Injuries are part of the sport and hockey goals are not immune. For hockey goaltenders, a meniscus tear can have an impact on performance and can also impact their other daily activities. 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 knee hinge joint is made up of the femur (thigh bone) and tibia (shin bone). The end of the femur is somewhat rounded like a knuckle, where the tibial plateau is relatively flat. The knee isn’t the most stable joint, so the menisci (it has two, one medial and one lateral) help give a little more depth to the articular surfaces and provide a bit of cushioning between the femur and tibia.

The menisci are shaped like a hockey puck that has been squashed 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 you move towards the center of the meniscus, there is very 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 meniscus tears are and what they feel like. He described a meniscus tear as looking like a “hanging nail” in the knee. You know how you can get a hangnail, and it usually feels good, doesn’t hurt at all, until you spot that little flap of skin going against the grain. When that happens – WOW! Be aware; greater bread.

Hockey goalies who have a torn meniscus may be fine to complete all the activities they want, but then they can walk around a corner or fall into your butterfly and yikes! The knee may even give out from the jolt of pain. If you feel general pain below your kneecap, it’s likely more patellofemoral irritation than a meniscus tear.

The tricky thing about meniscus tears is that there are numerous mechanisms. I remember a person who spent an afternoon kneeling while repairing a floor and when she stood up, alas, 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 lands on the goalie’s knee when in a flexed position or the goalie is pushed back with their foot trapped under them.
2. The goalkeeper moves into a position where the knee is placed in medial/lateral (varus or valgus) stress and places stress on the meniscus, which over time or in an instant can cause meniscus irritation or tearing . I’m thinking particularly about the butterfly position for goalkeepers.

The goalkeeper will feel pain at the time of the 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 cannot 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 severe tear, you may need to see an orthopedic surgeon who can examine the knee to remove some of the rough edges and “clean up” things a bit. If it is a large tear towards the inside of the meniscus, the surgeon may decide to stitch it back together, which helps preserve the meniscus, which will greatly reduce the wear and tear on the knee over time.

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