Did knee surgery work for this Wimbledon??champion?

Last week I saw Novak Djokovic wearing a compression sleeve on his right knee at Wimbledon.

Djokovic has won 24 tennis championships and has been ranked No. 1 in the world during 13 years of his career.

It's an understatement to say that he is skilled and strong.

But early last month, he withdrew from a tennis tournament due to a right medial meniscus tear.

He underwent surgery and wasn't expected to compete at Wimbledon.

However, not only has he been competing, he's been winning.

Even though his knee is not hurting, Djokovic knows his knee is not 100%.

He told reporters that his knee injury has impacted his movement and decreased his speed a bit.

"[My knee is] not yet there where I want it to be. Kind of late on the balls that I'm normally not late on." (source )

Pain-free does not equal complete recovery.

Djokovic has played a lot of tennis.

He knows how to move on the court.

But he recognizes that his movement is not as good as it was before his knee injury.

Even though he is pain-free.

Why can't he move as well?

Over the past 20+ years, I've worked with hundreds of people who have had meniscus tears.

A meniscus gets injured when it's not strong enough to withstand the force placed on it.

This could be a one-time force -- like abruptly twisting your knee -- causing a traumatic tear.

Or it could be due to repetitive forces that eventually result in a degenerative tear.

And surgically trimming off a meniscus tear does not improve the remaining meniscus-- which is likely still weak.

In fact, "recent studies have conclusively shown that outcomes after [trimming off a meniscus tear] are no better than the outcomes after a sham/placebo surgery." (source )

Even when an activity or exercise isn't forceful enough to tear the weak meniscus, it can cause swelling.

If you've ever twisted your ankle, you know that the swelling indicates an injury has occurred.

Resting your ankle for long enough may be enough to allow the swelling to go away.

But in the meantime, swelling makes it difficult for muscles to contract normally.

The medical term for this is arthrogenic muscle inhibition (AMI).

Under normal circumstances, your brain tells your muscles to contract in a certain way and at a certain speed.

And the muscles respond by doing what they're told to do.

But if you have AMI, messages from your brain are not as effective.

Your muscles are sluggish.

Your body has recognized knee swelling and turns down the volume of the messages from your brain. (source )

This means your muscles can't 'hear' the messages from your brain as well.

AMI is essentially your body's way of protecting your knee from getting even more injured. (source )

Djokovic may be getting a small amount of swelling inside his knee.

Even a third of an ounce (2 teaspoons of extra fluid) causes AMI "despite the absence of structural damage." (source ).

This practically unnoticeable increase in knee fluid would explain why Djokovic is not yet moving like he did before his knee injury.

And the solution to this is strengthening his meniscus.

How a meniscus gets stronger

Strengthening is not just reserved for muscles.

Everything in your body-- from bones to blood vessels-- can get stronger. (source )

The meniscus is a specialized piece of cartilage which protects your leg bones by serving as a shock absorber.

A strong meniscus is firm .

It consists of microscopic cartilage cells and water molecules that hold very tightly to one another.

Weaker cartilage, on the other hand, is softer .

Cartilage cells and water molecules are not bonded together as tightly.

This means that the soft cartilage can not withstand activities that put pressure on the knees (perhaps lunging during a tennis match) without getting swelling.

X-rays and MRIs take a static picture of the inside of your knee.

They reveal the thickness of cartilage, such as your meniscus, but they don’t reveal the strength of your meniscus.

Scientific research has shown that cartilage changes based on the pressure and movement it receives. (source )

This means that if you give your meniscus (or other areas of cartilage) the right amount of pressure & movement-- not too much and not too little -- your meniscus will get stronger.

How much pressure is good for your meniscus?

Based on multiple studies, "continuous passive motion of the joint, after joint procedures, is an important stimulus for articular cartilage regeneration.” (source )

Continuous passive motion is like having someone else move your knee.

So, in short, the movement is not hard to do.

It's gentle rather than challenging.

It can be difficult to predict exactly what type and how much movement will be good for your knee.

That's why I help clients assess how much pressure their knees can handle.

This measurement helps me recommend the best type of strengthening for your knees.

What's next for Djokovic's knee?

His knee -- particularly his meniscus-- has been able to withstand the forces on the tennis court, well enough to defeat multiple opponents.

Now the world will be watching him in the semi-finals tomorrow, and hopefully the championship match this Sunday.

Despite not having knee pain, hopefully his team will provide the necessary coaching for his meniscus to recover and get even stronger before the end of this month.

Wishing him all the best in Paris at the Olympics!

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P.S. Do you know someone with knee pain or swelling? Please share this with them.