Transcript Slide 1

Lateral, Medial and Posterior Knee Pain
Lateral, Medial and Posterior
Knee Pain
Knee pain is one of the most common musculoskeletal
complaints. Knee joint is tough and once injured unless it is
treated correctly, can be difficult to heal.
Knee pain can be related tooveruse,
where small stresses are placed in
a large number of times on knee
without allowing adequate recovery.
For example running too much too
soon, or excessive jumping.
Or knee pain can be acute where
the injury is caused by an impact or
twisting of the knee.
Lateral Knee Pain
•Iliotibial band friction
syndrome (ITBFS);
•Excessive lateral
pressure syndrome;
•Biceps Femoris
Tendinitis;
•Superior tibiofibular
joint injury;
•Patellofemoral Pain
Syndrome;
•Osteoarthritis;
Iliotibial band friction syndrome (ITBFS):
Mechanism:
Repeated knee flexion/extension, the iliotibial band (ITB)
rubs against the prominent lateral epicondyle of the
femur.
Cause:
The two main causes of
ITBFS areinappropriate training
and abnormal
biomechanics.
Excessive downhill
running or running on an
uneven surface.
Sign & Symptoms:
Pain at or around the lateral epicondyle of the femur.
Pain normally aggrevated by running,
Pain during flexion or extension of the knee.
Decreased strength in hip abduction.
Tenderness present in the gluteal area.
Tightness of the iliotibial band.
Treatment:
Rest- avoid painful stimuli,
If swelling is present,the R.I.C.E. technique maybe used.
ITB stretches can be very effective in preventing reoccurring
pain.
 Self-massage techniques can also be very helpful in correcting
excessive ITB tightness.
Perform soft tissue or deep friction massage.
Electrotherapeutic treatment techniques such as TENS,
ultrasound and/or interferential Therapy.
Sports Massage
Stretches of the right iliotibial band
Specialist Stretching Techniques
Excessive lateral pressure syndrome
Excessive lateral-pressure syndrome (lateral patellar
compression syndrome) occurs with excessive pressure
on the lateral patellofemoral joint resulting from a tight
lateral retinaculum.
This excessive pressure may lead to increased bone
strain on the lateral patella, inflammation of the lateral
retinaculum and ITBFS.
Treatment:
patellofemoral mobilization and soft tissue therapy to
the lateral retinaculum.
Taping techniques rarely help.
In more advanced stage, surgical lateral retinacular
release, or removal of the lateral patellar fragment, may
be required.
Biceps Femoris Tendinitis
Biceps femoris tendinitis occurs with excessive
acceleration and deceleration activities.
Sign & Symptoms:
The pain can be produced with resisted flexion,
especially with eccentric contractions.
It is often found in association with tightness of the
hamstring muscles.
Treatment:
Treatment is based on the general principles of the
treatment of tendinitis:
reduction of inflammation,
 soft tissue therapy,
stretching and strengthening,especially eccentric
strengthening.
Soft tissue therapy
Eccentric strengthening exercise
Superior tibiofibular joint injury
Superior tibiofibular joint injury may result from direct trauma
or in association with rotational knee or ankle injuries.
Sign & Symptom:
Pain is produced by activities demanding tibial rotation.
The patient may feel the pain distally in the shin and not localized.
On examination, the joint is tender and there may be either
restricted or excessive movement on passive gliding of the
superior tibiofibular joint.
Treatment:
Mobilization.
Local electrotherapy can be used.
Strengthening of tibial rotators.
patients who fail to respond to conservative management, a
corticosteroid injection may be used.
Medial Knee Pain
Pain about the medial knee is less common than
Posterior and lateral knee pain.
Causes:
 Patellofemoral syndrome (common);
Synovial plica;
Pes anserinus Tendinitis\Bursitis;
Pellegrini-Stieda syndrome;
Medial meniscus Minor tear\Degenerative change;
Patellofemoral Syndrome
In most cases of medial knee pain, the pain is actually
anteromedial.
most frequently due to patellofemoral syndrome.
Sign & Symptom:
Aching pain occurs in the knee joint, particularly at the front,
around and under the patella.
 Pain under the patella when bending and straightening the
knee
.Tenderness along the inside border of the kneecap.
Usually swelling is present.
often worse when walking up or down hills or stairs.
A clicking or cracking sound may be present on bending the
knee.
Sitting for long periods may be uncomfortable.
Wasting (atrophy) of the quadriceps muscles.
Tight muscles including calf muscles, hamstrings, quadriceps
and iliotibial band.
Treatment:
•RICE (Rest, ice compression and elevation) to the injured knee.
This will help reduce swelling.
Rest until there is no pain.
•Use a knee support or heat retainer (with a hole).
•Electrotherapy such as ultrasound, laser and electrical
stimulation.
•Comprehensive rehabilitation program in conjunction with taping
techniques.
