Chapter 1:
The Quick Guide to Understanding How Your Knee Works

Chapter 2:
Guide to Meniscus Tear Recovery

This article will be your guide to meniscus tear recovery and hopefully provide some clarity on this common knee issue.  We’ll start with an easy understanding of the meniscus and what it does. Then we’ll help you identify potential issues and what research says about the most current treatment options.

The first note is that not all meniscus tears are the same and management will likely look a bit different for each case.  Nonetheless, with a better understanding of your meniscus, you can help navigate the best treatment option for you.

Quick Facts About the Meniscus

The Meniscus Picture

As we reviewed in The Quick Guide to Understanding How Your Knee Works, the knee bends and straightens like the hinge on a door.  Inside the hinge are two “C” shaped cartilage rings called the meniscus.  


It’s easily termed medial meniscus for the inner ring, and lateral meniscus for the outer ring.  Together they create a bowl for the femur to sit.  It helps provide stability for the knee and disperses loads evenly throughout the joint. It also reduces friction and adds padding to protect the bones from rubbing against each other.


When the doc says “bone-on-bone,” they’re trying to explain that the meniscus padding (along with other cartilage) is missing.  But the impression that the body is worn out like old brake pads on a car isn’t accurate and may do more harm than good.

It implies there is no way to fix the issue without a repair and the problem will only get worse.  Yet for many issues, including meniscus tears, a plan of exercise and rest often works well and is an ideal first approach (ref).

How Your Meniscus Becomes Damaged

Meniscus tears can occur in nearly any individual— ranging from elite athletes to older adults. Despite the different demands, abuse to the meniscus usually comes from landing and changing directions.

To help explain this, think of the meniscus as a wet paper towel squished between two rocks. If you merely compress the towel between the rocks nothing will happen. However, if you squish and twist the rocks, you can imagine how it would like the tear the paper towel. 

For older adults, tears develop with much less force. Think of the same wet paper towel analogy, but using a thin towel rather than a thick super-absorbent one. The thinner towel won’t take as much force to tear. Depending on the quality of the meniscus, walking stairs, or sitting or standing from a chair, could be enough force to tear the meniscus.

All of this makes the meniscus seem all too fragile— but it’s far more robust than a wet paper towel. It’s thick and rubbery, built to take a beating. Thus, not everyone with knee pain has a meniscus tear, nor does a tear even mean you’ll have pain. 

When Things Go Wrong 

Depending on the type, degree, and location, people experience different symptoms.  Below you will see the most common types of meniscus tears.  The upper row is a milder version than the more progressed version under it.


Additionally, a traumatic tear in a young soccer player will feel and recover much different than general wear and tear that’s common in people over the age of 40.


Yet, the common symptoms associated with a meniscus tear include:

  • Pain with Clicking*
  • Swelling that progressively increases over 24 hours 
  • There may be limited ability to straighten the leg completely or bend it all back all the way depending on the location of the tear.

(*Important Note- Many people have clicking in their knees that means nothing, so don’t freak out over the little creaks and pops you get in your joint.)

The gold standard for diagnosing a meniscus tear is by MRI. There are also clinical tests that can hint at a tear, which you can check out one in the video below. You can see it’s an aggressive test that could further your issue, so this is best left to a trained professional.

Acute vs. Chronic Meniscus Tears

The initial question a medical professional will often have about your injury is, “How did it happen?”  

For many tears, it occurs from a sudden or specific event such as a hard cut or land, and many report hearing a pop.  Despite the nature of the injury, most are still able to keep moving and many athletes will continue to compete in their event.  It’s not until later when they notice swelling, pain, or tightness, do they realize there is an issue. 

Meniscus tears due to accident or injury may also involve damage to other stabilizers as well.

“The unhappy triad” is the unfortunate, yet common situation, where the meniscus, anterior cruciate ligament (ACL), and medial collateral ligament (MCL) are torn during a fall, hit, or twist.  It usually occurs with force moving from the outside of the leg inwards with the foot fixed on the ground. All three structures are critical components to the stability of the knee, thus it’s a different issue altogether than just a damaged meniscus.

The other type of meniscus tear is more chronic in nature, without a cause or explanation.  These tears are more likely in people who have arthritis in the joint already. We’ll get more into treatment later, but many times chronic tears don’t make good surgical candidates due to complications from underlying arthritis in the joint (ref).  

