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The meniscus is the shock absorber of the knee. It is a C-shaped wedge of cartilage that cushions the joint and improves stability. Tears in the meniscus are incredibly common, both from acute twisting injuries (sports) and from degenerative changes over time (wear and tear).
A torn meniscus can cause sharp pain, swelling, clicking, and the frightening sensation of the knee “locking” or getting stuck. For many years, the standard treatment was Arthroscopy—going in and cutting out the torn piece.
However, modern research has shifted. We now know that removing the meniscus increases the risk of arthritis significantly. Furthermore, many “meniscal tears” seen on MRI are actually painless findings present in healthy people. The pain is often coming from somewhere else.
At Breakthrough Pain & Performance, we specialise in the conservative, non-surgical management of meniscal pain. We act as detectives to find out if the pain is truly coming from the tear, or if it is coming from the neurological guarding surrounding it. Often, by relaxing the protective muscle spasms and restoring joint mechanics, we can make a “symptomatic” tear become asymptomatic.
Patients with meniscus tears often report locking—they cannot fully straighten the knee. The assumption is that a flap of torn cartilage is physically blocking the joint (a “bucket handle” tear). While this happens, it is a surgical emergency.
However, in many cases, the locking is Pseudo-Locking. It is caused by a spasm of the Popliteus Muscle. This small muscle at the back of the knee is responsible for “unlocking” the knee to allow it to bend. If the knee is traumatised, the Popliteus goes into a massive protective spasm to hold the joint still. It acts like a doorstop.
This feels exactly like a mechanical block. The joint won’t open. But it is soft tissue, not bone or cartilage. We treat the Popliteus neurologically. We use reflex points to tell the brain to release the spasm. In many cases, the “locked” knee opens up fully in a single session. This confirms that the meniscus was not the block, saving the patient from unnecessary surgery.
The outer third of the meniscus has a blood supply (the Red Zone), but the inner two-thirds (the White Zone) does not. It relies on Synovial Fluid for nutrition. This fluid is pumped into the cartilage when you move and compress the joint.
If you rest too much because of pain, the meniscus starves. It becomes brittle and painful. Healing stops.
We use safe, unloaded movement to feed the meniscus. We might use a stationary bike with zero resistance, or specific leg swinging drills. This pumps nutrient-rich fluid into the tear without stressing the fibres. We accelerate the healing process by facilitating the knee’s natural biology.
Pain on the joint line (the gap between the thigh and shin bones) is the classic sign of a meniscus tear. However, the Saphenous Nerve runs right over this area. If this nerve is entrapped or irritated—perhaps by tight muscles in the thigh or a knee brace—it causes burning pain exactly over the meniscus.
We differentiate between the two. We test the nerve mobility. If we can reproduce your pain by stretching the nerve, or relieve it by flossing the nerve, then the meniscus is likely an innocent bystander. Treating the nerve entrapment resolves the pain, regardless of what the MRI says about the cartilage.
In degenerative tears, the meniscus can be squeezed out of the joint (extrusion). This means it stops acting as a shock absorber. The bones start to touch.
The brain senses this loss of cushioning and tightens the hamstring and calf muscles to compress the joint for stability. This increased compression wears the joint out faster.
We focus on Unloading. We strengthen the Gluteus Maximus and Medius to take the load off the knee. If the hip is doing its job of absorbing shock during walking, the knee doesn’t have to. We teach you how to walk and run “softly,” using your muscles as shock absorbers rather than your joints.
We are honest clinicians. If you have a true mechanical block (you physically cannot straighten the leg despite muscle release) or if the knee is giving way due to a massive tear, you may need surgery.
However, even in these cases, Pre-habilitation is vital. Going into surgery with full range of motion, no swelling, and active muscles leads to a much faster recovery. We prepare your knee for the operation and guide you through the rehab afterwards.
1. Unlock: We release the Popliteus and Hamstring spasms to restore full extension.
2. De-Swell: We use lymphatic techniques to drain the fluid. Fluid inhibits the muscles.
3. Feed: We prescribe high-repetition, low-load movement to pump nutrients into the cartilage.
4. Strengthen: We build the quads and glutes to act as the new shock absorbers.
This clinic is for you if:
We help you keep your natural parts for as long as possible.
