Meniscal tears and physical therapy

May 11, 2015 6:48 AM

Asking for my SO: Our patient in question has had knee pain on and off (mostly on) for 4 months that has recently been diagnosed as a meniscal tear. Doctor is recommending surgery; however there are several studies that indicate that physical therapy can work as well as surgery in many cases. If you have tried physical therapy for a torn meniscus, how did it work out?

YANAD, YANMD, YANHD. Looking for anecdata. Studies are welcome but the patient has already read many of them.

posted by under_petticoat_rule to Health & Fitness (6 answers total)

Best answer: Meniscal tear about a year and a half ago (think it had been torn (or starting to tear) for a while, I ran to catch a train and found myself on the ground in extreme pain). My knee guy said unless it was locking up and/or I was totally immobilized they try to avoid surgery, so I got a cortisone shot and 8 weeks of PT. The PT helped, but I'd say the cortisone shot made a much bigger and almost instantaneous difference that hasn't dissipated. I walk without any discomfort, ride my bike pretty hard, but in terms of impact if I jog at anything more than a very light pace for longer than a few moments I'll feel the knee stiffen (though pain remains minimal - I'm also overweight, so I'm sure that makes a difference) - I don't think you'd have anything to lose by trying PT first (my doctor also indicated I couldn't make anything "worse" by avoiding surgery, though that may have been related to the direction of my tear; I seem to remember one direction being worse than the other?)
posted by jalexei at 7:09 AM on May 11, 2015 [1 favorite]

Best answer: Depending on your insurance, "failing" physical therapy may actually be required in order to get approval for the surgery; that was the case for me. (My knee issue was initially diagnosed as a meniscal tear, but was actually a different problem that they fixed once they did the surgery. I failed PT, but I also didn't actually have a tear, so take that part of my experience with a grain of salt.)

If I had to do it over again, I would 100% start at PT before going into surgery, even if it wasn't required for insurance approval. The PT helped strengthen the muscles around the joint before I went into surgery, and taught me strategies to help keep the muscles around the joint strong after surgery. In my case PT didn't "fix" my issue, but in spite of that the PT was well worth it and I'd do it again (and I'd push harder to add post-surgery PT as well).
posted by pie ninja at 8:35 AM on May 11, 2015 [2 favorites]

Best answer: For my particular meniscal tear, PT was the orthopedist's first line of treatment (and eventually the only line). It was very successful for me, although the prescription for PT was extended … twice? (It's been a few years.) My problems were exacerbated by unusual muscle engagement (or unusual lack thereof) that allowed my kneecaps to move around more than they should and cause other inflammation. The PT strengthened the muscles that weren't engaging and did a bit of re-training to take load off the meniscus, and it totally worked for me.

But it also will depend on the nature of your patient's particular tear. Insurance companies are professional second-guessers, and as such I suspect an orthopedist would recommend surgery without PT only in an extreme case. Diagnosis -> PT -> lack of improvement -> surgery seems to be the normal order of operation, but I guess it depends on if the tear is minor or severe.
posted by fedward at 8:57 AM on May 11, 2015 [2 favorites]

Best answer: I tore my meniscus last May and went to a doctor about it. They gave me the options of surgery or PT. I met with the physical therapist once and he taught me a collection of exercises to do daily. I was back wearing heels about 5 months later, walking and doing low impact activities about 9 months later and I just started running again about a month ago. I'm glad I didn't choose surgery.
posted by chatongriffes at 11:06 AM on May 11, 2015 [1 favorite]

Best answer: I had a tear. The symptom was that at a particular point in my range of movement, my knee hurt like a bastard and couldn't bear weight. I saw the scans and it was a complex beast of a tear.

Had physiotherapy and anti inflammatories. Over months, almost a year, it did not get better. Had surgery. Worked so well that five years or so later, I have to check for the almost invisible scars to remind myself which knee it was.

So score one for surgery. In my case at least, it was very straightforward, done by a specialist who has probably done hundreds. After about six weeks of progressively adding more load and doing exercises, I was back to normal.
posted by i_am_joe's_spleen at 12:55 PM on May 11, 2015 [2 favorites]

Response by poster: Thank you for all the answers. An MRI revealed that it is not actually a meniscal tear.
posted by under_petticoat_rule at 7:25 PM on May 11, 2015