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Injury blog: Meniscus tears
Hello readers and welcome to another of our monthly health blogs. This month we take a look into the world of knee meniscus injuries. Studies from the US report approximately 61 in every 100,000 people experience a knee meniscus injury every year. You are more susceptible to injuring a meniscus in your knee if you participate in sports such as football (all forms), basketball, netball, skiing, baseball and wrestling. There is also a high rate of meniscus injury seen in those who work in the military on active duty. Essentially any job or sport that requires lots of squatting and kneeling can leave you open to an injury of this kind. But what is a meniscus?
The meniscus are found inside the knee joint, nestling nicely between the thigh and shinbones. They are crescent-shaped pieces of toughened tissue (a type of cartilage) and there are two in each knee. One sits on the outside part of the knee joint (i.e. lateral meniscus) and one sits on the inside part (i.e. medial meniscus). They act as shock absorbers to the various loads and forces that pass through the knee during movement. They also have a slightly wedge-shaped appearance being thicker around the outside compared to the inside, and this provides a deepening of the joint surface to allow for a more snug-fit joint. The top of the shinbone is quite flat compared to the very rounded ends of the thighbone… The meniscus help to stabilise this slight mismatch of joint surfaces.
Causes of a tear
The most common cause of a meniscus tear is an excessive or forceful twisting of the knee whilst the foot is planted on the ground. This might happen as a result of landing awkwardly from a jump, or from the force of another person or opponent’s body acting on the knee. During this type of movement, if the force is too much for the meniscus to withstand, tearing may occur. The medial (inside) meniscus tends to be injured more than the lateral (outside) meniscus. This is because the medial meniscus attaches to other structures inside the knee joint, leaving it less mobile to forces acting on it compared to its lateral counterpart.
Signs and symptoms
The experience of a meniscal tear will vary from person to person depending on the cause. A young footballer who has been injured during a tackle with high forces involved will likely present in a great deal of pain with a swollen and restricted knee. Injuries sustained in this way are likely to be more severe with associated ligament injuries as well. On the flip side, an older person who has been gardening for the weekend spending lots of time squatting and kneeling may present to the clinic with a very different picture. There may be no high force movement involved, but instead the tear has occurred due to degenerative changes that have occurred to the cartilage tissue. Symptoms in these types of injury are less likely to be so acute and may only appear 24-48 hours down the line. Signs and symptoms you might expect from a meniscal tear may include any or all of the following:
- – Pain when walking, squatting or jumping
- – Restriction of the knee joint with or without swelling
- – Knee joint locking
- – A popping or clicking sensation (often following an episode of locking)
- – A feeling that the knee may give way
- – Tenderness around the line of the knee joint where the tear has occurred
Diagnosis and treatment
The first thing to do if you have injured your knee is to see a physiotherapist as soon as possible. A painful, swollen, restricted and inflamed knee following an incident is a sign something is not right, so seek help quickly. We will ask questions about what has happened and examine your knee closely. Some people will be able to move around well, others with a severe injury may be more limited. The management of meniscal tears will vary depending on how the injury happened (i.e. are we also dealing with a ligament injury?), and the age and goals of the patient.
In some instances, we might suspect a small tear and a patient is presenting with pain but has good overall movement and doesn’t have any of the more severe symptoms such as locking or giving way. In these cases,; we’d use hands-on treatment and exercise prescription in order to strengthen the knee and restore full function through massage, mobilisation and whole body movement.
In instances where we suspect a large tear and a patient is presenting with high amounts of pain, restriction and locking and/or giving way in the joint, we may first need the assistance of some imaging or surgery (i.e. an arthroscope) to determine the severity and clear the knee of any large tears. Some tears require removal of the cartilage tissue whereas some can be repaired. The surgeon will always try to retain as much of the meniscus as possible to reduce the impact on knee mechanics following recovery and for the future.
Regardless of the initial management, rehabilitation will aim to:
- – Reduce pain and increase range of motion to the knee
- – Improve strength of the quads, hamstrings, calves and other knee and hip related muscles
- – Return to sport or previous duties as soon as possible without risking further injury
Seeing us as soon as possible will help to limit complications and help get you back to 110% (we always like to get you back fitter than you were before the injury!) at the earliest possible opportunity. Whether your goal is to garden or return to kicking goals, we can help get you there. Call us today on [insert clinic number] to book your appointment.
