Can I treat a knee cartilage injury myself?
For the first 48-72 hours think of:
- Paying the PRICE - Protect, Rest, Ice, Compression, Elevation; and
- Do no HARM - no Heat, Alcohol, Running or Massage.
Paying the PRICE:
- Protect your injured knee from further injury.
- Rest your affected knee for 48-72 hours following injury. Consider the use of crutches to keep the weight off your injured knee. However, many doctors say that you should actually not keep your injured knee immobile for too long. You can usually start some exercises to help keep your knee joint moving and mobile. Start these as soon as you can tolerate the exercises without them causing too much pain. You can ask your doctor when you can start to move your knee joint and what exercises you should do.
- Ice should be applied as soon as possible after your knee injury - for 10-30 minutes. Less than 10 minutes has little effect. More than 30 minutes may damage the skin. Make an ice pack by wrapping ice cubes in a plastic bag or towel. (Do not put ice directly next to skin, as it may cause ice-burn.) A bag of frozen peas is an alternative. Gently press the ice pack on to your injured knee. The cold from the ice is thought to reduce blood flow to the damaged ligament. This may limit pain and inflammation. After the first application, some doctors recommend reapplying for 15 minutes every two hours (during daytime) for the first 48-72 hours. Do not leave ice on while asleep.
- Compression with a bandage will limit swelling and will help to rest your knee joint. A tubular compression bandage can be used. Mild pressure that is not uncomfortable or too tight and does not stop blood flow is ideal. A pharmacist will advise on the correct size. Remove before going to sleep. You may be advised to remove the bandage for good after 48 hours. This is because the bandage may limit movement of the joint which should normally be moving more freely after this time. However, bandages of the knee are sometimes kept on for longer to help keep swelling down and to keep the affected knee more comfortable. Ask your health professional what is best in your case.
- Elevation aims to limit and reduce any swelling. For example, keep your foot on the affected side up on a chair with a pillow under your knee when you are sitting. It may be easier to lie on a sofa and to put your foot on some cushions. When you are in bed, put your foot on a pillow. The aim is that your affected knee should be above the level of your heart.
- R is sometimes added to this list to make PRICER. R stands for Rehabilitation which is the most important part of the treatment for meniscal tears - to get you and your knee back to normal. You may need to see a physiotherapist or sports therapist for advice about exercises to do to strengthen and stretch the muscles around your knee if your symptoms persist.
(Note: despite the common guidance of putting an ice pack on injuries, there is some evidence from animal studies that it can delay healing and some researchers in the field suggest the evidence base for putting ice on an injury should currently be thought of as equivocal.)
Avoid HARM for 72 hours after injury. That is, avoid:
- Heat - for example, hot baths, saunas, heat packs. Heat has the opposite effect to ice on the blood flow. That is, it encourages blood flow. So, heat should be avoided when inflammation is developing. However, after about 72 hours, no further inflammation is likely to develop and heat may then be soothing.
- Alcoholic drinks, which can increase bleeding and swelling and decrease healing.
- Running or any other form of exercise which may cause further damage.
- Massage, which may increase bleeding and swelling. However, as with heat, after about 72 hours, gentle massage may be soothing.
What medication will help?
- Paracetamol and codeine: paracetamol is useful to ease pain. It is best to take paracetamol regularly, for a few days or so, rather than every now and then. An adult dose is two 500 mg tablets, four times a day. If the pain is more severe, you may be prescribed codeine, which is more powerful but can make some people drowsy and constipated.
- Anti-inflammatory painkillers: these medicines are also called non-steroidal anti-inflammatory drugs (NSAIDs). They relieve pain and may also limit inflammation and swelling. There are many types and brands. You can buy some (for example, aspirin and ibuprofen) at pharmacies, without a prescription. You need a prescription for others. Side-effects sometimes occur with anti-inflammatory painkillers. Stomach pain, and bleeding from the stomach, are the most serious. Some people with asthma, high blood pressure, kidney failure, bad indigestion and heart failure may not be able to take anti-inflammatory painkillers. So, check with your doctor or pharmacist before taking them in order to make sure they are suitable for you.
But note: National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summaries (CKS), a well-known source of guidance for doctors in the UK, do not recommend that anti-inflammatory painkillers be used in the first 48 hours after the injury. This is because of concerns that they may delay healing. The logic is that some inflammation is a necessary part of the healing process. So, it may be that decreasing inflammation too much by taking these medicines may impair the healing process. This is a supposed (theoretical) concern, as no trials have proved this point. Further research is needed to clarify the use of these medicines following an injury. Also, if you are having surgery to repair a torn ACL (see below), it is thought that, theoretically, NSAIDs may not be a good idea to take for a long period of time after the surgery because they may have an effect on the success of the surgery.
Rub-on (topical) anti-inflammatory painkillers: again, there are various types and brands of topical anti-inflammatory painkillers. You can buy some, without a prescription, at pharmacies. You need a prescription for the others. There is debate as to how effective rub-on anti-inflammatory painkillers are compared with tablets. Some studies suggest that they may be as good as tablets for treating sprains. Some studies suggest they may not be as good. However, the amount of the medication that gets into the bloodstream is much less than with tablets and there is less risk of side-effects.
This will then depend on:
- The severity of symptoms.
- How any persisting symptoms are affecting your life.
- Your age.
- Your general health.
Further reading and references
Englund M, Guermazi A, Gale D, et al; Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med. 2008 Sep 11359(11):1108-15.
McDermott ID, Amis AA; The consequences of meniscectomy. J Bone Joint Surg Br. 2006 Dec88(12):1549-56.
Sihvonen R, Paavola M, Malmivaara A, et al; Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med. 2013 Dec 26369(26):2515-24. doi: 10.1056/NEJMoa1305189.
Knee pain - assessment; NICE CKS, March 2011 (UK access only)
Bark S, Piontek T, Behrens P, et al; Enhanced microfracture techniques in cartilage knee surgery: Fact or fiction? World J Orthop. 2014 Sep 185(4):444-9. doi: 10.5312/wjo.v5.i4.444. eCollection 2014 Sep 18.
van den Bekerom MP, Struijs PA, Blankevoort L, et al; What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults? J Athl Train. 2012 Jul-Aug47(4):435-43. doi: 10.4085/1062-6050-47.4.14.
Holzer LA, Leithner A, Holzer G; Surgery versus physical therapy for meniscal tear and osteoarthritis. N Engl J Med. 2013 Aug 15369(7):677. doi: 10.1056/NEJMc1307177#SA1.
Hi all I’ve been managing my pain and excersizes but woke up today feeling really low and tearful gone back to bed. Anyone else felt like this? XSuki66
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