Can I make a meniscus tear worse if I run on it?

Runners often develop knee pain.  Some make the mistake of rushing for an MRI of the knee too soon.   If given enough time,  cross-training, and physical therapy your knee pain will often subside.  Degenerative “posterior horn meniscus tears” are very common in runners. Most runners will not need knee meniscus surgery… and most runners will be able to return to running.   As a matter of fact, meniscus surgery in some runners might end their running career.    

When a runner sees an Orthopedic Surgeon they may be referred for an MRI.  Keep in mind. Virtually no one over 40 has a “normal” knee MRI.  Upwards of 30-35% of runners over 50 have meniscus tears. Does a runner have to stop running because of a meniscus tear? 

Runners are often inclined to jump for surgical options thinking they might be able to get back to running sooner.  That might be the wrong decision.  

That’s not the best strategy if you wish to continue running for years to come. As we discussed earlier in this blog, having a portion of your meniscus taken out can predispose you to develop arthritis of the knee. For every runner who might have done well following an arthroscopy, there are one or two who never went back to running.  The key, as we will discuss is patience, and not making quick emotional decisions about how to treat your meniscus tear if you are an active runner. 

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.

Most common questions from runners with a meniscus tear: 

1. Can I continue to run with a meniscus tear?
2. Can I make a meniscus tear worse if I run?
3. 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 tears, 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 go to an Orthopedic Surgeon’s office when their knee hurts after a run.  Most runners do not recall any one particular injury- that’s why we call these degenerative meniscus tears.  

This group of runners with a meniscus tear is often 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. Most of these runners only require a good explanation that running will not make things worse.  

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 cannot 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 synovitis (inflammation) which will often settle down over time.  

Here’s how many runners get into trouble…  

Runners 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 itself doesn’t hurt.  The inflammation because of the tear and the nearby tissues the torn piece irritates.   It may take 6-12 weeks or more for that inflammation from the meniscus tear to settle down. 

And yes, the inflammation within the knee due to a meniscus tear in a runner can, and often does settle down without having surgery on the tear.

The research into these degenerative meniscus tears that often occur in runners has been pretty clear.  The vast majority of runners are able to avoid meniscus surgery.  

Having part of your meniscus removed 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.  On the contrary,  osteoarthritis may actually worsen faster if a runner has meniscus surgery. 

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.  Meniscus tears can always worsen… remember, this is a process of degeneration.  The meniscus has been changing or wearing out for a decade. 

That degenerating process won’t slow, even if you change to just walking. No one can promise you the tear will never become larger.  That’s like guaranteeing you that you won’t need stronger glasses or won’t lose more hair as you age :-(.  

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 beyond 3 months and is severe enough that you cannot 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.
• your surgeon strongly believes that it is realistic that you could return to running after surgery. 

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 arthroscopy for your meniscus tear.  

Runners with osteoarthritis and a meniscus tear are often considered a good candidate for a different procedure which I go into detail here.  

But remember, there is a chance that you will not feel great after knee surgery for a meniscus tear. The decision-making variables here are key to ensure the 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 cannot 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 change 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 an 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.