Blood Flow

Meniscus tears also differ based on their location within the ring.  The “red-red” zone is the outermost part of the ring and has the best blood flow.  This allows for increased nutrients and metabolites to give the tissue the best opportunity to heal.  The middle section is the “red-white” zone and does not have direct blood flow, but is close enough to the red-red zone to get some trickle over. The white-white zone is the innermost portion of the meniscus ring and has the least amount of blood flow.  Tears in this area can heal, but it’s much less likely.



Treating Your Meniscus Tear

The good news is many meniscus tears will heal on their own.  Based on what we currently know, the location of the damage in either the red-red zone vs. white-white zone is most telling for the tear’s ability to heal.

Yet some factors make surgery a necessary option.  Sometimes a meniscus tear can act like a hangnail, constantly getting caught up and aggravating things.  Other times, the tear may not be severe, but in a location that gets extra abuse. Like the neverending cut on the finger that’s constantly getting bent, bumped, and reopened 

The Conservative Approach

The difficulty is that you won’t know your opportunity for rehab success without giving it a try.  A physician can make an educated guess, based on imaging and your history, but this is no guarantee.

Acute and or painful tears usually start with a period of rest to allow things to calm down,  followed by physical therapy for 4-6 weeks to improve strength and range of motion.

Some patients will find that their tear won’t afford them the option of conservative treatment.  For example, for a big flap that’s causing locking and severely limiting the range of motion point to surgery as the only option.

Other Potential Aids (That Aren’t Surgery)

Cortisone is a steroid injection into the location of the tear. Cortisone will NOT heal the meniscus, but reduces pain for 3-6 months for more effective stretching and strengthening. 

It’s helpful for taking the sting out of the issue, but won’t likely have any lasting effect without strengthening.  And the most significant trouble with cortisone is the lack of short and long term research on its use.  

PRP (Platelet-rich plasma) is a newer treatment option and a hot-button topic.  The short story is a mixture of your own blood cells is injected into the injury location to promote the healing process. 

Studies on PRP for the meniscus have been promising but not definitive (ref).  The red-red zone appears to be an effective target for PRP, while treatment in the white-white zone seems to be less effective. Again, the red-red zone heals the best because it has the best blood flow to the area. 

Ultimately PRP needs more research. We currently don’t have a great answer for who it works for, making it a system of guess and check.  Insurance is not reimbursing for it yet either, but if you’ve got a couple of hundred dollars lying around, it may be worth it.

Surgical Options

If the conservative options don’t work, there are two surgery types to help correct the issue.

Surgical Removal

One option, called debridement, involves the surgical removal of the torn area of the meniscus.  This is a minimally invasive procedure using a small camera and tools inserted into the joint via keyhole incisions. Typically individuals return to their desired activities between 6-8 weeks. 

Surgical Repair 

Or it’s possible to repair the meniscus rather than cutting out.  This is an arthroscopic procedure as well, using a small stitch to connect the meniscus back to itself.  

Although, this is a delicate process that needs careful management afterward.  Some surgeons describe the procedure as sewing tissue paper back together.  

Depending on what research you are reading, the recovery for this process can take anywhere from 3 months to full year, but the big take-home is that it’s much lengthier than simply cutting it out.

Moving Forward with Your Meniscus Tear Recovery

At this point, this is what many of you are thinking…

I can give rehab a try, but won’t know if it will work for several weeks.

Or, I could have it stitched back together, and be out up to one year.

Or, I could have a doctor cut it out, and go right back to my activities in just a couple of months. 

While the third option probably sounds the most appealing, looking past the 6-8 week recovery, there are long term consequences to consider for removing a piece of the meniscus.

Going back to the original function of the meniscus, its job to help disperse loads within the knee. Removing rather than repairing a torn meniscus leaves more contact of bone to bone, which increases the chance of developing arthritis later in life.

Ultimately it’s worth the time investment if the meniscus can be saved (ref). 

Initially, try conservative management—and I mean seriously try—where you give your knee the best chance to rest and recover properly. Even if it’s not the ultimate fix for your knee, you only lost a few weeks and set yourself up to come back better and stronger after your procedure.

If you decide on the surgical route, it’s worth discussing with your surgeon about debridement vs. repair, and how it will change your rehabilitation process and the long term health of your knees.


Getting past a torn meniscus is not a one-size-fits-all solution. There are many options for managing a meniscus tear.  Hopefully, this laid out some of the information to help you make a more informed decision going forward!

