The main causes of injury to the meniscus are trauma, aging and overuse. Trauma may be sudden twisting or pivoting during sports or other physical activities normally in contact sports like football and basketball. With aging, our meniscus loses its flexibility and can become more susceptible to injury and this can occur with minimal force. Repetitive stress and wear on the knee can lead to degenerative changes and injuries to the meniscus.

Signs you may have a knee meniscus injury include pain when twisting or rotating the knee and during weight-bearing activities such as walking and squatting. Swelling may occur 6-24 hours after the injury and feel full or tight especially when bending or straightening the knee. You may experience reduced knee range of motion and find your knee to be catching or locking. In addition, the knee may feel unstable, causing a buckling sensation.

The Royal Australian College of General Practitioners (RACGP) has produced guidelines for the management of knee osteoarthritis, providing moderate evidence for the following interventions:

• Cognitive behavioural therapy (CBT) may benefit an individual with knee osteoarthritis when considering psychological comorbidities including depression and anxiety.
• Stationary cycling and hatha yoga may be beneficial to those who are finding more strenuous land-based activities difficult. Both cycling and yoga can be considered gentler exercise, though walking and strength-based exercises have been shown to provide greater benefits.
• Aquatic exercise or hydrotherapy can improve knee function. Although the water is a resistance and the knee joint can be loaded in an aquatic setting, it should be noted that there is less load on the knee joint in this environment and therefore, not as beneficial as land-based exercise.
• Massage therapy can be considered as a short course treatment and only has an adjunctive therapy to active interventions.
• Manual therapy including stretching, soft tissue mobilisation, joint mobilisation and joint manipulation can be utilised but only in conjunction with active interventions.

In the early stages of a knee meniscus injury, pain management and inflammation control are important and your physiotherapist may use ice, elevation and TENS to reduce pain and swelling. Passive interventions such as soft tissue mobilisation, joint mobilisation and passive range of motion exercises may improve joint mobility and reduce stiffness. Active interventions to increase strength of the joint and return you to your normal activities will be used. These include isometric exercises progressing to closed-chain exercises and eventually open-chain exercises to gradually expose your knee to increases in load. Following this, functional and activity-specific exercises will be prescribed. These may include sport-specific drills for athletes or functional movements like lunging and squat variations for those returning to work.

• Cognitive behavioural therapy (CBT) may benefit an individual with knee osteoarthritis when considering psychological comorbidities including depression and anxiety.
• Stationary cycling and hatha yoga may be beneficial to those who are finding more strenuous land-based activities difficult. Both cycling and yoga can be considered gentler exercise, though walking and strength-based exercises have been shown to provide greater benefits.
• Aquatic exercise or hydrotherapy can improve knee function. Although the water is a resistance and the knee joint can be loaded in an aquatic setting, it should be noted that there is less load on the knee joint in this environment and therefore, not as beneficial as land-based exercise.
• Massage therapy can be considered as a short course treatment and only has an adjunctive therapy to active interventions.
• Manual therapy including stretching, soft tissue mobilisation, joint mobilisation and joint manipulation can be utilised but only in conjunction with active interventions.