TORN MENISCUS: EFFECTIVENESS OF CONSERVATIVE TREATMENT IN WATER
SURGICAL INTERVENTION IS NOT ALWAYS NECESSARY. THE CURRENT APPROACH IS TO PRESERVE THE STRUCTURES WHICH CAN “MAKE IT ON THEIR OWN”. SO, WHEN POSSIBLE, CONSERVATIVE TREATMENT IS PREFERRED, AND WATER ACTIVITIES ARE ESPECIALLY BENEFICIAL.
by UMBERTO BORINO - [email protected]
Degree in Physical Education, professional athletic trainer, certified kinesiologist, rehabilitator for the U.C. Sampdoria football team, owner of the Motor Activities Centre in Domodossola, Italy.
The menisci are fibrocartilaginous structures located within certain joints of the human body. The best known are those of the knee: one internal or medial, shaped like a C, the other external or lateral, with a more rounded shape. Their function is to cushion the weight load and to help stabilize the knee.
Lesions of the medial meniscus are roughly 5 times more frequent than those of the lateral meniscus.
DOES TEARING OF THE MENISCUS ALWAYS HAPPEN BECAUSE OF DAMAGE TO A KNEE LIGAMENT?
No. There are wear-and-tear injuries that cannot be traced back to a traumatic event. They affect people over 40, in whom degenerative conditions are most frequent.
DOES A TORN MENISCUS ALWAYS REQUIRE SURGERY?
No, all the so-called “edge tears”, that is to say, injuries to the most peripheral part of the meniscus, are potentially capable of repairing themselves, since this area is vascularized and an anatomically valid scar can form. In some cases it takes time, but the problem can be resolved without the need for surgery.
WHY ARE WATER WORKOUTS CONSIDERED BENEFICIAL FOR THE RECOVERY PROCESS?
Water can reduce the functional limits of those suffering from motor impediments, because it supports most of the body weight. The water temperature (32°C-34°C) has an analgesic effect, and in fact raises the threshold of pain sensitivity, while also producing general sedation and muscle relaxation, with the result of facilitating movements and postures that would be impossible outside the water. All this frees the mind from fears and insecurities caused by the fear of pain, and therefore one can resume both everyday movements and those needed for athletic activities in shorter times.
Promote movements and postures that would be impossible out of water
HOW SHOULD FUNCTIONAL RECOVERY BE MANAGED AFTER A DOCTOR HAS DIAGNOSED THE PROBLEM AND EXCLUDED SURGERY?
Carefully, aiming initially at a full articular and proprioceptive recovery, then gradually moving on to muscle recovery. It is a common mistake to set excessive workloads with the intention of shortening recovery times. Loads must be set appropriately, evaluating the individual characteristics of each person, whether they are athletes or not.
WHAT ACTIVITIES SHOULD HYPOTHETICALLY BE INCLUDED IN AN EXERCISE PROTOCOL?
In addition to swimming, there should be motor activities that include the use of small and large equipment designed and made to be used in water, capable of differentiating movements and responding to the needs of the person.
We can divide them into
1. Deep water activities (without impact), to reduce joint loads:
- Running with the use of swim belts (picture 1), first without then with diving fins;
- Dorsal pedalling (picture 2), first without then with diving fins;
- Working on the joints to recover flexion, extension, adduction, abduction and intra-extra rotation movements.
2. Medium-depth water activities (with impact), useful for proprioceptive and muscular reinforcement, since it provides more points of support:
• Moving forward, laterally, backwards, using floating and non-floating resistance bands;
• Use of large equipment such as the Galaxy Aquabike (picture 3), Aquatreadmill (picture 4), step, and elastic carpet "Round Jump" (picture 5)
DOES AN UNSUCCESSFUL CONSERVATIVE TREATMENT MAKE SURGERY ADVISABLE? IN THAT CASE, WAS THE WATER WORKOUT POINTLESS?
Absolutely not! The improvements (articular, muscular and proprioceptive) allow you to undergo surgery in the best possible physical condition. In fact, it is always advisable to precede the operation with a preparatory phase of well-focused motor activity.
To help those who don’t have much experience with water get comfortable with it, deep water exercises can be performed using the raft designed for children’s activities (picture 6), dorsal pedalling or running (main picture).