None of us ever want to admit that we are getting older. However, the creaking and popping of the
knees on the way up the stairs or limitations with walking, hiking, skiing or pickleball are a quick
reminder that wear and tear is a real deal. A few weeks ago, I had a 48-year-old pickleball player come
into my clinic looking for help with his knee pain. He had stopped playing on a weekly basis, and was
having problems with running and jogging.
Presentation: The pickleball player presented in my office for his first visit with limited motion, pain with
squatting motions, limited dynamic activity and mild quad weakness. He further explained that beyond
his limitations with sports and every day activities, he was really struggling to sleep at night due to the
deep ache at the knees. At this point his wife stated that he was ‘walking like a 90-year-old’ and it was
time to get something done.
Treatment: PT started with a clinical examination and a sonographic image of the knee or what is called
musculoskeletal ultrasound. The exam identified the main problem of meniscus pain with a mild tear of
the medial meniscus visualized on the ultrasound image. From there, I knew exactly how to start
treatment to reduce the pain and inflammation, gradually restore full pain free motion, maintain
strength of the quad and hamstring, and protect the medial meniscus during the healing phase of knee
rehab. Physical therapy, including ASTYM and dry needling, offers effective treatment for meniscus
tears by promoting tissue healing and reducing pain. These techniques, combined with targeted
exercises, can restore knee function and prevent surgery. Athletes often return to sport faster with PT-
based interventions (Reis et al., 2019; Krych et al., 2020).
Return to Sport Testing: Are you ready? Withing a few weeks, my pickleball player had started court
work with sport specific drills. As pain resolved even further, more dynamic testing with hopping and
jumping was incorporated into his care with sprints at 70% weight bearing in our Anti-gravity Alter-G
Treadmill. He soon advanced from 70% to 80% and then onto 100% pain free. A follow up
Musculoskeletal Ultrasound Image showed the meniscus tissue was healing and the inflammation had
resolved. And finally, isokinetic testing (speed and load specific computer testing) showed the right
knee was equal to the left knee. It was time to go!
Proactive Action: No matter what the cause of knee pain, walking, running, or playing through the pain
may only make the condition worse. Click and make an appointment or call 208-233-2248 to get in with
a Board-Certified Doctor of Physical Therapy and get to the root of the problem in Pocatello, American
Falls, Fort Hall, Idaho Falls and Rexburg. Our knee specialists are ready to get you back in the game,
running again, or just back to playing with the kids or grandkids.
Sincerely,
Bart McDonald, MPT, ECS, FMSK
President Superior Physical Therapy
Reis, F., Macedo, L., Silva, A., & Machado, G. (2019). Non-surgical management of meniscal tears: A
systematic review of physical therapy interventions. Journal of Orthopaedic & Sports Physical Therapy,
49(9), 658-666. https://doi.org/10.2519/jospt.2019.8545
Krych, A. J., Reardon, P. J., Johnson, N. R., Mohan, R., & Stuart, M. J. (2020). Meniscus tear
management: A comparison of rehabilitation outcomes with and without surgical intervention.
American Journal of Sports Medicine, 48(2), 475-481. https://doi.org/10.1177/036354651987394
