yo what's up it's Eric Wong here from Precision Movement and today we're gonna
talk about the meniscus and how to recover from a knee meniscus tear
so I'm actually dealing with a Nima's meniscus tear right now myself I got
mine at the time of shooting this video about two and a half months ago and I
would say I'm about 90 to 95% to being 100% okay and we're gonna talk about
exactly how to diagnose it with three different tests as well as four
exercises to help you get to full recovery now these aren't all the
exercises that you're you're gonna need and it depends on what sport you do but
these exercises will help to restore the core functions of the knee and to ensure
that you have the movement and mobility that's required to keep a meniscus
healthy for the long term okay so I got my meniscus injury and I've injured the
medial meniscus because I was doing some exercises experimenting with some
exercises and I got a little too aggressive and after there's some
rotational stuff of the knee some deep squat crawling so then he was in full
flexion and I had to be rotational on got my meniscus tear and right away the
first few days it was very very stiff okay now one way to differentiate
between a joint or a connective tissue injury and a muscular strain is simply
just do isometrics and activate the different muscles activate quads
hamstrings calves adductors whatever muscles that you suspect might be
involved do a strong isometric contraction and if there's no extra pain
or if there's just a little bit more pain then it's likely that you've got a
connective tissue injury and not a muscular strength okay because if you've
got a muscular strain and you do a strong isometric contraction of that
muscle you're gonna feel it okay so that's one quick way to differentiate
between muscular strain and connective tissue like meniscus
injury yep so let's go through go through three
tests for the meniscus specifically so the first test is just palpation there's
gonna touch the joint line so find your knee and touch right in the medial
aspect here and just kind of add some pressure and if you've got some
tenderness going on somewhere in this area you might have a meniscus injury
same with the lateral line you can just kind of palpate and rub right along the
knee joint there and if you've got some tenderness suspected meniscus so that's
the first test you can do just kind of get a general idea next up we're gonna
go and do some open chain tibial rotation so the tibia can rotate
externally so when the knee is flexed only not when it's extended when the
knee is flexed you can rotate the tibial tibia externally and internally okay so
here to test your meniscus first you want to go to lift the leg up and then
actively bring your knee to flexion into flexion so if you've got an injury
you're gonna be limited and you're gonna maybe hit an area like oh right there is
where I have pain so at that area you want to go into external rotation and
internal rotation and one of those directions is likely going to increase
your level of pain if it's external rotation that increases your level of
pain that's your medial meniscus if it's internal rotation that's your lateral
meniscus okay so here now we've got a little more information on what tissue
exactly is painful so again active knee flexion to the point of pain once you're
there go to external rotation external tibial rotation that's gonna be medial
meniscus and then internal rotation that's going to test your lateral
meniscus and you can add a little more flexion just to increase the pain there
okay so that's going to tell you okay lateral medial meniscus figure out what
shit is then we'll know what we've got a target well we don't even have to target
anything we still want to restore full function of the joint regardless of if
you have lateral or medial yeah just something to look out for final test
will go through is simple one knee extension
full knee extension so straighten your knee and if you cannot achieve full knee
extension what that's indicative of is you might have what's called no one has
a bucket handle tear of the meniscus and that's when basically the meniscus
there's a rip right in the middle and it's like you could like the handle of a
bucket yep what's showing here is that the flap might have folded over and now
it's lit basically like say the meniscus is normally like this flat folds over
itself you cannot go to a full extension pulling the extension anymore because
the compression is gonna happen and you won't be able to straighten through
otherwise you'd be really squeezing that tissue hard and that would cause just
too much pain so if you cannot achieve full in the extension you might have a
flap that's kind of folded over and something that happens with that issue
is a lot of times it might just go away on its own the flap might just restore
itself one way to facilitate that is with a little bit of traction okay so
with this we just loop a band around your ankle lie down and have to bend
pulling that way that's just gonna decompress the joints a little bit and
it might allow that meniscus flap to go back and lay flat okay so it's not
folded over alright so there you have a few different tests to figure out a is
it my meniscus and B what kind of meniscus tear do I have whether it's
medial lateral bucket handle just gives you a little bit more inferring
information but regardless the treatment is gonna be pretty much the same now
there's a study out in 2013 in the New England Journal of Medicine that tested
physiotherapy versus surgery okay they had two groups and there was like 350
patients two groups and split them in
half sent them into either physio or surgery
and what they found is that six months the pain outcomes and functional
outcomes we're pretty much the same between both
groups now that's very important to note however what they found is at the
six-month point thirty percent of the people who started in the physical
therapy group moved over to the surgery group okay so basically what this means
is it's probably a good idea just to start with exercise and if you're going
for six months and you find either the pain is maintaining staying the same or
it's getting worse then surgery might be a good idea yeah I'm not against surgery
at all I just think that a lot of times that's prescribed too early where we
could try these more conservative op op treatment options and find the same
level of success so my suggestion is start with exercise give it a good go at
least three months but up to six months and then make your decision if you want
to go into surgery at that point okay so if you don't want to go into surgery
and you want to do some exercises let's do that right now
so the first technique should stay down call it open chain of tibial rotation
isometrics so what you're going to do is yeah you've got a sore meniscus you're
gonna find the end active range okay so let's say this is my end active range
and any more than that I get pain okay so end active range you want to back off
just a little bit from there and all we're gonna do is internal a nice
external isometric so from here you're gonna go to external rotation and you're
gonna keep externally rotating for five seconds hold it and then you're gonna go
into the internal rotation and hold it for five seconds and you can do three
repetitions of either of those okay what this is doing is we're firing up the
muscles that obviously create external and internal rotation so this is going
to help to facilitate blood flow in the area which is going to facilitate