Chapter 3:
A Quick Guide to Knee Sprain Rehab

A quick turn followed by a pop of the knee may be the pinnacle of oh s*** moments. It’s a common occurrence in sporting events but also happens in everyday life.

It’s not always a grave situation—knees make creaky noises all the time and are quite robust— but the dreaded knee sprain does happen to many and is immediately impactful.

Despite the suddenness of the injury, it leaves a prolonged aftermath. Not only painful and limiting, but the biggest struggle is the extended time to heal, and potentially the need for surgery.

In this article, we’ll help explain the knee sprain and guide a path to getting you back into action.

Anatomy Review

A knee sprain is the result of damage to the ligaments of the knee joint. There are several major ligaments, and a few lesser ones, that will be covered shortly.

A ligament is a fibrous tissue that attaches bone to bone. Ligaments are often confused with tendons, but it’s a different part of the anatomy.

If you want a full review of the knee and how everything ties together, check out our Quick Guide to Understanding How the Knee Works. But if you want to get straight to it, let’s focus specifically on the ligaments of the knee.

Understanding the difference between the types of tissue in the knee is important because it helps answer the usual question…

 “How long will this take to heal?!!?”

The reason is due to blood flow! In general, the ligaments in our bodies have a poor blood supply. Bone has a great blood supply, the muscle has a great blood supply, but cartilage, tendons, and ligaments do not.

Without quick access to new blood, and therefore healing factors that our body uses to repair, it takes an extended time to heal those strained or sprained tissues.

Sprain vs. Strain vs. Tear

Damage to the ligaments gets classified as either:

A sprain is when we overextend a ligament.

A tear is when we overextend, and the two pieces lose their connection.

(Note- A strain is another common orthopedic injury term, but this occurs when we overextend a tendon or muscle.)

All ligaments have a threshold of strength. Just like a rope has an amount of force that it can withstand when holding two objects together. And just like the rope, if a ligament gets stretched too quickly OR too hard, then it gets damaged.

Each ligament provides a specific restraint to prevent the knee from going too far in one direction. Here are the major ones and usual suspects when it comes to knee sprains:

  • Anterior cruciate ligament (ACL) is commonly injured in fields sports, volleyball, gymnastics, and skiing. Typically injuries occur by a hit to the side of the knee, or if there is a twisting motion with hyperextension at the knee.
  • Posterior cruciate ligament (PCL) is most commonly injured in what is called the “dashboard” mechanism—when knees are bent to the chest (called hyperflexion) and the shin bone is pushed backward.  This happens in a car crash (hence the name) or may also occur by getting tackled while the knee is bent.
  • Medial collateral ligament (MCL) commonly injured in field and ice sports. This ligament protects the knee from bending inwards.
  • Lateral collateral ligament (LCL) protects the knee from going out and is injured much less than the MCL.
  • Medial patellofemoral ligament (MPFL) is a small but mighty ligament that helps to stabilize the knee cap in the groove over the knee. An injury to the MPFL is likely anytime there is a dislocation of the knee cap.

You have other ligaments in the knee, but you’re not as likely to injure them.

Grading Your Sprain

Sprains are graded by the level of injury to the tissue. These grading systems vary for different ligaments in the body, but the most common scale for the knee ligament injuries is I-III (least to worst.)

A grade I sprain occurs due to overstretching. It is considered a “mild” sprain and usually results in minor swelling and stiffness of the knee. Current evidence shows that a grade I sprain in the knee will heal and return to normal in anywhere from 4-8 weeks.

It’s a frustratingly long time for some “minor” stretching. But the blood supply issue pushes the healing time out longer than most people suspect. And since the knee is so crucial to getting around, even minor discomfort doesn’t go unnoticed.

A Grade II sprain means there is a small tear, but it’s not all the way through the ligament. At this time, it’s unknown how much those sprains truly heal, but it’s safe to assume that you can get back to your sport after some time off. 

A Grade III sprain is equivalent to a full tear in which the ligament has torn apart from itself and don’t expect these to heal. Grade III sprains often undergo surgery, although there are currently many valid non-operative options.

Diagnosing Your Knee Sprain

If you’ve been hit with a knee sprain, start by looking for the following Red Flags as a reason to seek further medical evaluation.

