Meniscal knee pain

Understanding meniscal knee pain

The meniscus is a crescent-shaped cartilage on either side of the knee. It acts as a shock absorber in the knee, between the long bones of the leg. Meniscus pain can be caused by injury or overuse, causing pain, swelling and locking of the knee.

Meniscal knee pain can be common in sports due to twisting/rotational movements of the knee when playing them, accounting for 12 to 14% of knee injuries. However, it is also recognised that the meniscus weakens with age, and degenerative changes are common, accounting for 30% of all meniscal tears.

Research has shown that those older than 40 years old are 4 times more likely to experience meniscal knee pain, and more than 40% of those older than 65 years old will experience pain associated with the meniscus of the knee.

Symptoms of a meniscus injury can include:

pain
swelling
stiffness
a popping sensation during the injury
difficulty bending and straightening your knee fully
a feeling that your knee is locked ‘stuck’ in place when you try to move it

How to manage meniscal knee pain

Initial treatment may include offloading the meniscus through avoiding/resting from any sports or activities, which may be the cause and/or contributing to the cause of the injury.

Initial use of ice to help reduce any swelling and pain for 15 to 20 mins at a time (but not longer than 20 mins) and up to 3 to 4 times a day with at least 30 mins between each time.

Well-structured exercises aiming at increasing the activation and strength, particularly of the quadriceps and gluteal muscles. Exercise can often be challenging and uncomfortable. However, it is advisable that you do not push into pain or experience large increases in pain levels that stay for more than 24 hours after exercise.

Considering the use of orthotics may help to offload stress on the meniscus. Try and avoid deep knee flexion (bending), twisting, and rotating, particularly when weight bearing and kneeling. Try and avoid high-impact activities and excessive forces being put through the knee.

Do I need an MRI?

A Magnetic resonance imaging (MRI), can be used to help investigate meniscal knee pain. Research has shown experienced examiners are able to identify patients for surgery with meniscus tears just as well, if not better than an MRI.

Research has shown a lot of changes occur within the meniscus in those without symptoms, which indicates that changes in the meniscus can be a normal phase that the knee passes through. About 19% of over 40 years have meniscus tears that do not cause any problems. It is important to note that meniscus tears occur naturally. This understanding promotes confidence in the examiner's clinical findings when assessing the knee and can help provide the most appropriate treatment pathways to you quicker.

Do I need surgery?

This is not always a straightforward question if your knee is locking, ‘getting stuck’, or you cannot fully extend your knee, then this may be something that is discussed in further detail.

However, research shows that in the absence of your knee locking then when reviewing long-term outcomes of surgery vs conservative management, there is minimal difference and managing conservatively is reported to lower the risk of osteoarthritis later in life. Further to this, there is no strong evidence to demonstrate that surgery is more effective as a treatment than physiotherapy for degenerative meniscal tears.

How much exercise should I do?

A senior couple on yoga mats outside in a park in a bent knee standing pose with arms outstretched.

Exercise every other day

Allowing enough rest is important to let soft tissues recover and develop.

cropped image of two people, one black and one while in shorts and t-shirts on an exercise bike pedalling. Close crop on their hands on handle bars and their legs moving.

Choose 3 or 4 exercises

Choose exercises that are challenging but manageable.

Young asian man running on the spot wearing a t-shirt and shorts in their living room on a wooden floor.

Repeat the exercise

Perform 8-15 repetitions of each exercise, 3 times a day.

Rest

Rest for up to 1 to 2 minutes between each set.

Once an exercise is easy, progress it

Increase the number of repetitions or hold the positions for longer for a more challenging exercise. Try and avoid high-impact activities and excessive forces being put through the knee.

How much pain is too much pain?

Before exercising

Before exercising, rate your pain at the moment on a scale of 0 to 10, where 0 is no pain and 10 is the worst pain you can imagine.

A maximum pain level

A maximum pain level of 4/10 whilst exercising is fine as long as it eases within 45 minutes of the session and does not interfere with sleep or activities the next day.

If your pain increases

If your pain increases beyond this, simplify the exercise by reducing the range of movement or number of repetitions, or try an easier exercise.

Supportive Exercises

Find exercises to help improve movement and reduce stiffness in the knee. Repeat each exercise 8 to 15 times, 3 times a day for maximum benefit.

Knee end-range extension in supine

Mini-squat with support

Bridge

Hip abduction in sidelying

Heel raise

Single leg standing

Step-up with thigh thrust

Need more help?

Consider self referring using the link below:

If you have a new injury or problem, please look at the self help information in our advice pages. We will often complete the same exercises and share information in clinic appointments.

If you still need some more help you can self refer into our service. Please note that the NHS is currently experiencing longer than normal waits, for more information visit our waiting times page.

Refer yourself to physiotherapy