•Vastus Medialis Obliquus (VMO) strengthening exercises
combined with iliotibial band (ITB) stretches.
Taping for patella pain
Strengthening exercises
Pes anserinus Tendinitis\Bursitis
The pes anserinus ('goose's foot'):
It is the combined tendinous insertion of the sartorius, gracilis and
semitendinosus tendons at their attachment to the tibia.
A bursa, the pes anserinus bursa, lies between this insertion and
the bone. The pes anserinus tendon attachment and its
associated bursa may become inflamed as a result of overuse in
swimmers,cyclists or runners.
Sign\Symptoms
Characterized by localized tenderness and swelling.
Pain may be elicited on active contraction or stretching of the
involved muscles.
Treatment
Follows the general principles of tendinitis/ bursitis
management.
 Cortico-steroid injection into the bursa may be extremely
effective.
Pellegrini-Stieda syndrome
It is a disruption of the femoral origin of the MCL with
calcification at the site of injury.
It may occur following direct trauma or, less frequently,
following grade II or III sprain of the MCL.
Sign\Symptoms:
It is an important cause of knee stiffness.
The patient complains of difficulty straightening the leg
and twisting.
On examination, there may be a marked restriction in
joint range of motion.
Treatment:
Active mobilization of the knee joint
Infiltration of a corticosteroid agent to theMCL
attachment if inflammation persists.
Posterior knee pain
Posterior knee pain is a common site of referred pain
from the lumbar spine and from the patellofemoral joint.
Alternatively, local structures (e.g. popliteus, hamstring
tendon) may cause posterior knee pain.
Causes:
•Knee joint effusion
•Referred pain from Lumbar area;
•Popliteus tendinitis;
•Gastrocnemius tendinitis;
•Hamstring tendinitis;
•Baker's cyst;
•Deep venous Thrombosis;
Popliteus tendinitis
Pain may arise from the popliteus muscle, its tendon or the
popliteus/arcuate ligament.
These structures are situated close together and pain in this area
is difficult to isolate.
Occasionally, it is inflammed as a direct result of overuse in
acceleration/deceleration activities.
Treatment:
Reduction of the inflammatory process using NSAIDs,
electrical stimulation and ultrasound
Soft tissue therapy and mobilization may help to correct
any restriction of tibial rotation, knee flexion.
Posterior knee structures, especially the hamstring muscles,
should be stretched.
Strengthening of tibial rotators and hamstring muscles is also
necessary.
Strengthening of tibial rotators. This may be performed against manual resistance
Gastrocnemius tendinitis
Inflammation of the origin of the medial gastrocnemius at the
posterior femoral condyle occurs occasionally with overuse.
It may occur as a result of excessive hill running.
Sign\Symptoms:
On examination, local tenderness may be elicited.
 Pain may be reproduced on resisted knee flexion, jumping,
hopping or, occasionally, with stretch of the gastrocnemius
muscle.
Treatment:
ice,
 electrotherapy
NSAIDs to settle inflammation,
soft tissue therapy to correct generalized or focal abnormalities
of the gastrocnemius muscle,
graduated stretching/strengthening program.
Hamstring tendinitis
The hamstring muscles consist of the Biceps
femoris, Semitendinosus and
Semimembranosus. These muscles are used
to bend (flex) the knee.
Inflammation of these muscles can result
from a partial rupture that has not healed
properly or through overuse, (particularly
acceleration and deceleration)
Sign & Symptom:
Tenderness and swelling where the
tendon inserts onto the bone (tendonitis).
 Pain when try to bend the knee against
resistance.
Stiffness after exercise.
Hamstring tendon inflammation
Treatment:
Rest and apply ice / cold therapy.
anti-inflammatory medication such as ibuprofen.
 ultrasound or laser treatment.
 Prescribe a full rehabilitation programme consisting of
pain reduction, stretching, strengthening and sports
massage techniques.
Sports Massage
Baker's cyst
Baker's cyst is a chronic effusion that
herniates between the two heads of
the gastrocnemius.
It usually occurs secondary to
damage to the knee joint, most
commonly degeneration or meniscal
damage.
Sign & Symptom:
A rounded swelling,the size like a
golf ball.
 A sensation of pressure in the back
of the joint which can go down into the
calf muscle.
 Difficulties in bending the joint.
 Aching and tenderness after
exercise.
Baker's Cyst / Popliteal Cyst
Treatment:
Rest.
 Operate to correct or remove the bursa. Patient
should be out of action for 8 to 12 weeks following
surgery.
Deep venous thrombosis
Deep Vein Thrombosis is a blood clot in
a vein.
It is more common in the calf muscle
area, particularly following surgey.
Sign & Symptom:
•Constant calf pain.
•Tenderness at a point deep in the
muscle.
•Swelling.
•Increased temperature.
•If the ankle is dorsi flexed (toes pushed
upwards to stretch the muscle by the
therapist whilst the athlete remains
relaxed) this may cause pain.