Medical Red Flags

  • Knee gets “locked” in position- either bent or straight
  • New onset of painful clicking or catching
  • Feeling of instability or giving out
  • Swelling that lasts >5 days

If you test out of all these and want to save the time and money, then it’s fine to wait it out.  

But, if you’re worried about your knee, get it checked out by a medical professional for peace of mind.  It’s not really an emergency situation though, so no need to rush to the emergency room.  

If you have direct access to a physical therapist in your state, this is probably your best resource for the sake of time, cost, and a more comprehensive recovery plan when appropriate. Otherwise, a general practitioner or urgent care clinic can evaluate the issue and provide further recommendations, which are usually rest and anti-inflammatories, and potentially a referral for a sports medicine doctor (ref).

The Process for Knee Sprain Rehab

If you’ve sprained your knee, the first question is likely: What should be done? It’s a simple, yet challenging task, and that is resting the injury.

Rest will be slightly different for each type of sprain, but in general, it means eliminating painful activities. In the best-case scenario, inflammation takes about 14 days to resolve. Thus, the rule of “if it hurts, don’t do it” is a safe bet to follow for 2 weeks. Trying to push through the pain will only bring further inflammation and ultimately slow healing time.

In total, you’re looking at a healing time of 6-8 weeks, but will be feeling better between 2-4 weeks. You will notice a reduction in swelling, and your range of motion will return to normal. You’ll feel that it’s time to get back to life—unfortunately, it’s not done healing.

It’s in the window of weeks 2-4 that people run into issues because they jump right back into their previous activity level. Even though the knee feels better, it’s still missing some stability, which increases the risk of hurting the same ligament again. If not something worse!

It’s during these weeks that a properly structured exercise plan becomes super important.

Low impact exercises targeting the glutes, core, and leg muscles will keep those muscles engaged, while healing occurs. This makes it easier to return to full activity, and potentially even solving some of the underlying strength issues that caused the knee sprain to happen.

If you need help with this, we walk you through everything in our 30-Day Knee Fix.


Preventing Knee Sprains

As Ben Franklin once said, “An ounce of prevention is worth a pound of cure.” And considering the time and limitation caused by a knee sprain, an effort towards prevention is worth it. That’s especially true if you’re at higher risk, like in a sport with lots of contact or cutting.

When it comes to knee sprains, there are some things you can’t control. These are known as non-modifiable risk factors and include items such as:

  • Ligament Size (some people just have smaller ligaments)
  • Gender (women are at higher risk of knee sprains)
  • Physical requirements of a sport or task (for example, soccer players are at higher risk of knee sprains than bowlers.)
  • Background or history of training (previous time spent working with a strength coach)

Yet there are still things you can do to reduce the risk of knee sprains.


Building the strength of your muscles can help reduce the risk of a knee injury.

The knee is a rather simple joint—which flexes and extends—using the ligaments to keep it along its tracks. A blow to the knee can knock it out of place damaging the ligaments, or forces of just bodyweight moving in an awkward direction can strain a ligament as well.

That’s where strength and stability come into play for protecting the knee joint. Strong muscles slow the body and effectively transfer forces.

For example, the picture above shows the common mechanics for non-contact ACL tears. Someone with weak external rotators is 8x more likely to injure their ACL than someone who isn’t (ref). That’s because the external rotators (AKA- the glutes) help to control the position of the knee when landing and changing direction without overloading the ACL.

Speed and Timing

Again, speed is an essential component behind injuries to the ligaments as well. You could demonstrate the above position slowly and have no risk of injury, but if you got pushed that way, things could easily go wrong.

Again, we prevent entering these positions through the control of the hip extensors, abductors, and extensors. But it’s not enough to just have the strength of the muscles, it’s also essential to engage them quickly and with the right timing.

For that reason, practice and training of explosive cutting and jumping in a controlled situation helps prepare athletes to safely take on the demands of their sport. In sports performance training, this is commonly known as plyometrics, but it’s important for more than just sports performance.

For Now and Forever

If you landed on this to help get past your knee sprain, I hope you found the answers you were looking for. It’s going to take some time, and we would love to help guide you through that.

Our 30-Day Knee Fix will give you a progression of strengthening and active rest to get you back to where you once were.

But it doesn’t end there!  Hip and Core strengthening is an important part of knee injury prevention and should be part of every athlete and active person’s regiment.   Be sure to check out our glute and core guide to learn more about the key muscles needed to fight off injury.

Chapter 4:
The Crossover Approach to IT Band Syndrome