Injuries are part of the sport and hockey goals are not immune. For hockey goalies, a meniscus tear can impact performance and can impact their other daily activities as well. Let’s look at the symptoms of meniscus tears, the mechanisms of a meniscus tear, and what you can do to prevent or recover from this injury.

The hinge joint of the knee is made up of the femur (thigh bone) and the tibia (shin bone). The end of the femur is somewhat rounded like a knuckle, where the tibial plateau is relatively flat. The knee is not the most stable joint, so the menisci (it has two, one medial and one lateral) help give the joint surfaces a little more depth and provide some cushioning between the femur and tibia.

The menisci are shaped like a hockey puck that has been flattened a bit in the middle. It is a cartilaginous material and the big problem with meniscus tears is the fact that the meniscus has little blood supply. The outer edge of the meniscus has some blood supply, so a tear in this area can heal. As it progresses toward the center of the meniscus, there is little or no blood supply, so tears in this area will not heal.

When I worked as an exercise specialist at a sports medicine clinic, one of the physical therapists had an amazing analogy about what meniscal tears are and what they feel like. He described a meniscus tear as a “hanging nail” in the knee. You know how you can have a dangling nail, and it usually feels fine, not painful at all, until you feel that little flap of skin going against the grain. When that happens – WOW! Be aware; larger bread.

Hockey goalies who have a meniscus tear may be fine to complete all the activities they want, but then they may walk around a corner or fall on your butterfly and ouch! The knee may even give way from the jolt of pain. If you feel general pain under your kneecap, it is more likely a patellofemoral irritation than a meniscus tear.

The tricky thing about meniscal tears is that there are numerous mechanisms. I remember a person who spent an afternoon on his knees while repairing a floor and when she stood up, ouch, she tore her meniscus. But for hockey goals I think there are two common mechanisms.

1. There is a collision between a skater and a goalie in which the skater falls on the goalie’s knee when in a flexed position or the goalie is pushed backwards with their foot caught under them.
2. The goalie moves into a position where the knee is put under medial/lateral strain (varus or valgus) and puts stress on the meniscus, which over time or in an instant can cause a meniscal irritation or tear . I’m particularly thinking of the butterfly position for goalkeepers.

The goalkeeper will feel pain at the time of injury and there may be some swelling in the knee. If you think you’ve torn your meniscus, start with rest, ice, and elevation. He may settle. If his knee is locked, meaning he can’t physically strengthen it or if he tries to do so it causes severe pain, then he should go straight to the phone and call his local sports medicine professional.

If you have torn your meniscus, you should have physical therapy from a good sports physical therapist. If it’s a serious tear, you may need to see an orthopedic surgeon who can examine the knee to remove some of the rough edges and “clean” things up a bit. If it is a large tear to the inner part of the meniscus, the surgeon may decide to sew it back together, which helps preserve the meniscus, which over time will greatly reduce wear and tear on the knee over time.

Whether you’ve injured your meniscus in the past or you’re a hockey goalie looking to reduce your risk of injury, the basics are the same. While he is symptom-free, he should make sure to include work on hip internal rotation so he can get into his butterfly by getting hip range, not twisting the knee.