Knee Pain

[physiojlb]

I have had several clients recently with a stabbing pain on the medial aspect of the knee. No pain on resting, but pain on all weight bearing. No family history or previous history of knee pain. One client is 48yo a runner who experienced this pain following a run and another who is an 70 who described an insidious onset.

Iniitally I thought that both were refered pain from meniscal injuries however no positive meniscus tests and all other ligament tests were clear, no pain on patella grind test. Only TOP over the area of pain. This then lead me to think of the inflammation of the pes anserine.

I have used the following treatment methods;
DTF, Acupuncture, US + IFT, Kenisio tape to off-load the structures with no real success. The older client reports feeling absolutely no symptoms following treatment but returns with no improvement and the younger lady reports increase of pain following some treatment which settles but no real improvement. I have included a body chart for the pain.

Any ideas or help? thanksknee pain.jpg

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[Dr Damien]

Dear Physiojib

If you dont mind can you tell us in details what your history taking questions were and what your physical examination looked like?
I may be able to help if you could give more detail...I think your history taking and assessment may not have been complete to be able to make a diagnosis...

some other physios may be able to give you a straight answer with what they think but id rather we go through your assessment and physical examination to be definite on a likely cause...

Just an idea of some things that might be missing

i.e what aggravates and what relieves? for the runner is the pain always there on weight bearing, is there a time of the day it gets worse? what happens with stair climbing? any pain medication affecting this problem? is this problem getting worse? does it even get painful at rest or at night even if its a little? have you checked her hips, SIJ and lumbar spine? any swelling increase in temperature in that area? is there an activity that aggravates it other than running? what is the alignment in the knee? what is the patellar tracking like? does passive tibial rotation cause pain? what about resistance tests, knee and foot? what is the alignment of the foot, or tibia on the foot? for all alignment assessments whats the difference with the other limb? check hip alignments as well?

same goes for the elderly chappie...

you may need to add more to your assessment and consider some radiological investigation, the area you have marked is largely bony...

runners are prone to stress fractures, elderly folks are prone to athritis, pain from osteoporosis/ostepenia...

some of the treatments may likely cause pain around the area...especially ultrasound being such a bony region...

we always tend to think every musculoskeletal problem has gotta be soft tissue related, this makes us struggle a lot with our managements, we forget that bone is also a structure that can be damaged as well...

i generally start my treatments with cryotherapy if i think that the area of pain is localised because irrespective of what is happening locally some level of inflammation is likely happening...all the treatments you mentioned have been pain relieving modalities with very little focusing on real physiological changes, this is why i dont rely much on the above mentioned therapies...taping is effective if your assessment has indicated so, as we dont know what your assessments have been thoroughly im not sure of the indication...

lastly, if its a bony problem...its not likely any of your treatments will help..

Im almost certain the problem is bony...

[JayPhysio]

What have you needled exactly? Acupuncture or dry needling?

To me with no other causative factors besides running, I'd go with Pes anserine Bursitis.
I have treated this many times with dry needling of semitendonosis, gracillis and massaging and stretching the same musculature.
Home programme is just stretching adductors and medial hamstring. Check out other options for the older patients though as Dr Damien mentions.

Of course foot/ankle/knee/hip biomechanics also need to be checked.

[allina11]

I am acupuncture professional, and I have been working form last five years and I have had many positive responses in patients with knee pain of many different causes. In treatment includes knee osteoarthritis, bursitis, tendonitis, strains, local contusions, as well as improvement in motion with conditions such as hamstring and quadriceps strains. Putting a needle through the skin serves to improve local blood flow to an area that may have relative lack of blood flow, which then benefits greatly from a local improvement in circulation.

Acupuncture treatment provides pain relief by activating the pain modulation system of the body, and changes both the processing as well as the awareness of the painful information at various levels in the central nervous system. By modulating pain, decreasing the awareness of the incoming pain signals, improving blood flow, improving the production of pain relieving substances, and in general promoting healing in the area of trauma, acupuncture helps to generate improved blood flow resulting in improved healing to the area.

[JayPhysio]

Any progress physiojlb? And more info?