Popliteal strain?

[Brian_C]

Hi - the back of my left knee is pretty sore and has been for sometime - I've had to stop cycling and running. I went to see a Physio who thought I had a Pirifomis Syndrome, I stopped going to him as I thought it wasn't working, I'm now seeing a guy who says it's a strained popliteal muscle/tendon. He has found a point that is very sore when he presses on it. It's located left of centre and about half an inch below the fold line of the knee. I get a tight feeling right across and slightly below the fold line pretty much all the time.
When I do a slump test I get a tight feeling and can't fully straighten the knee at first, but once I've done 3 or 4 of these slump test stretches I can straighten it, but still tender and tight. When the physio rotates my foot inward while doing a slump it's very sore to the left of the knee (probably the outer hamstring tendon??).

Anyone know what this is? Popliteal, Plantar, Hamstring train???

Knee doesn't "lock". MRI showed no problems with a mensical tear.

The pain or ache is there pretty much all the time.
I never jarred or fell on the knee, it just became sore after a run.
I never get sharp shooting pain.

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[marj]

The slump test is for assessing neural mobility and sensitivity. If you look up during the slump test, does it change your symptoms? If so, you are experiencing pain from sensitive nerve. Often, nerve pain that is relatively localized in this area is related to dysfunction at the upper tibiofibular joint. I suggest you ask your physio to check this.

[Brian_C]

Hi Marj, thanx for the reply. When I do the slump test and raise my head it eases the pain/discomfort - the same if I move my foot/toes pointing away from my body/head - does this fit in with your theory? I'm seeing my physio in about 45mins so I'll mention this to him. He had mentioned in the initial assessment something about the joint, and did a little work on it using, for want of a better word, a spring-loaded hammer.

[ATTIreland]

Hello Brian C,

Your description of the symptoms and the relief when lifting the head during the slump test does tie in with a diagnosis of ANT (adverse neural tension) as suggested by marj. The adhesion causing the tension can be anywhere along the nerves pathway but common places are the superior tibiofibular joint, the piriformis muscle (may explain why your previous physio was concentrating on this area) or where the nerve leaves the spinal canal.

Localised manual therapy at these points can help to relieve the tension on the nerve by increasing nerve mobility.

A usefull approach is also to use a neural stretch - you've already identified this yourself ("When I do a slump test I get a tight feeling and can't fully straighten the knee at first, but once I've done 3 or 4 of these slump test stretches I can straighten it, but still tender and tight"). What you were doing there was a type of neural stretch that helps mobilise the nerve. There are a few ways of doing these stretches but the key is to have an on-off cyclic movement rather than a sustained stretch like you would with a muscle stretch. I would typically have a patient perform 3x30 three times a day but this varies depending on severity of symptoms and you may need to build up more gradually to that amount so as not to irritate the nerve and increase the soreness initially. You would need to have the correct technique doing these exercises so its better that you talk to your physio about them rather than have me try describe them over the net.

Hope thats someway helpfull,

ATT Ireland

[GrantP]

all great advice above. as always diff over the net but your physio sounds onto it and may have already checked these anyway. as mentioned does seem neural tension and if your physio is manip trained and if your spine is stiff, then a manip here to either lumbar spine or SIJ (if they are in fact dysfunctional - i have even had results from manip to the cervical spine, thoracic spine if they seem dysfunctional) may help. piriformis can also be involved as can hamstring and calf. also foot biomechanics/shoes/stability etc. can and likely to be complex and combination of a few factors, even get your bike set-up checked to ensure frame and cleats are correctly fitted etc. good luck

[violablue]

Usually popliteus trigger points are felt central or more often slightly medial to the posterior knee joint. Plantaris the same or slightly more central. Usually with lots of walking, running, skating type activities the popliteus can become involved. I've seen that often as a trigger for pain in the posterior knee. Hamstrings, yes. If your hamstring are tight, you can have pain referring into the back of your knee and into your calf.

As the other physios have mentioned, a lot of other issues can contribute, as well.

If you want to look more into trigger points as an issue check out:

Trigger Point and Referred Pain Guide

And most especially Trigger Point Therapy Workbook; Your Self-Treatment Guide for Pain Relief

The webpage doesn't get into the popliteus, but the reasonably priced book does so better than any I've seen to date.

Wishing you good fortunes with tracking down your problem.

[Brian_C]

Thanks for all the replies - great stuff. Seen physio yesterday and he says the popliteal feels tight and lumpy, but not as much as last week. I've asked should I be doing stretches or excerises and he said not to at the moment. Even when the popliteal is aching pretty bad he can still do deep tissue massage on it - but there is still that one little spot (about size of a finger nail) that is very sore/tender. Located left of centre, half an inch below the fold line of the left knee.

He has been massaging and working on the popliteal area and upper tibiofibular joint followed by "cracking" my spine as well as the pelvis. After he does this I can do Slump test with no pain, very free.

Can I also add. Last year, I took a week off work to paint the outside of my house, so I was climbing ladders, lifting and pulling and stretching all week - not a bother on the knee. I was back in work (office work at a desk) less than an hour and the pain/ache came on again. I have another session tomorrow so I'll mention this.