over 40 (maybe even much earlier) you would likely find some kind of degeneration or wear and tear. These findings DO NOT always correlate with pain, and are just a normal part of the aging process. Sometimes runners with knee pain will jump the gun to get an MRI, find a meniscus tear, and feel the need to get surgery to fix it when in fact the meniscus tear might not even be the current pain generator and likely existed long before the pain started.
In other cases, symptomatology makes it fairly obvious that a degenerative meniscus tear is present and is also causing the symptoms. Symptoms of a meniscus tear include: Popping and locking of the knee joint, marked swelling around the knee, tenderness to touch at the joint line, difficulty fully extending or flexing the knee, and weakness in the affected leg especially going up and down stairs. There may be no acute moment that the runner feels a tear occur, usually there is a short timeline of a few runs that really started to flare up symptoms of what may be a previously existing degenerative tear. Perhaps a week of more increased demands on speed work, higher mileage, extra trail work, or all of the above mixed in with a new pair of extra bouncy (or carbon plated) shoes that your body hasn't adapted to.
Many runners who present with these more severe symptoms associated with a meniscus tear become fearful of the healing time and often want to jump right to surgery thinking it will jump start the healing process and fix the problem immediately. However, the research says otherwise.
The meniscus itself carries no innervation and is likely not the cause of the pain unless it has been displaced and is catching in the knee. The marked swelling and inflammation in the knee joint around the tear is generally what causes such intense pain and lack of mobility. This inflammation can take 6-12 weeks or more to settle down, especially if you have a job or daily activities in which you have to be moving around or on your feet a lot.
Even so, the research shows that in most cases, physical therapy outperformed surgery in both short and long term outcomes of pain and function from a degenerative meniscus tear. Having a part of the meniscus removed in surgery can lead to longer term issues such as a greater risk for osteoarthritis down the line. The inflammation from the surgery itself can also extend the recovery and time off of running.
If you are experiencing general knee pain due to a meniscus tear, avoiding banked streets or trails as well as wearing a compression sleeve can be very helpful during periods of flare ups. If you are currently experiencing pain with a meniscus tear and unable to run at all, having patience and trust in the process is the best (and hardest) place to begin. Strength training and physical therapy is warranted in both cases, and is a great place to pour your energy into while unable to run.
When you have put in a good trial of 6-8 weeks of rest and conservative care and are still experiencing pain, swelling, and inability to run or walk up and down stairs comfortably, then it is likely time to consult an orthopedic surgeon to see if they feel surgery would be beneficial for the type of tear you present with. It is also important to note that in the unlikely event that you do end up needing surgery, your time on PT was not at all wasted. Strengthening and rehabbing your injury prior to a surgery can help with recovery time post surgically as well since you've already built a great base of strength!
Below are some linked research articles if you’d like to dive deeper!