Runners often develop knee pain. If given enough time, or perhaps cross training and physical therapy that pain will often subside. When a runner sees an Orthopedic Surgeon they may be referred for an MRI. Virtually no one over 40 has a “normal” knee MRI. Upwards of 30-35% of runners over 50 have meniscus tears. Runners might be inclined to jump for surgical options thinking they might be able to get back to running sooner. That’s not the best strategy if you wish to continue running for years to come. So an MRI of a runner’s knee with pain might show a meniscus tear. Does that mean that the meniscus is the cause of pain? Does that mean that the runner needs surgery? Can they continue running?
Running is a great exercise. Runners are a unique breed of athlete to treat. Running is meditative and enables us to relax, as we hit our goal of exercising a few days per week. If we cannot run because of a meniscus tear or knee pain we will be very upset. As you can imagine this blog receives hundreds of private comments each month. The following questions appeared three times recently in slightly different formats… The questions centered around running and meniscus tears.
- Can I continue to run with a meniscus tear?
- Can I make a meniscus tear worse if I run?
- Will meniscus surgery help me run better?
As you know, we have two menisci in each knee, we discuss what a meniscus is here. Most meniscus tears, especially in runners tend to occur along the posterior horn of the medial meniscus. These tears tend to be degenerative, possibly (but not proven to be) associated with a long running career.
Runners and meniscus tears?
Meniscus tears can present in two different ways in runners. Whether or not you can run depends on which group you are in.
Group 1: Most runners find out that they have a medial meniscus tear because they head to an Orthopedic Surgeons office when their knee hurts after a run. Most runners do not recall any one particular injury- that’s why we call these degenerative tears. This group of runners with a meniscus tear are able to run. They have varying amounts of pain after the run, or during the run, especially if they run on a cantered road, or a trail. This group is most concerned with making the tear worse if they continue to run. They wonder if they can continue to run despite having a meniscus tear.
Group 2: Sometimes a runner presents with pain on the inner side of the knee or the back of the knee. The pain is severe enough that they can not run, squat, pivot or twist. These runners are concerned because they are not able to run. Because runners are so committed, and often “need to” run, they may overreact and choose the wrong treatment option.
What is causing the pain? Often times when these degenerative tears initiate or occur the knee pain will be more severe for a few weeks. Yes, a few weeks… perhaps even a month or two. The pain is usually due to a synovitis (inflammation) which will often settle down over time. Here’s where many runners get into trouble. They rush into a docs office, they get an MRI and surgery is scheduled before they give the pain a chance to improve on its own. A meniscus does not have nerves in it. The tear doesn’t hurt. The inflammation because of the tear leads to pain. It may take 4-8 weeks for that inflammation to settle down. And yes, the inflammation can settle down without having surgery on the tear.
Having part of your meniscus removed – torn or not – as a runner could end a long running career. Surgery for a meniscus tear in a runner might help for a short while, but the loss of meniscus might initiate an arthritic process causing more degeneration within the knee. Runners in general have a lower incidence of arthritis than a non-runner — but not if part of the meniscus is removed.
Can I run with a meniscus tear?
First off… many if not most meniscus tears do not require surgery. Surgery will not prevent arthritis from occurring. Many runners get back on the road, even elite runners, with a degenerative meniscus tear. If you have a mild ache during the run, or a mildly sore knee after a run then you can often continue running. There is very little risk that running will worsen the tear. You may wish to wear a compression sleeve during the run. Compression sleeves have been proven to improve knee pain and improve a sense of knee stability. If you run on a cantered road, perhaps change the direction you run. If you run single track trails perhaps run on carriage trails. Those little changes can make a big difference. Surgery for a meniscus tear in a runner should be considered only if:
- the pain continues and is severe enough that you can not run.
- your pain did not improve with appropriate physical therapy – yes it works.
- a compression sleeve does not improve your symptoms
- you waited at least 6-8 weeks for your knee to recover on its own.
- you have no evidence of moderate or severe osteoarthritis.
Meniscus surgery in a runner.
If you are a runner and the pain you have from a meniscus tear is keeping you from doing what you love then there is a chance that surgery might be the right option for you. As long as you do not have confounding issues such as osteoarthritis then you might feel great after an arthroscopy for your meniscus tear. But remember, there is a chance that you will not feel great. The decision making variables here are key to ensure best chance of success. Understand the principles of shared decision making before signing the dotted line. Perhaps consider seeing an Orthopedic Surgeon who is also a runner. Being an active trail/endurance runner gives me a much greater appreciation of just how important running is in your life!
When can I run after meniscus tear surgery?
Runners start to whither if we can not run. I am one of you! I get it! But rushing back out onto the road is a recipe for a disaster if you return to running too soon. When a part of the meniscus is removed, the physics of how the knee works and the stress that certain parts of the knee are subject to changes significantly. You must allow for the knee to recover and get used to its new environment. That might mean returning to running at 4 weeks, or it might mean 6-8 weeks depending on the appearance of the other structures in your knee at the time of surgery. If you head back out on the road and your knee swells significantly then your knee is telling you that it is not ready. Do your exercises and wait a few more weeks. Plan on slowly adding your miles back. Plan on slowly adding to your pace. Do not plan on intense interval, track or hill work for at least 3 months after meniscus surgery. Think long term… we are trying to prevent secondary damage to your knee and give you a longer running career.
Disclaimer: this information is for your education and should not be considered medical advice regarding diagnosis or treatment recommendations. Some links on this page may be affiliate links. Read the full disclaimer.