The Precision Report:

Your Guide to Pain Free Fitness

Do You Really Need Surgery for a Meniscus Tear? What Active Adults Need to Know

If you’re an active adult who lifts weights, does CrossFit, or trains regularly and you’ve heard the words“meniscus tear,”your first thought might be:

“Does this mean I need surgery?”
“Am I done squatting or lifting heavy?”

The good news is this: that’s not always the case.

Many types of meniscus tears respond extremely well to conservative management, meaning you can often return to training and daily activities without surgery — and without ongoing pain.

If you are more of a visual learner, watch the whole YouTube video here.

In this article, I’ll walk you through:

• What research actually says about meniscus surgery

• How to tell if your symptoms might be meniscus-related

• Simple self-tests you can try

• How to modify training so you can keep lifting

• Mobility and strength strategies that help reduce pain

• When Blood Flow Restriction (BFR) training or a personalized plan may be helpful

Meniscus Tears: What the Research Really Shows (click here for video explanation)

One of the most common types of meniscus injuries is a degenerative meniscus tear. This happens gradually over time as the cartilage becomes more worn and less resilient.

Historically, these tears were often treated with surgery called a partial meniscectomy, where part of the meniscus is trimmed away. However, research over the past decade has changed how we think about this approach.

A high-quality study compared:

• People who had real meniscus surgery (partial meniscectomy - meaning the torn part of the meniscus is removed and shaved down to a smooth surface)
  vs

• People who had sham surgery (they were put under anesthesia but the torn part of their meniscus was not removed)

Both groups completed exercise afterward — and their outcomes were essentially the same at follow-up 1 year later.

👉 What this tells us:
For many people, surgery itself is not what leads to improvement. Proper rehab, strength training, and load management often do.

This doesn’t mean surgery is never appropriate — but it does mean that many meniscus issues can be managed successfully without it, especially in active adults. In some cases - with severe catching or locking - or certain types of meniscus tears - surgery is recommended. However, it is often helpful to try rehab first, as avoiding surgery may be possible, and if it is not - going into surgery stronger and with more mobility is always helpful.

How to Test If Your Knee Pain Might Be a Meniscus Tear

No single test can definitively diagnose a meniscus tear on its own, but when several signs cluster together, the likelihood increases. The following tests are meant to be a cluster, meaning when all done in succession, if you have 4 or 5 positives, there is a higher likelihood you are dealing with a meniscus tear. However, one individual test by itself is not all that useful.

Below are five common indicators clinicians look for.

1. Catching or Locking Sensations

This is not normal clicking or popping.

True “locking” feels like the knee gets physically stuck when bending or straightening, sometimes requiring you to wiggle it free.

2. Joint Line Tenderness

Run your fingers along the joint line on either side of the knee (the small groove where the thigh and shin meet and dimples are present just below the knee cap and to the sides).

If pressing there reproduces your familiar pain, that’s another indicator.

3. Pain or Limitation With Full Knee Bend

Try bending your knee fully using your hands.

If you feel:

• A block

• Sharp pain

• A feeling that it won’t go further

that may suggest involvement of the meniscus if it reproduces your pain.

You can also test this by kneeling and attempting to bring your heel toward your glutes. Pain or restriction here can be meaningful.

4. Difficulty Fully Straightening the Knee

Lying on your back, allow your knee to relax into full extension.

If your knee:

• Won’t fully straighten

• Feels blocked

• Causes pain when pressure is applied

that adds another data point.

5. Rotation-Based Symptoms (Modified Test)

Standing on the affected leg, gently rotate your body left and right with a slight knee bend.

If twisting causes pain, clicking, or discomfort along the joint line, this may also suggest meniscus involvement.

👉 Important note:
One positive test alone doesn’t mean much. But if four or more of these are present, the likelihood increases.

At that point, working with a qualified physical therapist is strongly recommended.

Why You Can Still Train With a Meniscus Issue

One of the biggest mistakes people make is stopping all activity.

In reality, staying active — with smart modifications — is one of the best things you can do.

The goal is not to push through pain, but to train in a way that:

• Builds strength

• Maintains capacity

• Reduces stress on the irritated tissue

How to Modify Training Without Making Things Worse

1. Adjust Squat Depth

Deep squats often stress the knee at its most sensitive range.

Instead:

• Use a box squat

• Limit depth temporarily

• Maintain even loading between legs

This allows you to continue training without aggravating symptoms.

2. Use Single-Leg Strength Work (Done Correctly)

Single-leg exercises can be very effective — but only if done with control.

Examples:

• Reverse lunges (with support if needed)

• Controlled split squats

• Focus on keeping weight over the working leg

• single leg knee extensions working on slow controlled speed.

If instability increases pain, reduce range or use support.

3. Strengthen the Hamstrings

The hamstrings attach near the meniscus and play a key role in knee stability.

Effective options include:

• Elevated bridge variations

• Single-leg bridges

• Controlled hamstring curls on machines or using bands/ankle weights

Strengthening these muscles helps offload stress from the knee joint. However, this must be dosed appropriately to make real changes.

4. Use Machines Strategically

Knee extension and hamstring curl machines can be very helpful because:

• They allow isolated strengthening

• They avoid deep joint angles

• Load is easier to control

When used appropriately, they help restore strength without irritation. Single leg press variations are also helpful at improving overall leg strength on the affected limb without having to work through painful ranges of motion.

Improving Mobility When the Knee Feels “Stuck”

If you struggle to fully bend your knee, mobility work can help — especially when paired with strengthening.

Towel-Assisted Knee Bend

Placing a towel behind the knee and sitting back gently can help restore comfortable flexion.

Hold for ~30 seconds
Repeat 3–4 times

Improving Tibial (Shin) Rotation

Limited internal rotation of the shin can block knee bending.

A simple drill involves:

• Keeping the foot planted

• Gently guiding the shin forward and inward

• Repeating controlled reps to improve motion

This can immediately improve squat depth and reduce pinching for some people.

What If Even Modified Exercises Still Hurt?

If traditional strengthening still causes pain,Blood Flow Restriction (BFR) trainingmay be a great option.

BFR allows you to:

• Use much lighter weights

• Still build strength

• Reduce joint stress

• Maintain muscle during rehab

This approach should always be guided by someone trained in BFR programming, but it can be extremely effective when higher loads aren’t tolerated.

The Big Takeaway

If you’re dealing with knee pain or a suspected meniscus issue:

✅ You are not automatically “broken”
✅ Surgery is not always required
✅ You can often keep training
✅ The right combination of mobility, strength, and load management matters

With the right plan, many active adults return to squatting, lifting, and training confidently again.

Want a Personalized Plan?

If you’re serious about getting back to CrossFit, weightlifting, or staying active without knee pain, I offer an online knee program designed specifically for active individuals.

You’ll get:

• A personalized plan

• Smart progressions

• Guidance on strength, mobility, and load

• Optional Blood Flow Restriction integration

👉Apply for a free discovery call here.

And if you found this helpful, be sure to subscribe for more videos on managing knee pain, training smarter, and staying active long-term.

– Dr. Ryan Kalkbrenner, PT, DPT, OCS
Precision Fitness Physical Therapy- Owner