Osteoporosis: Myths and facts
It’s no secret that as we get older, concerns about health start to grow for many. Chronic disease statistics within the global population increase with age. By the age of 75, there is a 60% chance of having developed two or more chronic conditions. By 85 this increases to a 75% chance. Some of the common conditions people associate with getting old are osteoarthritis, type 2 diabetes, dementia, hearing loss and eye conditions including cataracts and glaucoma. One very important condition that affects millions of people every year around the world is osteoporosis. Considering it affects so many of us as we age, it’s not always up there at the fore-front of people’s minds as one to watch out for.
We’ve put together this blog to inform you fully on some of the facts and myths surrounding osteoporosis and to let you know why it’s so important to act early in life to avoid this potentially debilitating condition.
What is osteoporosis?
Osteoporosis is a condition that affects the density of bones of the skeleton causing them to become weak and fragile to breaks. It occurs when bones lose high amounts of protein and minerals, particularly calcium. The internal structure of the bone changes (i.e. the amount of bone that makes up the structure decreases) and this weakens the bone. The condition mainly affects the elderly population, but this is a condition that can take years to develop with lifestyle decisions early on in life playing a major role in its development in some people.
Myths and facts
Let’s outline some of the myths (and debunk them with facts!) surrounding osteoporosis. We believe a healthy population can only come from being an informed population.
Osteoporosis only affects women: Stop right there! Yes, women are more susceptible to developing osteoporosis due to the hormonal changes they go through during menopause. The reduced production of oestrogen following menopause is one of the biggest risk factors for developing this condition because of the weakening affect it has on the bones. Make no mistake, men can also develop this condition. A fifth of men over 50 in the US will experience an osteoporotic bone fracture in their lifetime!
Osteoporosis only affects Caucasians: Osteoporosis can affect anyone regardless of race or ethnic origin. The stats show there are higher numbers of cases in white than black people. Research suggests black people tend to develop a greater bone mineral density during the growth stage of life than white people, leading to overall stronger bones. It also suggests black people lose bone at a slower rate than white people as they age. This condition should however be taken seriously by all.
Osteoporosis only affects the bones: Whilst osteoporosis primarily affects the strength of bones leading to increased fracture rates, this condition can affect the body in other ways as well. Recovery from hip fracture surgery due to a osteoporosis-related fall can be problematic and sometimes fatal due to other bodily complications such as immobility, heart and lung problems and increased infection rates following surgery.
You’re only likely to fracture if you have a fall: Falling down is a common way people fracture bones, particularly if you have a low bone mineral density or osteoporosis. Unfortunately for people with severe osteoporosis, even the smallest of movements could lead to a bone fracture. Sneezing, reaching to pick up an object from the floor, stepping off a pavement onto the road or even a sudden change in direction whilst walking are all movements that may trigger a break in someone with this condition.
Osteoporosis is painless: Many people believe that this condition is painless unless you physically fracture a bone. This may be true in the early stages of the disease as there may be no signs or symptoms of something changing in the bones until you experience your first fracture. As the disease progresses, chronic pain can be a big problem, particularly if there have been multiple fractures over the course of a person’s life. Osteoporosis is strongly linked with loss of muscle mass as we age, which leads to further deterioration of bone health. The body loses its ability to support the skeleton and various scenarios of pain states relating to posture and persistent pain following the healing of a fracture can exist.
I’ll worry about osteoporosis if it happens: Take no chances. How you live your life in the early stages will affect your body later on. Children and adolescents need to be active and eat a healthy diet consisting of the right vitamins and minerals because it is at this stage of life where our bones build in mass and strength. Females reach their peak bone mass around the age of 18 and males reach it around 20 years of age. After this, we start to lose bone as the years progress. Staying active and being healthy throughout life will help to reduce the loss of bone that occurs with age. The rule is to act early (teach your kids the importance of being active) and continue to act as the years go by!
There is so much more we could discuss on this topic, but we’d be here all day! We hope this has given you a sound understanding of what osteoporosis is and the importance of acting early in life to avoid this condition. If you would like to know more, feel free to ask us next time you are in for a treatment or a chat. Stay safe everyone!