Managing Your Meniscus with Chiropractic
What you need to know
FAQ about the meniscus
How Chiropractic can help
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Chiropractic care for the meniscus
Current guidelines recommend acute inflammation management (rest, ice, compression and elevation),
anti-inflammatory medications and Chiropractic in the early stages, prior to potential surgical intervention
Each treatment session usually consists of , Chiropractic, massage, shockwave therapy and/or dry needling.
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Recommended Weight Bearing Exercises
Glut max
Glut med
Quad
Hamstring
The recommendations for aerobic activity were moderate-intensity activity for a minimum of 30 minutes for 5 days each week (150 min/wk) or vigorous-intensity activity for at least 20 minutes for 3 days each week (60 min/wk).
Moderate-intensity activity produces noticeable increases in heart rate and breathing, whereas vigorous-intensity activity produces large increases in heart rate and breathing. Muscle-strengthening exercises should be performed a minimum of 2 days a week and should include 8 to 10 resistance (weight) exercises
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Meniscus exercises
Plyometric exercises should also be incorporated into the training regimen, focusing on jumping, landing, and cutting biomechanics, to decrease forces on the knee and normalise lower-limb alignment.The goal of these exercises is not only to help return athletes to their sport but also to prevent future injuries
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Example Rehab Program
8 weeks with 16 sessions
Warm up stationary bike
Exercise :
Calf raises on a leg press; standing hip extension in a “multi-hip” training device;
balancing on wobble board with both feet;
calf raises standing on one leg;
leg presses with the shinbone placed horizontally and the knee starting at 110°;
unilateral lunges with <90° knee flexion; balancing on wobble board with one foot with throwing a ball;
cross-trainer for cardiovascular exercise; stair walking; walking; running; jumping
Rehabilitation of the Knee
Functionality You Will Love
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Weightbearing Versus Nonweightbearing After Meniscus Repair.
Weightbearing Versus Nonweightbearing After Meniscus Repair.
Outcomes after both conservative (restricted weightbearing) protocols and accelerated rehabilitation (immediate weightbearing) yielded similar good to excellent results
Meniscus tears represent one of the most commonly treated knee injuries. The meniscus is critical to normal function of the knee, including load transmission, joint stability, lubrication, and nutrition of the articular cartilage. Loss of normal meniscus function leads to increases in knee contact pressures and articular cartilage degeneration over time
Seventy percent of the force within the lateral compartment and 50% of the force within the medial compartment is transmitted through the respective menisci, reflecting their relative contact areas in the femorotibial joint
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Medial Collateral Ligament Rehab Treatment Protocol
Grade 1 (0- to 4-mm medial joint gapping with valgus stress at 30° knee flexion)
Treatment : Rest, ice, compression, NSAIDs, physiotherapy within one week for supervised early return to activity
Grade 2 (5- to 10-mm medial joint gapping with valgus stress at 30° knee flexion with a firm end-point
No laxity in extension)
Treatment Unlocked ROM brace for three weeks or more, full weight bearing, early physiotherapy while in brace for lower limb strengthening and neuromuscular retraining
Grade 3 (>10-mm medial joint gapping with valgus stress at 30° knee flexion without a firm end-point
Laxity in extension implies injury to other structures (eg ACL or PCL)
Treatment
Unlocked ROM brace for six weeks or more, full weight bearing for isolated MCL injury
Consider reconstruction if associated
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What Imaging should you get for knee injuries
Xrays-
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First-line investigation for significant acute sport-related knee injuries
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Will demonstrate fractures, dislocations and abnormal patella positioning with extensor mechanism disruptions
Ultrasound
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Limited role
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May be used to diagnose quadriceps or patellar tendon ruptures if MRI not available
CT Scan
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Limited role
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May be used to detect occult fractures
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Useful for preoperative planning for intra-articular fractures
MRI
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Investigation of choice for collateral, cruciate and meniscal injuries
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May be used to diagnose tendinous disruption of the extensor mechanism
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Will also demonstrate chondral injuries and occult fractures
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Lateral Collateral Ligament Protocol
Grade 1 (0- to 5-mm lateral joint gapping with varus stress at 30° knee flexion with a firm end-point)
Treatment
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Unlocked ROM brace for six weeks, full weight bearing, early physiotherapy while in brace for lower limb strengthening and neuromuscular retraining
Grade 2 ( 6- to 10-mm lateral joint gapping with varus stress at 30° knee flexion with a firm end-point)
Treatment
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Unlocked ROM brace for six weeks, full weight bearing, early physiotherapy while in brace for lower limb strengthening and neuromuscular retraining
Grade 3 (>10-mm lateral joint gapping with varus stress at 30° knee flexion without a firm end-point
Laxity in extension implies injury to other structures (eg ACL or PCL)
Treatment
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LCL repair or reconstruction depending on acuity
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Repair
What is the meniscus
How does the meniscus work
Anatomy of meniscus The meniscus, a fibrocartilaginous structure essential for stabilising the knee joint, absorbing shocks, distributes forces and protects the articular cartilage . Acute tears of the meniscus may be symptomatic, impacting negatively quality of life and sport participation, and may lead to early onset osteoarthritis . Rotational and shear forces on the menisci, especially during kneeling, carrying heavy loads and movements with acceleration, deceleration, jumping, and change of direction, are the main causes of acute tears of the meniscus Direct traumas to the knee might also cause meniscal damage and are often associated with damage to adjacent bone and ligaments
Problems with the meniscus
Lets Discuss the different type of mensical Tears - Longitudinal (Vertically oriented parallel to the edge of the meniscus) - Longitudinal Horizontal(Horizontally oriented perpendicular to the edge of the meniscus. The superior and the inferior surfaces of the meniscus are divided) - Radial (Vertically oriented extending from the inner edge of the meniscus toward its periphery) - Bucket Handle (The inner fragment of a longitudinal tear displaces over into the intercondylar notch) -Flap or Parrot-Beak (oblique tear)(Radial tears with a circumferential extension creating a flap of meniscal tissue) - Complex(Combination of other tears that occurred in multiple planes) -Ramp (menisco-synovial)(Tears located at the posterior meniscocapsular junction and/or tears of the posterior meniscotibial ligament) - Root (Defined as either radial/oblique tears located within 1 cm of the meniscal attachment or a bony/soft-tissue root avulsion) - Hypermobile Lateral Meniscus ( Hypermobile lateral menisci are thought to result from either congenital absence of posterior capsular attachments or from tears of posterior capsular attachment, in particular the popliteomeniscal fascicles)
How to Prevent meniscus problems
Evidence of risk factors for meniscal tears Over weight loss Male sex Trauma type Sports participation Generalised joint hyper mobility Occupational activity
Return To Play Advice with meniscus
After surgery Unfortunately, many patients have residual quadriceps and hamstrings muscle weakness 1 to 3 years after operations, which strongly influences the ability to return to recreational and fitness training activities as well as patient satisfaction rates
