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Old 08-25-2006, 11:02 AM   #1
Jim Lark
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I have a client who is having knee issues, but also on one knee, she has pain smack dab in the middle part of the back of the knee. Only thing I know of that would be in that spot are ligaments (ACL or PCL). She went to a Kaiser doctor and he diagnosed arthritis. I don't buy this diagnosis given the location of the pain. On the front, it's low and on the sides, more of a lateral and medial meniscus issue. (I say this because I had meniscus surgery a couple years ago).

I did some isometric ROM tests with her on a leg extension machine and her greatest degree of pain is when the knee is at 90 degrees. Then we went to a non-load bearing horizontal hip sled and she had no pain whatsoever, even going below 90 degrees.

Any thoughts what might be causing this? I recommended she get a second opinion because of the location of the pain and the symptoms. I don't buy the arthritis diagnosis.

Thanks,
Jim
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Old 08-28-2006, 08:15 AM   #2
Jerimiah Childress
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I agree with you about the arthritis diagnosis, but as of yet I can't figure out what it might be. I would want to check the stability of the knee ligaments. There are some smaller muscles in that region, so that might part of it, and sometimes tight hamstrings or gastrocs can present with pain in this region, but typically not while flexed. Let us know if you find out anything new, you have intrigued me.
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Old 08-31-2006, 05:05 AM   #3
Herb Sampson
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I have the same issue. My left knee flares up after box jumps or OHS. The pain prevents me from going deep in the squat and I feel it on the landing of the box jumps. It goes away in 2-3 days, most times.

It’s not arthritis pain; it feels more like a twinge in the back of my knee. My guess is it has to do with lack of flexibility (I have none) or lack of hamstring strength.
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Old 08-31-2006, 05:34 AM   #4
Michael Stehle
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There are many structures that cross the back of the knee such as tendons of the knee flexors, abductors and adductors as well as bursa. Some times a meniscal tear can cause posterior pain. This sounds like an overuse type injury as opposed to an accute injury. Arthritis is easy to diagnose w/ a simple x-ray and many of us have arthritic changes in our joints from years of wear and tear(doesn't sound like the symtoms). I would go for the second opinion, can't hurt.

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Old 08-31-2006, 04:25 PM   #5
Joe Beman
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I think you mentioned pain near the sides? If it's felt near the femur/tib0fib joint, chances are it's a menscus. Ask her if there is a feeling of intability to go along with the pain. If so, slam dunk.

I had meniscus surgery in March. I think you need an MRI to positively diagnose.

Good luck,
Joe
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Old 09-05-2006, 04:36 PM   #6
David Philipson
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Hey guys, first post.

I'm a Chiropractor, and I trained in Active Release Technique (ART) years ago. A common reason for that back of knee pain is the popliteus muscle.

It gets strained, then tightens and can cause a change in the rotational mechanics of the knee causing inflammation and pain, even in the front of the knee.

If you get in there with your thumb and stretch it out ( if its the problem, it will be painful as ) you should get some immediate improvement over the next 2 days...and should walk easier right away.

If you can't figure out how to do it, find a ART practioner and it will be fixed quickly, if thats what the problem is.

I'm sure anyone trained in deep tissue work could also do it if you direct them to the popliteus muscle.

Good luck.
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Old 09-06-2006, 08:30 PM   #7
Jim Lark
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BINGO!!!

The popliteus was the culprit. She sat down, I pressed directly behind the knee and got the reaction. So, now that we know what it is, I have some questions:

1. Since it's a muscle (small tho it may be), what could have caused the strain?
2. What can be done to rehab? Is rest the only thing?
3. What can she do so that this doesn't happen again in the future? Are there specific exercises or stretches that will help?

Thanks,
Jim
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Old 09-08-2006, 12:04 AM   #8
Christian Lemburg
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Jim,

as for part 2 of your questions - self massage, administered about 6-12 times a day, for about 1 minute or so.

See http://www.crossfit.com/discus/messages/27/14941.html and http://triggerpoints.net/userfiles/Popliteus.jpg for further directions.

She could self-massage this easily by using supported thumbs, the knee of the other side leg when sitting, or by pressing the area on the edge or corner of a chair.

For more information about what this little muscle does, see http://www.sportsinjurybulletin.com/...popliteus.html - this might help to identify causes and possible ways to avoid re-injury.

Good luck, and fast recovery,

Christian
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