Mary Ann had the French ski trip of a lifetime planned over the New Year, but she had one big problem: the meniscus in her knee was torn. Last summer, Mary Ann was having knee pain that later got diagnosed as a meniscus tear; things like stairs and standing from chairs were hurting, she had to stop doing her daily 5-mile walks, and she could feel the other side of her body starting to compensate. Surgery was not recommended, and she was told to let it rest to heal. But four months after the diagnosis and resting, she wasn’t feeling much better. Her ski vacation was only two months away, and she was afraid she wouldn’t be able to ski or, worse, wouldn’t be able to go on the trip at all. She contacted Dr. Alex, and the countdown to the trip began. Was her body going to be ready in time?
What is a Meniscus, and What Does a Tear Feel Like?
Let’s start with what a meniscus is. The meniscus is a thick pad of cartilage that sits between the femur (your thigh bone) and the tibia (your shin bone). Its primary role is to cushion the force that happens when you walk, squat, jump, whatever–it’s a very effective shock absorber. When the meniscus is torn (usually this happens over time but sometimes from a specific injury), many people complain about a catching or clicking sensation in their knee when bending and straightening, and it can cause pain and irritation as that tear catches on other structures around it. Mary Ann was feeling pain and instability in her knee, and her leg was about to give out with walking and doing stairs. It’s not good for someone two months from a big downhill ski trip.
Assessing the Knee and Where to Start with Rehab
Mary Ann and I (Hi, Dr. Alex, here!) live in different states, but that part doesn’t matter because we met online over a video call for her movement assessment, and here were the significant findings:
1) On 2 legs, Mary Ann couldn’t squat without pain and shifting away from her injured leg.
2) On 1 leg, Mary Ann could barely bend and straighten her leg while balancing on it. Her noninjured leg could do this easily.
This was a problem because, with downhill skiing, you need to be able to hold your body weight on both legs and shift the weight side to side while bending your knees.
We needed to get started on exercises right away because exercise is how we get our body ready for what we ask from it. For Mary Ann, we were eight weeks away from asking her body to support her in downhill skiing and lots and lots of walking. Squatting and single-leg squatting were our problem areas, but that’s not where you want to start with exercise. If someone asks you to do an exercise that’s consistently painful, you aren’t likely to do it. When pain is involved, even if you try the exercise, you will not likely do it right. For Mary Ann, we needed to start with the muscles around her knee and hip to strengthen them in a safe but challenging way. We needed to start by working on balance on one leg that wasn’t painful and helping her regain the knee flexibility she’d lost after months of hurting and avoiding exercise. Her doctor told her to rest, remember?
Resting Won’t Solve Your Injury
Mary Ann did what many people do when they get injured–she took time off, which was the advice of her physician. Time off can help with pain, and it can help reduce inflammation, but (read this part carefully) time off does not heal injuries.
Time off doesn’t strengthen muscles, restore range of motion, or keep the other parts of your body strong. I can think of almost no injuries that would require absolute time off. In nearly every situation I have encountered (and that’s thousands and thousands of injuries), there is always some level of movement and exercise that is not only safe to do but is highly productive for your body after injuring it. Starting safe movement and exercise the day after an injury speeds up recovery, prevents people from hurting for extra weeks, months, and years, and gets people back to living their lives and doing the things they want. This is a soapbox speech, but it’s so true I’ll say it repeatedly. Doing nothing and letting your body “heal” rarely works–especially if you hope to return to those active things in your life.
Exercise Should Progress, But Only When Your Body is Ready
Back to Mary Ann. I waited a solid month before introducing deeper squats and single-leg squats to her exercise programming (those things that hurt our first visit). She first needed to get back the strength that was going to support her in those movements before it was safe to assign those exercises. So we strengthened her quads, her hamstrings, the muscles of her inner thigh, outer thigh, and butt. We worked on her knee flexibility and added a little bit of focus on her core. And we kept advancing. Her exercises slowly got harder, but only when her body showed she was ready for them.
Four weeks before the ski trip, we started with deeper single-leg squat patterns–think chair-level. And they were hard. Very hard. But they didn’t hurt the way they did at the first visit. One test I like to use is standing in front of a chair on one leg, sitting your butt back to tap the seat of the chair, then standing back up. Mary Ann could not do this on her injured leg, even though she could do it on her other leg fairly easy. We still had some work to do.
Mary Ann was consistent. She did 15-20 minutes of exercise we assigned each day, and she started increasing her walks, which were no longer hurting. That feeling that her leg would give out went away slowly, and when we tested the strength of her hips, each of the muscle groups was improving.
At Last, She Skis
Eight weeks after we started, Mary Ann went on her trip and sent me this message from France: “My knee works! Thank you, Dr. Alex. […] We are extending our stay.”
She skied six days in the French Alps and spent time in Paris, Courchevel, Lyon, and Bordeaux (how cool does that sound?). She didn’t reinjure her knee; she walked over 20,000 steps on some days, and she got to have the family vacation she had been dreaming of.
This did not happen by resting, and it did not happen by magic. Mary Ann had the most critical ingredient in getting better: wanting to get better. She also had the second most important ingredient: willing to do a little work to get better. My role was figuring out where we were starting, where we wanted to go, and the steps we needed in between to get there. As a physical therapist, I can’t exercise for someone, and I can’t put in the work their body needs. She did that.
Mary Ann, you are amazing, and I am proud of you. The next time you go on such an amazing adventure, take me with you.
What about My Knee Pain?
If you need guidance on getting started with healthy exercise for your body, or if you’re dealing with pain or injury, contact us. Dr. Alex is here to support you every step of the way, no matter where you are. Book your free 15-minute consult to talk with Dr. Alex about your concerns and learn more about how we work! Our online physical therapy and personal training can help you regain what you thought you’d lost and go strongly into your future.
At motivPT, we believe your body deserves to feel great.
