posterior knee pain

[jyoung]

Hi, I have a 38y.o woman who tried to return to working out (wt room stuff) 10 months following the birth of her baby. She appears in reasonably fit to start with. After the 2nd exercise session, she experienced pain, fullness in the popliteal fossa centro-medially especially with static standing. She thinks it may have been the hip extension machine where she felt a twinge.

She says it's been about a year now and although the pain is better the sensation of fullness is still there with standing, also popliteal fossa has some minor swelling on standing, possibly some sensation changes in the foot. Exercise does not make it better or worse.

Clinical findings: no joint swelling, lig. test neg, meniscus test neg. Ultrasound was negative for Baker's cyst. MRI showed no abnormalities.

Any ideas on what this might be would be greatly appreciated! Thanks.

[kennethckyuen]

Hi Jyoung,

I, as a manip physio, also experienced the same problem in my left knee. I found out not much in the literature but by personal clinical trial might be helpful. After I sprained my knee (meniscus injruy), I got posterior knee pain when I reture to play light intensity basketball. I found out that my quadriceps was weak and everytime after I play, pain experienced; and it was just come on in any occasions except resting. I therefore trained up my quad and after 2 months, I got no pain now. But if I really play very very hard game, the posterior knee "discomfort" will appear again. This might be because of my insufficient endurance of my quad. I, therefore, could only conclude weak quad could lead to posterior knee pain of muscular origin. Anyway, I hope this could help your client.

Cheers,
Kenneth

[karen.hankey]

I agree with Kenneth. If you can't find any structural injury e.g. ligament/muslce strain, meniscal damage, trhen i would look to increase the stability of the knee though a strength programme.

Just as a side line, have you assessed her pelvis to check that the source of pain isn't from there. My line of thinking is that following pregnancy the hormone relaxin is still in the system, whcih affects the laxity of ligaments around the pelvis to allow for birth. She could have a pelvic problem casuing altered biomechanics leading to her popliteal pain. Just a thought...

[rockin ronnie]

what is her knee ROM? PFJ tenderness/referral? Pain on popliteal contraction? SLR asymmetry?
can be v/tricky the posterior knee pain. try mobilising any stiff lumbar segments as per "GINGER"

[linbin]

hi
as mentioned by karen it can be a lig laxity secondary to the hormonal alterations seen as a sequelae of pregnancy and gestation.i think general hyperlaxity of joints should be ruled out.abservation of posture,any biomechanical alteration.as the body of a pregnant woman undergoes significant biomechanical alterations we should give more importance to a detailed assessment

[bobbypt]

hey...
is the patient recovering from her post. knee pain...
how was her gastroc...centro medial pain against resistance knee flexion and ankle PF may be due to micro trauma in medial gastroc head that she might got during hip extension exercise. please update the patient outcome....