Coping with meniscus tears - Women's Running

Coping with meniscus tears

Author: Chris Macdonald

Read Time:   |  August 30, 2016

Women’s Running Editor-in-Chief Christina Macdonald is training for this year’s Virgin Money London Marathon four years after tearing her meniscus, the cartilage in the knee that provides cushioning and support. So far, with adequate rest periods and lots of strength work and cross-training, her training has been going smoothly. However, a torn meniscus is not to be taken lightly and is unfortunately more common than many runners realise. We asked Keith Hall from Balance Physiotherapy in Balham ( how to treat a torn meniscus and what it means for your running.


Firstly tell us how a meniscus tear can affect a person when they run?
Generally in runners a small meniscal tear may mean running is painful either during or after their run and can produce swelling that takes a number of days to settle. It can create a chronic inflammation which inhibits frequency, volume and intensity of running
A large meniscal tear would probably prevent running altogether.

How serious is it as an injury?
Although very common it can be a serious injury depending on size and side of tear. A large lateral meniscal tear in the white zone is considered more serious than a small medial meniscus tear in the red zone. This is due to the lateral compartment of the knee taking more load and the white zone not having a good blood supply therefore it is unlikely a cartilage saving repair would be performed. Ultimately it can mean losing a percentage of the protective meniscus through arthroscopy.

Keith Hall

Why can’t the cartilage repair itself?
A small tear in the outer red zone of the meniscus has a chance of healing as it has a good blood supply and therefore an inflammatory response can happen and help heal the tear. A tear in the inner white zone doesn’t have a good blood supply and gets it’s nutrients from the synovial fluid therefore healing is not possible.
A tear in the red zone can be repaired via surgery and preserves this meniscus.

For someone returning to running after a meniscus tear, what is your initial advice?
In my eyes the same advice should be given to someone who is returning to running from a tear without surgery as it is with someone who has had the tear resected via surgery.  It would be to strengthen around the hip, knee and foot, to increase flexibility, to improve biomechanics to ensure even distribution of load and to slowly progress into impact exercise to avoid any inflammation and pain brought on secondary to overload.

For someone who wants to do long distance events like marathons after a meniscus tear, what is your advice?
For many, straight line running is not a problem after a meniscus tear. Sports that involve twisting and turning can be. It would be to improve strength of the lower limb to absorb impact and load. To have your biomechanics assessed so this load can be evenly distributed throughout the body. To learn to run more efficiently to reduce ground reaction forces per step which may involve a running coach. Most importantly to be realistic and learn what programme works for that person which may involve doing more recovery and cross training sessions

What is your key advice for Christina?
To continue on the path you are on and to continue to listen to the professionals around you who can make considered and objective suggestions for your training. Your biomechanics and knee control has a way to improve but the fact you are pain-free when running is a good initial sign. Strength endurance must be considered now as the hardest part will be managing your response to increased mileage and impact.

You talked about doing flat, straight running rather than uneven trails when we met… why is this?
Uneven surfaces increase load on different parts of the knee. Downhill running for instance increases load on the patellofemoral joint and can lead to anterior knee pain. Running on a camber can exacerbate ITB symptoms. Running trail can subtly increase twisting which creates sheer forces in the knee which may increase the chances of meniscal damage.

How common are meniscus tears for runners in your view?
It is widely accepted that twisting/turning while the knee is flexed under load is the most common way to tear a meniscus, therefore simple straight line running in a normal knee of a person with good biomechanics is not that common. There are much more common injuries reported by runners.

Is there anything runners can do to prevent them?
Technique and lower limb control would be the main way to prevent any injury. However, runners are as likely to tear it stepping of the bus as they are running. I tore mine walking pivoting round the physio bed!

Balance Physiotherapy is based in Balham, South West London and has an anti-gravity treadmill that removes your body weight to reduce the impact of running for those who are recovering from injury. For more information, visit or call 020 7627 2308.


Chris Macdonald

Editor-at-Large, Women's Running

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