The movements inherent to rock climbing can put significant stress on the meniscus. High-stepping, heel hooking, drop-knees, and planting/twisting can make the knee susceptible to meniscus tears. Both traumatic and degenerative meniscus tears are common among climbers, but there is excellent evidence showing that conservative treatment should be the first line of treatment in the vast majority of cases.
Tears in the meniscus (the cartilage within our knees) can occur due to injury or degeneration attributed to the aging process. The latter is a much more frequent scenario and often these tears are found on MRIs of patients without knee pain. These false positive results cast doubt on the direct correlation between a picture of your knee and the symptoms you are experiencing. Thus, meniscal tears are found in patients without pain and those with pain can have a negative image. Unfortunately, arthroscopic surgery for these age related tears is on the rise with 700,000 procedures performed in the United States each year (Cullen et al. 2009). Interestingly, a previous randomized controlled trial in the New England Journal of Medicine found no difference in patient outcomes between this meniscal surgery and a sham surgery (Sihvonen et al. 2013).
In the study, 70 patients were randomized to a partial menisectomy (removal of the meniscus) and 76 were randomized to a sham surgery (Sihvonen et al. 2016). In the article published in the Annals of Internal Medicine the authors reported close to half of the patients in either group reported mechanical symptoms such as locking or catching prior to surgery. Surprisingly, no differences were noted between the surgery and sham surgery for relief of pain or mechanical symptoms. The authors concluded, “resection of a torn meniscus has no added benefit over sham surgery to relieve knee catching or occasional locking”.
Mend Recommendation: Rock climbers with meniscal tears are advised to work with a local Physical Therapist on a cost and clinically effective treatment plan before considering any surgical procedure.
In another recent review and statement paper released in the British Journal of Sports Medicine highlighted evidence regarding the management of meniscal tears (Thorlund et al. 2018).
The authors highlighted the trials comparing surgery to Physical Therapy and reported exercise interventions improved pain and function to the same extent as surgery. As expected, greater strength gains were found among the exercise therapy vs. surgical groups. In addition, the authors found no clinically relevant effect of surgery in addition to exercise therapy on pain or functional outcomes for degenerative meniscal tears. To date, no randomized trials have been performed including patients under 40 or including patients with traumatic meniscal tears.
If you’re a rock climber experiencing knee pain, schedule an appointment with a rock climbing specialist at Mend. We have locations in Boulder and Lafayette, Colorado. Many physicians, surgeons, and physical therapists do not understand the sport of rock climbing and may give incorrect or ill-advised advice on whether or not to return to climbing. The rock climbing specialists and Mend understand the sport and know when and how to safely return to rock climbing.