The meniscus is a wedge-shaped piece of cartilage that acts as a shock absorber in the knee. There is a pair in each knee: one on the inner side, one on the outer. They are thought to be a very common cause of knee pain — meniscus surgery is the most common orthopedic surgery in the U.S.
But an article in the New England Journal of Medicine calls into question the connection between knee pain and meniscal tears. In this study, researchers recruited 991 adults age 50 and older through random phone calls; the only requirement was that they be able to walk. Participants were asked about knee pain the month before and were given an MRI of their knee.
The results were contrary to what most people believe about meniscal tears and pain. While 63 percent of people with knee pain had tears, 60 percent of those without any knee pain also had tears. Not surprisingly, the number of tears seen on MRI increased with age, from a low of 19 percent with tears in the 50 to 59 age bracket to a high of 56 percent with 70- to 90-year-olds.
It is an easy assumption that if your knee hurts and an MRI shows torn cartilage, then the pain must be from the cartilage damage. But now we know the truth is not so simple. Not only do plenty of people without any pain show signs of damage, but patients with torn cartilage and knee pain often find relief from conservative care without surgery or drugs. While those with torn cartilage in the knee may be more prone to problems, it certainly doesn’t mean the only option is surgery.
Manipulation often is very helpful for knee pain. While the treatment may be needed in the knee itself — there are manipulations to reset a displaced meniscus — the knee often “pays the price” for misalignments in the foot, ankle, hips and pelvis.
When I had my own intense episode of knee pain, the chiropractor I saw never treated the knee, just the pelvis. There was immediate relief with the first treatment, and I was able to walk without a limp.
Another great treatment option is acupuncture. Some patients respond best to a whole body style, treating traditional points. Often this is combined with treating local “hot spots” that are tender and inflamed. Others do well with ear acupuncture. The ears can be seen as a map of the body, and the spots on the ear that correspond to the problem area often are as tender as the injured part.
Once patients get some relief of their knee pain, they are more able to start a healthy exercise program, even if it is just walking for a few minutes a day to start. Exercise is a crucial part of recovery for patients that can handle it.
As with any condition, some patients have rapid, dramatic relief with care while others take a while to feel any relief. But most patients get enough relief with care that they don’t need to go on to surgery. It is best to save surgery for those cases where it really is needed, after other treatment options have failed, instead of choosing it first.
Dr. Michael Noonan practices chiropractic, chiropractic acupuncture and other wellness therapies in Old Town. He can be reached at noonanchiropractic@gmail.com.