Why Your Knee Pain Might Not Be a Meniscus Tear

When Is It Serious?

“But my physician took X-rays and told me my knees are bone-on-bone.”

Yes, arthritis is commonly found in the knee joints. Arthritis occurs in all joints of the body, especially as we age. If you’re over the age of 50, you’ve got arthritis — it’s a natural aging process. Arthritis is like wrinkles and grey hairs but on the inside. Unless you have arthritis beyond what’s expected for your age, it’s not the problem causing your pain.

RARELY is arthritis a cause of pain. It is more so a contributing factor. Arthritis can alter joint mechanics, increasing the sensitivity of surrounding tissues.

“But I was on the YouTubes and I think I have patellar tendinitis.”

Knee pain near the kneecap can be caused by a tendon issue called patellofemoral pain syndrome, or patellar tendinitis. The symptoms are usually present in athletes or individuals with a sudden increase in physical activity over a short period of time. However, if your knee pain is not activity-dependent — knee hurts when approaching the 2nd mile of the running — tendinopathy is less likely.

Unideal joint movement still more commonly causes anterior knee pain.

Your knee pain is more serious when it’s constant, excruciating, and severely limiting your ability to perform normal activities of daily living. If this has happened as the result of an injury or trauma, seek medical attention ASAP. If it’s been progressively worsening over months to years, hopefully, you’ve sought treatment at some point. If not, it’s not too late.

The Meniscus Myth

A meniscus tear on an MRI sounds like a pretty convincing explanation for knee pain.

And sometimes it is.

But here’s the part that gets missed: meniscus tears also show up on MRIs in plenty of people whose knees don’t hurt at all. In other words, finding a tear doesn’t automatically prove the tear is the reason your knee is painful.

You can have knee pain, get an MRI that shows a degenerative meniscus tear, go through the right rehab, get back to walking, squatting, running, or training comfortably—and that tear may still be sitting there on the scan looking exactly the same.

That’s why we don’t treat the MRI. We treat the person attached to it.

Before assuming the answer is surgery, we want to know how your knee actually behaves: what movements reproduce the pain, what changes it, how well the joint moves, how you load the leg, and whether strength or movement limitations are keeping the area irritated.

For many degenerative meniscus tears, a well-designed rehab program can perform similarly to surgery over the long term.

So the MRI matters. It just isn’t the whole story.

Get the knee mechanically assessed before deciding the picture is the problem.

Can You Have Knee Pain Without Injury?

Not all knee pain is a knee problem.

Wait, WHAT!? I’ll explain.

Pain in the knee, or anywhere in the legs, is commonly a symptom of a low back problem.

“But I don’t have any back pain. How could knee pain come from my back?”

It’s likely you’ve heard of sciatica.

Sciatica is a common symptom originating from the low back. Classic sciatica presents as pain, numbness, or tingling down the back of the leg and can even travel to the calf or down to the foot.

Sciatica is most likely caused by irritation of joints in the low back. The irritated joints can cause interference of the nerves exiting the spine. The nerves exiting the lumbar spine on the left and right of the body converge to form the left and right sciatic nerves, which traverse down the legs.

Any irritation of low back nerves — due to poor joint mechanics — can produce symptoms anywhere along the path of nerves down the legs. And the symptoms, e.g., pain, numbness, tingling, burning, pins & needles, don’t necessarily travel like drawing a line from the back down the leg. Often, sciatica symptoms skip spots. It’s possible to have sciatica symptoms in only the hip and knee, absent of back pain.

Surgery Isn’t the Finish Line

Most people expect that once the structure is repaired, everything else falls into place. Sometimes it does. Often it doesn’t.

Surgery fixes structure. It doesn’t automatically fix how the joint moves.

Post-surgical rehab matters, and skipping it causes its own problems. Sometimes the structure doesn’t heal properly without it.

But even done properly, getting your basic range of motion back and managing a normal day isn’t the finish line. If you want to hike, climb, play a sport, or do anything past sitting, standing and stairs, you have to rehab for that specifically. Nobody gets back to something they never trained for.

That’s usually where it lingers. Walking and stairs feel fine, so the knee seems fine, until you try the thing you actually wanted your knee back for.

Plenty of people arrive here months or years after surgery saying a version of the same thing: it helped, but something still isn’t right.

At that point the structure usually isn’t the problem. A mechanical imbalance is. Those can exist with or without structural damage, which is why repairing the structure doesn’t always resolve them. If the imbalance is still there, the symptoms often are too.

So we assess the knee the same way we would if you’d never had surgery. Is the joint stuck moving in one direction? Is something tight or taking more load than it should, and keeping the area irritated? That’s what tells us why it still hurts when the imaging says it shouldn’t.