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Old 12-20-2011, 05:55 PM   #1
Chris Lane
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Tibiofibular Joint aggravated, Rehab help please!!

I had a fall on a box jump about 6 months ago banged up my shin pretty good, not totally sure if it relates to current Tibiofibular injury but symptoms were minor in nature around the same time and have progressed slowly.

Symptoms present as sharp pain in the back and slightly below the knee when flexion is greater than 90% especially when the there is either load on it or a strong contraction. So it is painful to get up of the ground without favoring the injured side, jump high, squat low, stretch quads, swing my leg up in to bed and so on. I have been treated by 2 physios and am continuing. Recently tried taping it with a little temporary success I think and I was referred for a custom brace or support to wear, waiting to meet with them for consultation. From what I have read this is relatively rare in occurance.

The advice I have received has included things like don't strengthen the posterior legs, don't jump, squat deep. I have of course toyed with my fate and pushed it a bit on all of these things. It is time to get this healed up so wondering if anyone has personal experience with rehabbing an injury such as this, can't seem to find any posts on it.

Thanks for the look
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Old 12-21-2011, 06:05 AM   #2
Steven Low
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Re: Tibiofibular Joint aggravated, Rehab help please!!

Where's the pain? What other movements hurt? What part of those movements hurt? Any other orthopedic issues? What muscles / tissues are involved and/or hurting?

Need a lot more information.
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Old 12-21-2011, 12:53 PM   #3
Chris Lane
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Re: Tibiofibular Joint aggravated, Rehab help please!!

Thanks for reading Steven, the pain is at the top of the calf posterior to the fibular head in a low squatting position, if I pull my leg behind me while standing or supine like I am stretching the quads it can be felt a little laterally as well. possibly biceps femoris insertion point? When I go into a low squat or crouch on the balls of my feet the pain is there on the way down but amplified to the point of loss of power on the upward phase only over 90 deg. flexion, less than 90 deg. little discomfort is felt. Same goes for a standing quad stretch or kneeling on knees and sitting back on my feet. There has been a few instances where I have buckled trying to get off the floor or up out of a crouch because of the sharp pain trying to get out of the hole so to speak.

When the calfs and hamstrings get tight it seems to be the worst so I am trying to manage these with Physio, massage and other mobility. I have no other issues in the lower body I know of but I did have what I think was tendinitis? in both knees prior to this, about 7-12 months ago but cleared up prior to this arising. Physio has also done some IMS on the gastroc, popliteus, hamstring and IT band but it has provided short term relief only.

Thanks for your time and attention, any input is appreciated.

Chris
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Old 12-21-2011, 01:31 PM   #4
Katherine Henry
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Re: Tibiofibular Joint aggravated, Rehab help please!!

Does your knee lock out, give out or feel unstable?

Have you had an diagnostic testing? (ie. XRay MRI etc?)
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Old 12-21-2011, 01:58 PM   #5
Steven Low
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Re: Tibiofibular Joint aggravated, Rehab help please!!

In addition to the above,

Is there any type of shooting or radiating pain or neuropathy at the bottom of the movement? What qualities would you ascribe to your pain?

Have the PTs performed any joint mobilizations on your fibular head?

Also, your ankle and feet as well since mobility at the feet/talocrural and subtalar joints can affect movement of the fibular head too?

Is the pain superficial or deep? More on a muscle, bony area, tendon, nerve, or other soft tissue?
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Old 12-22-2011, 12:16 PM   #6
Chris Lane
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Re: Tibiofibular Joint aggravated, Rehab help please!!

Katherine, the knee feels very stable, Physio says it is stable and strong. Have not done any diagnostics yet, I have been thinking of getting the MD to line one up, he previously recommended physiotherapy when it was less aggravating.

Steven, not distinctive shooting or radiating but sometimes hard to pinpoint and like I said a bit to the anterior of the Fibular head at times, I would describe the anterior sensation more as tightness or pulling. My leg wants to give out or stop the contraction when it is more severe usually only when not warmed up and on the ascent of a crouch or squat.

I would describe the pain as a sharp 5 and only a few times a sharp 8-9 in a compromising movement. As I warm up it usually fades to a 1 or 0.

Physio has performed some mobilization as they described it as stiff to begin with but no mobilization in the last month or two. It has been more painful since that period.

I do try and maintain ankle flexibility as I notice that I stiffen up, also trying to mobilize peroneals as that seems to give some relief. I definately get relief from mobility but I have not had any total relief from it. The pain is deep, maybe connective or nerve tissue, honestly never had any known bone fractures so can't really relate that.

Sorry my descriptions are crude at best, thanks for the interest. I am going to make an appointment to see the MD, hopefully get a referral for diagnostic imaging. Canada is great for our medical system but I will probably wait 3-6 months for anything other than an x-ray. Did an MRI on the other knee when I had tendinitis and it cleared up by the time the appointment rolled around.

Thanks again,

Chris
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Old 12-22-2011, 02:52 PM   #7
Steven Low
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Re: Tibiofibular Joint aggravated, Rehab help please!!

It seems like possibly some type of common or deep fibular/peroneal nerve entrapment or something of that nature.

Hmmm.

One thing I would do that it seems you haven't done yet is to do some leg nerve glides

wfs
http://www.ehow.com/way_5627704_nerv...cise-legs.html
http://www.youtube.com/watch?v=wNzuFqS76yA
etc.

That might help, if it's some form of entrapment to help see if it can loose some stuff up.

Myofascial work on the lateral compartment of your leg to try to stretch out the fascia some may be beneficial as well.

See if those helps after a coupel days or a week or so and then we'll see if we can figure anything else out.
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Old 12-22-2011, 04:14 PM   #8
Chris Lane
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Re: Tibiofibular Joint aggravated, Rehab help please!!

Thanks Steven, I have not done nerve glides, I will try them in conjunction with the other mobility work I have been doing.
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