Boot camp for your meniscus

In the last several years, we have seen a variety of new fitness programs hit the market. From P90X to Insanity to CrossFit, active (and inactive) adults are flocking to these high-intensity workouts for fast results. With proper execution many will achieve life-changing improvement in health and fitness. But many more are sidelined with unexpected and certainly unwanted knee injuries.

One of the most common injuries seen in adults who embark upon a new, high-intensity workout program is a torn meniscus. Nearly 1 million knee arthroscopic procedures are performed annually in the United States, and the majority of those include some form of treatment to the meniscus.

The meniscus is a rubbery shock-absorber that provides cushion and transmission of force across the knee joint, preventing the breakdown of the knee. As we age into our 30s and beyond, this tissue is not as resilient as before and becomes more easily susceptible to injury. When the meniscus tears, you will feel pain, locking and catching, and experience swelling and tightness in the knee. It can be disabling and derail your journey back to health via the high-intensity workout pathway.

Many of these newer programs push our bodies to extreme limits and involve high-impact techniques such as box-jumps, squats, lunges, jump-landing, single leg hops and twisting and pivoting motions. These put the knee and the meniscus at risk. Below are a few guidelines that may help to keep your knee out of trouble when starting a new program.

1. Keep the knee flexion below 90 degrees: When the knee bends past 90 degrees, more pressure is placed on the back portion of the meniscus. Adding weight-bearing movement or higher impact such as landing from a jump, squat or lunge then increases the forces acting on the back portion of the meniscus into the range of 8-10 times your body weight. It is no surprise, then, that the back portion of the meniscus is the most commonly torn area. Staying below 90 degrees of knee flexion can decrease your risk for meniscus tear. This can also apply to any knee “dips” or any leg-press activities in the weight room. The deeper you go, the higher the risk of a tear. So keep it below 90.
2. Modify: All of the programs mentioned above and the myriad of others out there allow for lower-impact or no-impact modification of the routines. Even if you feel that you are highly fit, it’s advisable to start slowly with modifications and gradually work your way up. Use the non-jumping and lower impact alternatives to the routine. But again, those of us in our 30s and beyond need to be aware that Mother Nature does not have our backs when it comes to high-intensity loading of the meniscus. No matter how athletic you are, as you age so does your meniscus. Avoid high-impact jumps/twists/landings when at all possible, and again keep the flexion below 90 degrees.
3. Proper warm-up and stretch: If your program does not include a slow, 10-15 warm-up and stretching phase, then add this to your workout. Muscular tone and flexibility across the knee joint will help to protect you from extreme positions and provide better control to avoid injury. The stronger your knee is, the better it will protect your aging meniscus.
4. It’s your knee, not your trainer’s: We all feel obliged to persevere and give workouts our best, especially when investing our precious time and money into a new fitness program. We want to succeed and please those around us, especially our coach or trainer. But don’t let the excitement or intensity of the workout cloud your common sense. If you haven’t worked out in years, or if you are trying to go to a completely new and higher level than you’ve been before, then take it slow and don’t be pressured. You take that knee home at night and you have to protect it. If it doesn’t feel right, don’t do it. You are paying the trainer to teach you and help motivate you, but not to tear up your knee. So feel good about yourself when you back it down a few notches to stay in your safe zone for your knee.
5. Don’t ignore meniscus tear symptoms: If injury to the meniscus has occurred, you may feel sharp pain, swelling, stiffness, locking, catching or giving way of the knee. The majority of meniscus tears don’t occur with a single traumatic event. So even if you cannot determine a particular time when you may have injured the knee, don’t ignore the symptoms above, as they likely indicate a tear. Once the meniscus tears, it does not heal on its own and will continue to cause pain and further damage to the knee. When you have the symptoms of a tear, it’s time to consult with a board-certified orthopaedic surgeon, and preferably one who is fellowship-trained in sports medicine to accurately diagnose and treat your knee.

You should always be aware of your overall health and any medical conditions that may affect your ability to participate in activities that stress your cardiovascular system. Seek out the advice of your primary physician for general health risks before engaging in a high-intensity or high-impact workout program. Please also feel free to contact the Midwest Sports Medicine Institute with further questions or to schedule a consultation.

And keep these tips in mind when embarking on your new fitness program. Be independent and remember that it’s your knee and it’s up to you to protect it!