Lateral Meniscus Pain

[Herk_Man]

I'm an athlete (47YO) not a medical professional so I'm urging caution in giving me too much credit on my diagnosis. However, I think I have a strain (if it's possible to have a strain and not a tear) in my Lateral Meniscus. I run distances on dirt trails and recently have been experiencing pain after about 3 or 4 miles of running.

The pain is on the outside of my right knee and is very localized. It is on the part of the outer knee that naturally bulges a little and seems to be right in the little gap between the upper and lower parts of the bulge.
I'm not experiencing any swelling.
If I stop and walk for a bit the pain subsides and I can run a bit before it starts to hurt again.
I don't have any clicking or grinding that I can feel or cause if I manipulate the knee.

From this information and poking around on the internet I'm calling it Lateral Meniscus. I can't find anywhere that talks about a strain instead of a tear (I realize that strains are just very minor tears) but all of the symptom charts mention swelling in association with a tear.

So right now I'm alternating cold and heat, about 20 minutes each, trying to keep it elevated, and I plan to take a week or two off from running.

I'm training for Tough Mudder in October so I really want to get this back on track and any advice from experts that lurk here is very welcome.

Thanks,

Herk

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[Herk_Man]

I'm training for Tough Mudder in October so I really want to get this back on track and any advice from experts that lurk here is very welcome.

Thanks,

Herk

[iphysio]

Hi Herk_Man. Do you have any locking of your knee? eg. where your knee cannot bend or straighten and you need to shake it a bit to free up the locking. Usually if there is any meniscus tear involved you will have some locking. If you do not have "locking knee", there is a possibility that you may have bruising or "soft tissue injury" of meniscus. Have you tried some anti-inflammatory gel on your knee? Rest sounds good! And gradual return to running. Hope you get better soon!

[Herk_Man]

Thanks so much for the response! No, there is no locking. I have no restriction in movement at all. Even when it starts bothering me while running I could keep going and just pretty much ignore the pain if I had to. But I don't want to make things worse and get to a point where surgery is necessary, if it isn't already.

I wasn't sure if there were even nerve endings in the meniscus or if it was just cartilage so I'm encouraged to hear that you can have soft tissue injuries in the meniscus without any actual tearing.

I don't have any swelling, but in conjunction with the ice and heat I'm taking some Ibuprofen and I do have some Blue Emu gel that is supposed to help with deep tissue injuries that I can start using as well.

I'm already getting cranky from not being able to get out and run so I really want to heal this as quickly as possible! The only saving grace is that Tough Mudder isn't until October so I've got plenty of time to heal and then get back in fighting form. And I can work on upper body requirements while the leg heals.

Thanks again and any other info you can throw at me is sincerely appreciated.

Herk

[iphysio]

Hi Herk. How long have you rested your knee? Is it 4-6 weeks? Is it getting better, worse or same? How would you rate your knee pain out of 10 where 0=no pain and 10= maximum pain when the pain comes on when you run? Can you do a full squat without pain? So far I'm still thinking "soft tissue" / bruising of lateral meniscus. Thanks. iphysio.

[Herk_Man]

Right now the pain is about a 3-4 after about 3 miles of running. I could keep going if I wanted to but it's annoying. I've only been resting it for about 3 days now. Full squat brings zero pain and I can do anything I want without irritating it. Been applying a heat compress for about 30 minutes twice a day.

How long do you think before a test run and what kind of exercises can I do to strengthen it so it doesn't happen again. I have a good set of weight machines at home I can use.

[iphysio]

Hi Herk. I would rest for at least one week then try running again. If your knee pain comes on then you should stop and ice it immediately for 20 mins. For now you can try wall squats 3-4 sets of 30-90 secs hold 3 times a day, bending up to 90 degrees at knee joint (prefer longer than 90 secs hold). I prefer you perform "isometric" type of strengthening while you resting. "Isometric" type of exercises are strengthening exercises without moving your joints. Please google it. Hope you get better soon Herk!

[Herk_Man]

Thanks! I'll give that a try. It kind of falls in line with what I was thinking except I wouldn't have thought of the isometrics.

One other question. Should I continue with any kind of ice/heat regimen? And will wearing a knee support sleeve help at all? (Ok, that was two questions.)

Hi Herk. I would rest for at least one week then try running again. If your knee pain comes on then you should stop and ice it immediately for 20 mins. For now you can try wall squats 3-4 sets of 30-90 secs hold 3 times a day, bending up to 90 degrees at knee joint (prefer longer than 90 secs hold). I prefer you perform "isometric" type of strengthening while you resting. "Isometric" type of exercises are strengthening exercises without moving your joints. Please google it. Hope you get better soon Herk!

[marj]

Thanks! I'll give that a try. It kind of falls in line with what I was thinking except I wouldn't have thought of the isometrics.

One other question. Should I continue with any kind of ice/heat regimen? And will wearing a knee support sleeve help at all? (Ok, that was two questions.)

How do you know it's the meniscus and not ITB?
You should see a physio and get them to diagnose it as well as assess your muscle balance and advise you if you need to add any strength, flexibility and or motor control exercises. Running will definitely make a meniscus problem worse or delay recovery. I'm resting my own. Make sure you are doing equivalent time pool running, cycling elliptical machine etc to maintain your fitness. Good luck. A knee support won't help meniscus but there are bands that you can wear for your ITB.
You might also benefit from US,TENS, laser etc.

