For a wear-and-tear (degenerative) meniscus tear, or an injury tear your surgeon is happy to treat without an operation, the right exercises strengthen the THIGH and hip muscles and retrain balance and control over about 12 weeks.
In trials of middle-aged people with worn tears, a 12-week exercise program did about as well as keyhole surgery for most people. In one of them, only about 1 in 5 of the exercise group went on to have the operation.
Early on, avoid deep squats and twisting on a bent knee. They squeeze the torn part of the meniscus, the rubbery C-shaped cushion inside the knee. Straight lines and shallow bends come first. Twisting comes back last.
Who this program is for
- Worn tears: usually over about 40, often with no clear injury. These are the tears exercise works best for
- Stable injury tears: where your surgeon or physio has said to try exercise first
- Not for a locked knee: if the knee jams and won’t straighten, get it checked before starting
- Not after a repair: a stitched meniscus has its own rules for bending and weight. See meniscus surgery recovery
For what the tear is and whether you need surgery, see meniscus tear.
Phase 1: weeks 1 to 3, settle it and get it moving
Most days. The numbers are starting points.
- Heel slides: lying on your back, slide your heel toward your bottom as far as is comfortable, then straighten the leg fully. Start with 10 to 15
- Thigh tightening (quad sets): sitting with the leg straight out, tighten the front of the thigh to press the back of the knee down, hold for 5 seconds. Start with 10. Getting the knee fully straight is the first goal
- Straight leg raise: lying on your back with the other knee bent, lift the straight leg to the height of the other knee, then lower slowly. Start with 2 sets of 10
- Calf raises: standing at a counter for balance, rise up onto your toes and lower slowly. Start with 2 sets of 15
- Exercise bike: 10 minutes, easy, with the seat high. If a full turn pinches, rock back and forth until it doesn’t
- Walking: keep walking within comfort. Ice and raising the leg help if it swells afterward
Phase 2: weeks 3 to 8, strength and control
Two to three times a week with a rest day between. Keep the knee lined up over your second toe on every exercise.
- Mini squats: feet hip-width apart, bend about a quarter of the way down, then stand. Start with 3 sets of 10
- Wall sit: back against a wall, slide down to a comfortable depth that doesn’t pinch, and hold. Start with 3 holds of 20 to 30 seconds
- Step-ups and slow step-downs: step up onto a low step, then lower the other heel to the floor slowly, keeping the knee from drifting inward. Start with 2 to 3 sets of 10
- Bridges: lying on your back with knees bent, lift your hips and hold for 3 seconds. Move to one leg when two is easy. Start with 3 sets of 10
- Side-lying leg lifts: lie on your good side, lift the top leg up and slightly back, lower slowly. Start with 3 sets of 10
- Single-leg balance: stand on the sore leg for 30 seconds. Progress to a folded cushion, then eyes closed
Straight before twisting, shallow before deep, slow before fast.
Phase 3: week 8 onward, back to sport
- Deeper squats and forward lunges as comfort allows, still in straight lines
- Sideways steps: with a resistance band around your ankles, step sideways keeping your knees soft
- Jogging: once you can walk briskly for 30 minutes, squat to a chair on one leg with control, and the knee doesn’t swell the next day. Start with short run-walk intervals on flat ground
- Hopping and landing: small hops on the spot, then forward, landing softly with the knee over the toes
- Cutting and pivoting last: gentle changes of direction, then sport drills at part speed, then full speed. Your sport’s full demands come at the end, not the start
The pain rules
- During exercise: a mild ache is fine, up to about 3 to 5 out of 10
- Afterward: it should settle within an hour or two
- The next-morning test: more pain, stiffness or swelling the next morning means you did too much. Cut back for a few days, then build again
- Sharp pain on the joint line, catching or giving way during an exercise: stop that exercise and make it shallower or slower
How to progress
- Move up when you can do 3 sets of 10 to 15 with good control and no swelling the next day
- Change one thing at a time: depth, then load, then speed
- Swelling is your guide: a knee that swells after activity isn’t ready for the next step yet
What to avoid early on
- Deep squats with a twist, such as picking something up from the floor while turning
- Pivoting on a planted foot, like turning quickly while your foot stays still
- Sitting on your heels, squatting all the way down, or sitting cross-legged
- Jumping straight back into your sport because the pain eased for a week
A worn tear often comes with some early arthritis. If that’s you, the knee arthritis exercises work alongside this program.
Get it checked soon if
- The knee locks and won’t fully straighten
- It swelled up within a few hours of an injury
- You can’t put weight on it
- The knee is hot, red and swollen, especially with a fever, or your calf is swollen and painful
See your doctor or physio if
- The knee keeps giving way
- Swelling keeps coming back after activity despite cutting back
- Pain hasn’t improved after 12 weeks of regular, progressing exercise
Build the muscles around the tear first. Twisting under load is the last thing to come back.