A reader sidelined with a knee injury wonders when to get back on the road.
A forum user writes: I had a medial meniscus tear, confirmed by an MRI, about two months ago. The pain went away within a week, and the doctor said surgery wasn’t necessary. I was training for a marathon and an avid runner before the injury.
I would love to go back to running, but I’ve been experiencing mild – not painful – discomfort with certain activities, such as a hardcore spin class. I am not sure if it’s safe to try running, only two months out. I also don’t know if I’ll ever be able to run without pain, and what the possibility is of re-injuring / tearing it by running.
This is tough to answer without some of the basics of your story like your age, sex and the circumstances of your knee problem. Meniscus tears can occur with trauma, damage in sports, or wear and tear with ageing. However, I will try to answer your questions in the broad strokes.
The meniscus is a crescent-shaped piece of cartilage located inside the knee joint between the ends of the femur (the leg bone above the knee) and the tibia (the bone below). There is one on the lateral side – or outside – of the knee and another on the medial side, or inside. The medial side is most often involved in an injury my experience, and fits with your MRI finding.
The meniscus helps cushion the forces through the knee and creates a ‘cup’ for the end of the femur. It can move up to a centimetre within the knee. It tears in two main ways. A radial tear leaves a flap that often catches and clicks, and a longitudinal or circumferential tear usually occurs with the wear and tear of aging.
A radial tear can be “fixed” with surgery, and in younger people it can sometimes be fully repaired. The longitudinal tears are generally left alone, as studies have shown that surgically trimming those usually does little to improve either knee pain or function.
You should be able to return to running, but the question is when. If your knee has calmed down and you are able to perform daily activities, along with non-impact training, you are on the right track. The discomfort during spin class, however, is a bit concerning and suggests that the area is not completely healed and so not ready for the impact load of running.
A radial medial meniscus tear in an adult does not usually heal or repair itself, though the tear may thin and stop catching or irritating the cartilage on the ends of the femur and tibia. Once the pain and discomfort associated with spin class and other activities disappears, it should be safe to try running again.
While you are away from running it would be good to shore up your core and glute strength to help control your femur when you run. Weak glutes will allow the femur to rotate in while you are loading the knee during the foot strike portion of your running gait. This extra ‘wobble’ may irritate the meniscus and cause more pain for you.
While your doctor should be able to give you advice regarding your return to running, or refer you to someone who can help you with your return, a physical therapist may be able to evaluate your gait, strength, and kinetic chain motion, and get you on a return program that includes correcting any problems with your neuromuscular control.