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Old 12-20-2013, 08:35 PM   #1
Jay Roberts
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Help me solve this problem - sharp pain in the back of my knee

Hey everyone, I have an ongoing knee problem and I want to get everyone's input on what it might be and how I can fix it. I've been to a few physios and a sports physician, and had an MRI done, none of which have been able to identify/solve the problem. So I'm hoping someone here can do a bit better . . .


Here's the summary:

- I get a sharp pain in the back of my left knee when it's bent under load such as when squatting, lunging, on stairs etc.

- The pain is right in the back center of the knee, not far from the surface.

- I can bend it through a full range of motion with no pain at all if there's no weight on it.

- It gets aggravated much more by fast bending movements under bodyweight than by slow movements (even under much heavier weight). For example, I can do multiple 1.5xBW back squat sets and be fine, but if I lunge quickly onto it (such as doing a fast dip when dancing, or even dipping quickly in a push press), that's what seems to aggravate it.

- The problem comes and goes and I can't see much link between cause and effect. Sometimes it will come up randomly on a day when I've put no demands on it at all. On the other hand, sometimes I can do lots of fast lunging/dipping motions and not run into any problems at all.

- When the problem comes up, if I take it easy for a few days, it goes away and I can go back to doing everything pain free.

- However, even when the pain is gone, the knee still doesn't feel very strong and usually I instinctively don't want to push it too hard.

- The MRI showed everything normal - no signs of meniscal tear, ligament damage or other cartilage problems, no cysts, no tendon problems etc.

- I read another post on here about the popliteus muscle, but I don't get any pain when I press into the back of the knee, so that doesn't sound like the root of the problem.


Here's some more background:

In mid-December 2012, I was running along the beach in shallow water when my foot stepped into a pothole while the knee was fully extended. This jarred the knee and I had some pain (not in the same place as now) for a couple of days, but then it went away completely after that. This may or may not be relevant. I did lots of leg work in the weeks following this with no problems at all.

The first day I felt the problem I'm having now was in January 2013. In the morning, I did a jump rope warm-up (this is a strong point of mine and my style is very low jump height / low impact) and then a Tabata workout with kipping pull-ups, sit-ups, dumbell shoulder press and kettlebell swings. I didn't feel any problem whatsoever at that point, so I'm not sure if anything in that training session was the original cause.

A few hours later I felt the sharp pain in the back of the left knee when I was walking up stairs. By the evening, it was so bad that I couldn't even push the clutch in my car without getting massive pain.

For the next few days, the knee and calf/foot/toes swelled right up and the knee felt like jelly. I didn't even walk on it for about a week. After a few days, the swelling went down, but it still felt very weak. I went back to walking normally after a couple of weeks, but basically rested it (ie didn't put any weight on it when it was bent) for 2 whole months.

It slowly got better over the next few months and I got back into bodyweight squats and step-ups to strengthen the muscles again, but there was lots of clicking in the knee joint at different times - mostly on the lateral side.

Then, in the middle of the year, I'd been doing a lot of physical farming work overseas and the pain in the back of the knee came back again. Ever since then, it's come and gone - sometimes as a result of fast weight-bearing movements, but sometimes after I've done nothing demanding at all.

None of the specialists I've seen have had any ideas on what the problem might be or what I can do to solve it. The only thing the sports physician came up with was that the PCL looked a bit thin in the MRI. But since it was totally intact, there was nothing that could be done about it.

The only advice I got from the physios was "strengthen the quad", but I've done a lot of that and reached a point where I was back squatting more than I ever have before, yet this hasn't solved the problem by itself.

Has anyone got any ideas on what it might be and what I can do to solve the problem?

Thanks in advance

Jay
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Old 12-21-2013, 03:35 AM   #2
Steven Wingo
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Re: Help me solve this problem - sharp pain in the back of my knee

Here is a resource you can review on some possible causes:

http://www.knee-pain-explained.com/p...-the-knee.html

I doubt you have a cyst--the MRI almost certainly would have revealed a cyst. However, when it comes to meniscus tears MRIs can be very misleading--there is about a 20% false negative rate. That means you have the injury but it doesn't show up on the MRI. In the end, the best way to know for sure is for a surgeon to go in there with an arthroscope (a camera) and actually visualize the meniscus and ligaments of the knee. But you typically don't want to do that--it is surgery--until you have ruled out conservative treatment options.