healing because if you're not moving and you're not creating the forces that need
to go through the knee for it to be healthy you're not going to bring in the
forces that are needed strengthen that tissue so the meniscus
is just like ligaments it's just like tendons just like muscles your response
to force and when you load it through in this case external and internal rotation
you're creating those forces and that's going to stimulate recovery yeah it's
user to lose it if you're never loading it your body's not going to adapt and
make that tissue stronger all right so that's the first one I just want to do
three repetitions hold your five seconds in either direction
think of it as kind of a warm-up and a restoration and activation of this
movement pattern and of these muscles okay next up simple squats two painless
end range doing 10 10 repetitions however you normally squat like if
you're if you do back squats or front squats in the gym whatever your stance
is do the same stance this is kind of as a guide to where you're at okay because
your range of motion is going to tell you if you're progressing or not so if
you can normally just get down to there before you feel pain then after a week
or two weeks you should be able to get a little bit lower each time okay so ten
repetitions just squat the end range and like I said I'm about two and a half
months in and I can start to feel it right about there okay so pretty good
all right so that is the second exercise third exercise
hip bridges with ankle plants here in dorsiflexion so there's a couple key
points here I'm gonna lie down in the supine position okay and I want first
thing to set up that's actively go into knee flexion and then once you feel the
pain back off of that range a little bit okay so just get out of the painful end
range so all these exercises we shouldn't be going into pain repeatedly
and trying to force our way through it but we just work just before pain is
elicited and we're still gonna build strength beyond that range and this will
help again to facilitate recovery blood flow build strength and progressively
build strength throughout the full range okay so here you're gonna hip bridge
first activation is just squeeze the glutes fire them up bridge up and then
from here maintain the position of the pelvis and the spine and you're just
gonna go into plantar flexion so lift the heels off the ground by activating
the calves and then slowly into dorsiflexion ya plantar flexion breathe
hold just a couple second old and
dorsiflexion okay so this you're gonna do anywhere from four to six cycles of
the planter in dorsiflexion and then do three repetitions of that okay what this
is doing is a lot of the exercises that we do are gonna build the knees from
above so quads hamstrings those muscles this exercise helps to build the knee
stability from below okay the calves tibia to Vialis anterior okay so this
way we're hitting all of the muscle groups needed to keep the knee healthy
okay so that's the hip bridge with ankle planter and dorsiflexion three
repetitions with four to six cycles between ankle planter and dorsiflexion
now the last exercise that we're gonna do you've got to be really conservative
with I call this one leg tibial rotation squat okay so this one you want to go
really slow and controlled do not go into this with momentum or with speed
otherwise you're gonna injure yourself but if you do this properly
you're gonna strengthen exactly what you need to strengthen to keep the knee
healthy okay so you're gonna load up one leg so working on my left knee here and
all I'm gonna do is I'm gonna squat down keeping the weight on my heel and the
ball my foot especially underneath the big toe okay
the weight is evenly distributed there and I'm just gonna squat down and drive
the knee outside of my foot to the left but make sure you plant the ball of the
foot the foots gonna want to lift up like that I want to plant the foot
pressure on the foot on the ball and the heel and then I'm pushing myself up
through this leg okay from there I'm gonna go tibial external rotation so the
knee goes the inside you can see how it's as if the tibia externally rotated
that way same thing squat this time keep the feet flat but a
little more pressure on the outside ball of the foot so the pinky toe okay
and heel foot stays flat just go slow painless and range and then drive
yourself back up using these muscles okay this is just here for balance my
right leg so again drive the knee to the outside
of the foot think of pushing the ball of the foot down keeping the heel flat on
the ground and then push up through the painless end range and then on the
inside of the foot think of pushing through the pinky toe metatarsal and
keep the weight on the heel here okay and you want to do about six repetitions
of either going slow and under control think of with that map I call it the
movement and/or activation pattern that I described and that's gonna build up
the stability of the whole lower limb from the foot up to the hip yeah so it's
gonna integrate that all and what you'll find is as you do these exercises I
recommend you do them on a daily basis it's not a lot it's gonna once you get
them down it's gonna take you about five minutes to do but this is going to
simultaneously speed healing build strength and stability and it's gonna
ensure that you're increasing the mobility the range that is needed okay
because if you don't have good rotation of the tibia then any time you get into
that whether it's a sport or training whenever you're forced there you're
going to hit and range very quickly and that's where you can damage the tissue
okay so those are four exercises to get you on the path to the full recovery if
you're just doing extensions and hamstring curls you're
gonna heal the minister is just gonna heal over time but you're not building
that all-important rotational mobility of the knee that is critical for
meniscus injuries yeah you've got to restore that so there you have it
tests and exercises for full medial or full meniscus recovery and whether it's
medial or lateral it doesn't matter okay if it's medial in my case you're just
gonna hurt a little bit more whenever you do tibial external rotation
techniques so turning the foot out or when you're squatting the knee going
inside the foot yeah and vice-versa for lateral the pain is
gonna increase a little bit sooner but you're always working the painless end
range anyway so it doesn't matter and these techniques apply to both
conditions alright so this is these are just four exercises now I've got a
complete course called lower limb control that works everything restores
full function and takes you from basic techniques some of which we showed here
to more advanced techniques where you're actually getting into some ballistics
and some jumping some plyometric type techniques okay and that's important to
train as well because if we're jumping we're running in real life and we got to
rehabilitate ourselves using those techniques so we don't continue to
reenter ourselves and continue to stress those tissues so check that out
you go to precision movement coach forward slash and lower - Liam - control
put a link down there - expect you to remember that in the description and at
the end of the video if you want to ensure that your whole lower limb is
functioning properly to prevent injury and heal any problems that you're having
right now ok so thanks again for checking this video out I'll see you
next time peace
you
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