[nmarman]

It's u likely to be meniscal tear because of mode of injury and that you can run thought it. Locking and giving way are clear indicators of meniscal damage.

More likely it's runners knee caused by tight ITB: follow a protocol of foam Rolling on ITB 5 rolls 4 times a day for 3 weeks and ice knee where it hurts twice daily.
You can get a ITB strap and wear it everyday during week one then just during Higgs and runs.

No doubt you also have a fall arch or run in what it's termed a valgus fashion so have a look for some running orthotics - these help in 75% of knee pain cases.
Hope that helps,

Niall Manifold

[neurospast]

I fully aggree with Marj. To me the chance that it is the ITB which rubs over the epicondyl lateralis (small elevation of the bone on the outside) seems rather reasonable. One of the main reasons is that you did not describe an injury mechanism (which would be plausible with a meniscal injury, you would have known.... well most of the time). Do a self assessment on this:a 1 leg squat: Can you keep your pelvis horizontal and not rotating towards the knee or away from the knee. Can you squat (as deep as possible) with the knee in a straight line in between 1st and 2nd toe (or goes it with a wobble?).b Do a clamp exs (lying on your side with effected side up) How far can you part your knees without moving your pelvis (keep a hand on the pelvis and tighten your core muscles). c Lie on your front. Tighten your core, put hands under the hips (some bones will stick into your hands), bend the knee 90 dgrs and lift knee up: does one side pushes into your hand?d Do a bridge (shoulders and feet on floor with 90 dgrs bend knees), tighten core, push pelvis up so that shoulders knees and hips are in a straight line, lift up the none affected leg by straightening knee so that on this side the shoulder, hip, knee and ankle form a straight line and keep pelvis horizontal. Do these 4 tests also for the none affected side. If there is a big difference it is likely related to the ITB or in general knee control. Another possibility is a pelvis mis-alignment which will change the biomechanics of the leg (but for this you have to see a PT). Oh yes, palpate outside of leg and see if it is tender on several places 9compare with none affected side). And Flexibility compare right left: Piriformis, hipflexors (rectus femoris and Psoas), Hamstrings Gluts and Calfs Just go on U-tube and you'll find massive ammount of tests. In case of ITB and general muscle tightness invest in a foam roller. Marj has already suggested other modalities. In case of big differences, stretching, foamrolling and work on the cause: most of time poor gluts and/or poor core strength/movement control.

[Herk_Man]

Thanks for all the info. After reading up on ITB I'm almost leaning that way. Mostly because the activity that caused it is almost perfectly described in the most common causes I looked at. I've been running long distances on mountain bike trails to train for Tough Mudder. So I've rested it for almost 2 weeks now and while I can still tell that it's not completely normal, I have done a lot of the suggested rehab exercises and I can go complete days without noticing any pain at all.

I think I'm going to take it out for a test run this next week. I did go buy a new pair of shoes that are NB and specifically made for trail running.

One question I have, I'm a little afraid to ask because I've HATED running until I started to run on trails. I'd honestly never run more than about 4 miles but when I started trail running I quickly ramped up to 9 miles and even 13 on occasion. I'm going to be really bummed if I have to cut back just to avoid aggravating my knee again.

I think I'm going to start wearing some knee support, which was recommended in an ITB article I read. And I'm hoping the new running shoes help as well. My old shoes were pretty worn and there was one worn spot on the back outside heal of the sole that would probably tend to exacerbate the issues related to trail running. Side slopes and lots of hills are the main causes cited so this worn spot would increase the angle my foot and leg would have to take to negotiate the inclines.

Again, thanks very much for the info and advice. I'll let you know how things go this week.

Herk

P.S. I can do all of the things in Neuropast's post with zero pain. It really only hurts me if I run long distances or if I sit with the leg in one position for a long time. But as soon as I manipulate it a bit, the pain goes away.

[Herk_Man]

I took the knee out for a run this morning for the first time in a couple weeks. No issues on a 4.5 mile trail run! I did some good knee stretches, wore my new trail running shoes from New Balance, and wore a knee sleeve. Very happy with the result. I'm going to be a little less rabid with my miles and try to rest a day or two between each run and we'll see if I can keep it healthy.

I really appreciate the help here.

Herk

[marj]

I took the knee out for a run this morning for the first time in a couple weeks. No issues on a 4.5 mile trail run! I did some good knee stretches, wore my new trail running shoes from New Balance, and wore a knee sleeve. Very happy with the result. I'm going to be a little less rabid with my miles and try to rest a day or two between each run and we'll see if I can keep it healthy.

I really appreciate the help here.

Herk

Well done Herk_man. Regarding the core tests, recommended by neurospast, you should try them again again observe if it is easy to keep your pelvis and trunk still and symmetrical while you move your leg. If you have trouble with any of these then do them as core exercises and then seek assistance re progressing them when you are ready. I still think you should have your muscle balance assessed by a physiotherapist, as, if you have persisting imbalances you will be vulnerable to recurrent injuries.

Keep the concepts in mind that you have mentioned re rest days and gradual building of mileage. Good luck with your event!