What Is A Meniscus Tear? A Physical Therapist’s Guide To Healing
Knee pain can stop you in your tracks, whether it’s from sports, an awkward twist, or simply wear and tear over time. One of the most common knee injuries I see as a physical therapist is a meniscus tear. If you’ve been told you have one or suspect you have one, you might be wondering what it means, how serious it is, and what you can do about it.
This article breaks it all down in simple terms by a Doctor of Physical Therapy. We’ll cover what the meniscus is, what a tear involves, how it’s diagnosed, what causes it, signs and symptoms to watch for, and the most effective treatment options. I’ll also share a section where I’ll include my go-to exercises for meniscus rehab.
What Is the Meniscus?
Think of your knee like a hinge made of bones, ligaments, cartilage, and soft tissue that all work together to keep you moving. Inside your knee are two C-shaped pieces of cartilage called the menisci (one on the inner side of the leg called the medial meniscus and one on the outer side called the lateral meniscus).
These structures act like shock absorbers between your thigh bone (femur) and shin bone (tibia). They also:
Improve joint stability.
Distribute weight and forces evenly through the knee.
Protect the articular cartilage (the smooth surface covering the bones).
Without them, your knee would have a lot more wear and tear, making it more prone to arthritis and injury.
What Is a Meniscus Tear?
A meniscus tear is a rip in that C-shaped cartilage. Tears can vary in size, shape, and severity, and they’re classified based on their pattern (e.g., horizontal, vertical, radial, flap, or bucket-handle tear). Some tears are small and may heal on their own, especially if they are on the outer “red zone” of the meniscus, while larger ones can cause catching or locking of the knee.
The Red and White Zones of the Meniscus
The meniscus doesn’t have the same blood supply throughout, which plays a huge role in how well it can heal after an injury.
The “Red Zone”: This is the outer edge of the meniscus, which is vascularized (has a blood supply).
It makes up only 10–25% of the lateral meniscus and 10–30% of the medial meniscus.
Because it gets blood flow, tears in this zone have a better chance of healing on their own or with surgical repair through a meniscus repair.
The “White Zone”: The inner 65–75% of the meniscus is avascular (no blood supply).
This area relies on synovial fluid for nourishment through diffusion and the pumping action of joint movement.
Tears here have limited healing potential, which is why some of these injuries might require partial meniscectomy (removing the damaged part) instead of repair.
Understanding which zone your tear is in often helps doctors decide between conservative care, surgical repair, or trimming the tear.
How Is a Meniscus Tear Diagnosed?
Physical therapists and orthopedic surgeons use a combination of your history, symptoms, and special tests to figure out if your meniscus is torn.
During an exam, we look for pain along the joint line of the knee, swelling, and difficulty with certain movements. We often perform special orthopedic tests, such as:
McMurray’s Test: The knee is bent, rotated, and straightened while we listen/feel for a click or pain.
Apley Compression Test: With you lying on your stomach, we press and rotate the heel to see if it reproduces symptoms.
Thessaly Test: You stand on one leg and rotate your knee slightly while bent for pain or catching, which may suggest a tear.
If the diagnosis is uncertain, an MRI is often ordered, as it provides a clear picture of soft tissues like the meniscus.
It is important to note that although special tests may be helpful, a positive test does not always guarantee a tear is present, and further testing may be needed.
What Causes a Meniscus Tear?
Meniscus tears can happen in a few ways:
Traumatic injury: Often seen in sports or activities with quick twisting or pivoting motions, like soccer, basketball, or tennis.
Degenerative changes: As we age, the meniscus may become thinner and weaker, making it easier to tear, even from simple movements like squatting or stepping awkwardly.
Sudden impact or overload: Jumping or landing incorrectly, or lifting something heavy with poor mechanics.
Signs and Symptoms of a Meniscus Tear
The symptoms can vary, but common signs include:
Pain along the knee joint line (either inner or outer knee).
Swelling, which might develop over a few hours or days.
Clicking, popping, or locking of the knee.
Feeling like the knee might “give out” or buckle.
Pain when twisting, squatting, or climbing stairs.
Reduced range of motion, like difficulty fully straightening or bending the knee.
How Do You Treat a Meniscus Tear?
The good news is that not all meniscus tears require surgery. Many people get better with a combination of physical therapy and activity modification. Treatment often depends on the type and severity of the tear, your activity level, and your goals.
1. Physical Therapy
Physical therapy is usually the first line of treatment. A structured program will focus on:
Reducing swelling and pain.
Improving knee mobility and flexibility.
Strengthening muscles around the knee (quads, hamstrings, glutes) to support the joint.
Returning you to normal movement patterns and activities.
It’s crucial to work with a physical therapist who truly understands your goals, listens to your needs, and tailors a plan of care that combines skilled therapy with progressive strength training to get you back to doing what you love. Unfortunately, I often hear of clinics where treatment is limited to ice packs and electrical stimulation for pain relief, with little to no focus on building strength or long-term recovery. If this sounds like your current experience, I strongly encourage you to seek out a physical therapist who goes beyond passive treatments and emphasizes active rehabilitation.
2. Activity Modification
Limiting your squatting to a pain free level, avoiding twisting movements of the knee, or high-impact activities in the early stages can give the meniscus time to calm down. The goal is to allow the knee to relax without stressing it too much to allow it to heal properly. Doing too much may continue to stress the knee and not allow it to recover. This may mean temporarily decreasing running distance or running all together, avoiding heavy squatting, or as mentioned limiting or completely avoiding jumping activities.
I always tell my clients, this doesn't mean that you can no longer perform these activities. It just means we need to temporarily reduce or limit them, and slowly return back to them as your knee feels better and gets stronger during the rehab phase.
3. Injections
Some cases may benefit from corticosteroid injections to decrease inflammation or PRP (platelet-rich plasma) injections to promote healing, particularly for degenerative tears.
While injections may help with pain, they do not completely fix the issue, and injections should not be the only treatment to seek. As the knee begins to feel better through injections, you need to continue strengthening the knee.
4. Surgery
When conservative care doesn’t help or when the tear is large, causing locking, catching, or inability to perform basic activities of daily living, arthroscopic surgery might be recommended. Surgical options include:
Partial meniscectomy: Removing the damaged part of the meniscus. Especially if it is in the “White Zone” that is avascular and has poor potential to repair itself.
Meniscus repair: Stitching the tear back together, which is preferred for younger, active individuals if the tear is in a vascular area “Red Zone” where it can heal.
Exercises for Meniscus Rehab
There is no one exercise that is best or works for everyone, but over the course of my career, these are three of my favorite exercises that I provide to my clients and have found to be most helpful.
Lateral Step Down
Single Leg RDL
Heels Elevated Squats
Final Thoughts
A meniscus tear isn’t the end of your activity or sports life. With proper diagnosis, rehab, and guidance, many people return to full strength without surgery. The key is early intervention, addressing pain, improving strength, and avoiding movements that worsen the injury.
If you’re unsure whether your knee pain is a meniscus tear, or if you’re struggling to recover, working with a physical therapist can give you a personalized plan to get back to what you love.
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