Knee pain: Tips for therapists

Knee pain, Muscle information / Wednesday, July 1st, 2009

When knee pain is of muscular origin, the quadriceps, hamstrings, popliteus and gastroc muscles are the most common causes. If treatment of those muscles doesn’t relieve pain, therapists might think about these tips for solving the pain puzzle: Pes anserinus, short adductors, ITB/TFL, a Baker’s cyst, or chondromalacia.

Remember this odd name from your therapy training? Pes anserinus means goose-footed and refers to the three-part attachment of tendons below the knee on the inside surface of the tibia below the condyle. The three tendons belong to the sartorius, gracilis and semitendinosus muscles. All three are long muscles crossing both the hip and knee joints. In addition to pain that may be coming from injury to the tendons themselves, there may be pain from the bursa beneath them or from Trigger Points that refer to or across the medial or posterior knee. All three have tendinous inscriptions that call for treating the entire length of the muscle to release tension. Also note that the sartorius can entrap the lateral femoral cutaneous nerve and produce tingling and numbness of the lateral thigh.

The adductors longus and brevis at the groin refer pain to the knee. Ask the patient about groin tension and test for it with passive ROM. If present, treat these muscles deeply, examining for local and referred pain and finishing with active stretching.

The iliotibial band (ITB) can have an impact on knee pain because it attaches at and below the knee (ITB friction syndrome). The tensor fascia lata (TFL) has tendon fibers that join and tense (tensor) the broad fascia (fascia lata) that surrounds the thigh. Other tendon fibers extend directly to the knee with a function of stabilizing it, so knee pain could be produced by tension on these fibers and from possible resulting joint tension.

A Baker’s cyst or popliteal synovial cyst can cause knee pain from swelling of the bursae behind the knee. The cyst is usually the result of injury or disease process in the joint. The bursae are either under the semimembranosus tendon or the medial head of the gastrocnemius. Pressure on a Baker’s cyst should be avoided.

A diagnosis of chondromalacia or patellofemoral syndrome is caused by the irritation of the kneecap rubbing too hard on the joint or tracking laterally. Presented with this condition, I go back to quadriceps tension and imbalance. See the post Knee pain: Understanding the quadriceps.

2 Replies to “Knee pain: Tips for therapists”

  1. Hi Christina!

    Your website is great! Very informative, thanks for sharing.

    I’ve had some knee swelling and discomfort, especially when going up and down stairs. I’ve done the stretches you recommended and they’ve been super helpful.

    I was wondering if there were specific tests I could do to find out which of the diagnoses you listed above applies to me? I have an array of symptoms… I feel tightness in my hamstring, behind knee and around the front side of my hip, but also tingling behind the knee and in lower half of quad.

    Thanks for your insight!

    1. Hello! There isn’t much in the way of diagnostics for muscles because you can’t see soreness and other symptoms on available imaging equipment. The way I learn what muscles are involved is from knowing symptoms from my 23 years of working, then testing the muscles I think might be involved by putting pressure on them to see if a pain response is elicited. If so, that usually means the muscle is unhealthy and would benefit from Neuromuscular treatments. Stretching and icing are really the key to self-treatment, but you’ll find more relief from muscle treatment by a knowledgeable therapist. Hopefully there is someone in your area.

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