Meniscus Tear or Anatomical Gray Hairs?

Picture this: You’ve only been skiing a handful of times. Your friend tells you that you’ll be fine skiing through the trees. The ski rental company didn’t adjust your bindings to a novice setting. Twenty minutes later, you’re stuck in a mogul with your leg twisted in a position you know isn’t right, and your ski, still attached to your foot, is pointing in an even scarier direction.

Somehow, you’re able to get up and ski down the mountain. But when you stand up in the gondola for the next run, you hear a pop in your knee. You make it through the rest of the day, but that night your knee is swollen. The next day, it hurts to walk and squat.

Welcome to the story of how I tore my meniscus.

Six months later, I hit my best squat PR: 245 pounds. This weekend, I’m running my first half marathon.

And I never had surgery on that knee.

Acute Trauma: Go Get an Image

Let’s get the disclaimer out of the way first.

Before we talk about imaging findings from X-rays and MRIs, I am not referring to situations involving acute trauma, falls, sudden swelling, severe nerve symptoms, or other significant changes that could indicate a serious injury.

In these situations, imaging and a timely professional evaluation can be an important part of determining the severity of an injury and how to proceed safely.

If you can’t stand or put weight on your leg after a fall, your shoulder dislocates, your knee swells dramatically later that night, you hit your head, or you experience anything similar, please seek medical evaluation promptly.

This conversation is not about those situations.

Instead, what we’re talking about is the person who hasn’t experienced a specific injury but has had an achy shoulder, hip, knee, or other joint for months or years and is wondering whether it’s finally time to get it checked out.

The Common MRI Experience

Maybe you’ve had nagging shoulder, hip, or knee pain for a while that hasn’t completely gone away. Eventually, you decide to see a doctor and get some imaging to figure out what’s going on.

Then you get the MRI report. And you get a diagnosis.

The pain may have been relatively mild and manageable before the MRI. But now you know you have a “torn meniscus.”

Suddenly, you’re worried that you need to protect your knee so you don’t make the tear worse.

So you start avoiding activity. Over time, your pain gets worse…..

You assume the tear must be getting worse, so you decrease your activity even more. 

And the cycle continues.

Reframing Degenerative Changes

You may have seen some of these terms on an MRI report before and felt intimidated by what they seem to imply:

• Rotator cuff tears

• Hip or shoulder labral tears or “fraying”

• Degenerative disc disease

• Arthrosis or arthritis

• Meniscus tears

These findings can sound scary, and emotionally they very much can be.

But many of them are also extremely common, even in people who have little or no pain.

In the Training = Healthcare course Josh and I attended a few weeks ago, we discussed MRI findings and what they actually mean in both surgical and conservative care.

A few studies from our discussion really stood out.

In one study, researchers performed MRI imaging on 800 asymptomatic shoulders. Only six of those 800 people had completely normal MRIs.

None of those people had shoulder pain.

In another study, researchers performed MRI imaging on 230 people without knee pain. 97% had an abnormal finding in at least one knee, including findings such as meniscus tears.

So what does that tell us?

An abnormal MRI does not automatically equal a painful joint.

And a painful joint does not automatically mean that the abnormality seen on an MRI is the primary source of the pain.

What Does This Mean?

In the absence of acute trauma, sinister symptoms, red flags, or other concerns for serious pathology, an MRI finding may not be as detrimental, or as limiting, as it initially sounds.

Many imaging reports describe structural changes that become increasingly common as we age.

This is what I refer to as Anatomical Gray Hairs.

The tear you see on an MRI might mean as much as having gray hair on your head. Those findings can provide useful information, but they don't necessarily tell us what you can or cannot do. 

An MRI finding is data, not a prognosis.

It does not automatically mean that you will be in pain forever, that you need surgery, or that you need to stop participating in the activities you love.

For a number of common musculoskeletal conditions, research has found that appropriately selected conservative care can produce outcomes comparable to surgery for some patients. Physical therapy can often improve symptoms, function, strength, and activity tolerance without changing the structural findings seen on the MRI.

That distinction is important.

Because sometimes, the goal isn't to make the MRI look normal.

The goal is to make you feel and function better.

“My Meniscus Hurts Every Time I Squat. How Is PT Ever Going to Fix That?”

This is where things get interesting.

Even when an MRI shows an abnormality, the pain you feel is not necessarily explained entirely by that structural finding.

You may have a meniscus tear.

But the fact that your knee hurts when you squat doesn't necessarily mean the meniscus tear is the reason.

In physical therapy, we can look at the bigger picture:

• How well you produce force

• How well you absorb force

• Your strength and capacity

• Your tolerance to different movement patterns & ability to control those movements

• Your training history and activity level

• Other physical factors that may contribute to your symptoms

For example, the knee with the meniscus finding may also have significantly reduced quadriceps strength, decreased hip strength, reduced capacity, and/or movement strategies that contribute to pain with squatting.

Those are things we can work on.

More importantly, we can improve many of those factors without changing the fact that the meniscus is torn.

Your MRI doesn't have to change for your function to change.

Your MRI doesn't have to change for your strength to improve.

Your MRI doesn't have to change for you to get back to skiing, snowboarding, running, lifting, or whatever else you love to do.

Your MRI Is Information—Not a Life Sentence

If you've had an abnormal imaging finding without a significant acute injury, don't automatically assume that your favorite activities are off-limits.

Your imaging is only one piece of the puzzle.

Your symptoms, strength, physical capacity, movement, goals, activity level, and response to treatment all matter, too.

If you've received an MRI diagnosis, want to ski or snowboard this season, and aren't sure how to move forward safely, come in for an evaluation and discussion.

You may feel lost or confused about what your imaging means and what you're allowed to do now.

You don't necessarily need a perfect MRI. 

You need a plan for improving your capacity and getting back to what you love.

Helping athletes RESOLVE THEIR PAIN by CLEARLY DEFINING THE PROBLEM and IMPLEMENTING EFFECTIVE SOLUTIONS to get them back doing the activities they love!

If you are currently struggling with an injury or unable to perform in the activities you enjoy. Please follow the link to schedule a consultation call to discuss how we can help you.