Introduction
A meniscus tear is a common knee injury, often caused by trauma or degenerative changes over time. While many acute tears are managed surgically or with basic rehab, chronic cases—especially those left unaddressed—can continue to limit function years later. In my clinic, I recently treated a patient who had been living with the consequences of a meniscus tear that occurred more than ten years ago. His primary complaint was limited knee flexion and difficulty with functional movements like squatting and lunging due to discomfort. Through a combination of Functional Manual Therapy (FMT), targeting mechanical capacity, neuromuscular function, and motor control, we were able to make meaningful progress—restoring mobility, improving control, and reducing strain on the knee joint during everyday activities.
Treatment demonstration in video
Case Background
The patient, an amateur soccer player, presented with chronic knee stiffness and functional limitations that had persisted for over a decade following a meniscal injury. He did not undergo surgery at the time of injury, and while the acute pain had resolved, the lingering loss of range—particularly in knee flexion—limited his ability to squat deeply, kneel, or perform certain exercises. He also reported frequent discomfort with playing soccer.
During the initial evaluation, I noted that the knee had clear mechanical restrictions, but I also found signs of compensatory patterns from the hip and ankle, as well as reduced motor control through the trunk and lower limb. This is not uncommon in chronic knee cases—longstanding joint dysfunction often leads to imbalances and overload in adjacent regions.
Assessment and Clinical Findings
On physical exam, the patient showed significantly limited active and passive knee flexion. Palpation and joint testing revealed restrictions in patellar mobility, as well as decreased glide and subtle misalignment in the tibia and fibula. These joint restrictions contributed to inefficient knee mechanics and abnormal loading patterns during weight-bearing tasks. In addition to the local findings, I observed decreased mobility and stability in both the ankle and hip. Functional movements, such as squatting or single-leg stance, revealed compensations through the trunk and pelvis, including excessive trunk flexion and lateral sway.
This presentation was a classic example of how knee dysfunction doesn’t occur in isolation. To effectively restore mobility and function, treatment needed to target not only the knee but also the surrounding kinetic chain.
Treatment Approach
My treatment strategy combined hands-on manual therapy with active neuromuscular retraining and motor control exercises. The cornerstone of the approach was Functional Manual Therapy—a treatment philosophy that focuses on improving mechanical capacity, neuromuscular function, and motor control for movement efficiency.
Manual therapy was directed at improving joint mobility within the knee itself. I applied specific mobilizations to the patella, tibia, fibula, and femur, working to restore normal glide and alignment that had been compromised for years. As knee flexion began to improve, we integrated movement-based training to reinforce those gains in functional positions.
To improve control in weight-bearing, I used lunge variations combined with proprioceptive neuromuscular facilitation (PNF) techniques. This helped activate and coordinate muscles around the hip and knee, encouraging better joint loading during closed-chain activities. We progressed from basic lunges to more dynamic step patterns, always emphasizing precision and muscle control.
Next, we addressed motor control in single-leg activities. These are particularly important, as poor alignment or weak control can place chronic stress on the knee. I incorporated loaded exercises to challenge his ability to stabilize while minimizing unwanted knee torque. This included variations of step-downs, single-leg deadlifts, and standing balance drills with resistance.
Recognizing that knee dysfunction is often perpetuated by issues above and below the joint, I also treated the patient’s hip and ankle through FMT. Soft tissue restrictions, joint stiffness, and neuromuscular inhibition in these regions can all create compensatory strain at the knee. We mobilized the ankle to improve dorsiflexion and addressed hip rotation and extension deficits to restore proper lower-limb sequencing.
Finally, I integrated trunk and hip functional training to improve his ability to squat and perform loaded movements with better control. Core stability and pelvic alignment played a big role in normalizing his movement mechanics.
Outcomes and Results
Before
After
Over the course of several sessions, the patient achieved a noticeable improvement in knee flexion range of motion. Tasks that had previously caused discomfort, such as squats and lunges, became smoother and more manageable. Just as important, he reported a new sense of control and awareness in how he moved—not just at the knee, but throughout his entire lower body. The integration of manual therapy, neuromuscular work, and functional strengthening allowed us to break out of the chronic cycle that had persisted for years.
Takeaways
This case highlights the power of a comprehensive, hands-on approach for treating chronic meniscus-related knee dysfunction. Rather than focusing solely on the site of pain or stiffness, we looked at the entire movement system—addressing joint mechanics, adjacent regions, and motor control deficits. Functional Manual Therapy, when combined with targeted movement training, offers an effective path for improving chronic conditions that traditional treatments may have overlooked.