I'd suggest you try to work with a physiotherapist or a chiropractor with training in chiropractic orthopedics to see if they can help. And I would do what Kelly Starrett calls "self-maintenance"--get his Supple Leopard book and really learn to work all your soft tissue and get stretched out well. The fact that rest helps you suggests there is some soft tissue issue going on there that gets a little better when it calms down.
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Old 12-23-2013, 02:33 AM   #3
Jay Roberts
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Re: Help me solve this problem - sharp pain in the back of my knee

Thanks for your helpful reply, Steven.

I have wondered if there might be a meniscal tear but the MRI didn't pick it up.

The thing is, I didn't do anything that could have caused it on the day the pain/injury first appeared except for those double unders (which were low impact - my toes only get a few inches off the ground). But the jarring I did when running 3 weeks before could definitely have caused a split/tear.

Is it possible that I did most of the damage (but not enough to cause any pain/symptoms) when I first jarred the knee, and then the double unders a few weeks later "finished it off"?
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Old 01-04-2014, 08:51 AM   #4
Shelby Duncan
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Re: Help me solve this problem - sharp pain in the back of my knee

try loosening up your calves.

Sounds stupid but It could be that easy of a fix.
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Old 01-06-2014, 02:39 AM   #5
Jay Roberts
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Re: Help me solve this problem - sharp pain in the back of my knee

Thanks, Shelby.

I'm willing to try absolutely anything that might solve the problem. I've started a daily program to stretch my calves as well as all of my other leg muscles.

I've also ordered Become a Supple Leopard and will start putting all the relevant approaches in action once it arrives.

Meanwhile, if anyone else has any insights on this problem, I'd still love to hear from you!
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Old 01-12-2014, 09:26 PM   #6
Sean Rockett
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Re: Help me solve this problem - sharp pain in the back of my knee

possibilities include hamstring tendonitis, referred hip or back pain, usually meniscal tear pain is reproducible and pin point tenderness. Best way to tell is a good physical exam
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Old 01-14-2014, 07:28 PM   #7
Jay Roberts
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Re: Help me solve this problem - sharp pain in the back of my knee

Thanks, Sean.

I've started to rule out a meniscal tear.

My knee has started to feel a lot stronger and more normal lately. Whether that's from the stretching or just from letting it rest, I'm not sure, but I'm hoping the stretching is on the right track for solving the problem (I've been going through a lot of Kelly Starrett's stuff, and he's mentioned in different places about tight calves causing knee pain).

I'll report back in a little while about the results. In the mean time, if anyone has any further thoughts on this, they're always welcome.

Thanks again everyone

Jay
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Old 04-04-2014, 02:48 AM   #8
Jay Roberts
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Re: Help me solve this problem - sharp pain in the back of my knee

Hey guys

It's been a while since I posted. Since everyone was very generous with their time and input, and because it seems to be a baffling problem, I wanted to get back with an update so we can all take something away here.

I've been to see a few more physios, and here's the summary of what I can piece together:

- I have a lot of movement in the knee joint, possibly due to a minor PCL injury/stretch (which my sports physician picked up on the MRI, even though this wasn't in the report).
- This extra play makes the knee joint a bit unstable, and when I put weight on it while flexing it quickly, it can get slightly out of alignment and cause aggravation/inflammation in the joint.
- If this happens enough without any recovery time, the inflammation builds and leads to pain when bending the knee with weight on it.
- If I let it recover for long enough, the inflammation settles down and the pain goes away . . . until the next time I put weight on it when flexing quickly.

To treat this, I am using a combination of:

- Strengthening exercises for the hamstrings, calves and quads so they can compensate better for the instability in the joint.
- Activating my hamstring immediately before and during knee flexion - this massively reduces the amount of play/movement within the knee joint.
- Stretching, mobility and soft tissue work in my leg muscles so they don't pull things further out of alignment.

I'm not through the woods with this yet, but I can feel some improvement already (it was only in the last few weeks that all these pieces have finally come together). Now I'm going to continue with these strategies so I can get back to being pain-free and functional again.

Thanks again to everyone for your help!
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