Popliteus

Hi, after some advice re testing for popliteus pathology.

Have Pt c/o posterior knee pain, he's sub-elite long distance runner age 44. Had enforced no running since London marathon due to infected heel. He's been doing OKC leg weights - seated knee extension and prone ham curls to maintain leg strength while not running + stationary cycling.

Did first 5k run 5/7 ago and got knee pain afterwards. Since gets pain on rising from deep squat (p= 3/10 and is sup to knee joint), no pain on ADLs. No running / weights since. Has tight hams bilaterally (runner!) No previous Hx.

No obvious MOI. Suspect compensatory overuse of popliteus due to overloading hams during weights session (he's increased ham weight gradually over last 3/52).

• Knee F, E, MR, LR, F+Ad, F+Ab all ok.
• 5/5 strength R=L on quads, hams, glutes, calves. No pain on resisted mvts.
• -ve SLR, Lx and hip ok.
• Tender on palp of popliteal area with knee in 20 deg flexion
• No effusion or heat
• PCL + ACL ok
• Tender on passive knee extension from flexion (McMurrays)

Is there anything I've missed? As for Rx - bearing in mind deep lying anatomy making it a difficult muscle to stretch, any suggestions other than ultrasound? I'm reluctant to do DTM in view of popliteal fossa.

Thanks in advance for any advice.

hi friend
what tests you did is fine.you are on right track.
i suggest you to try i more test
make the patient to sit in high sitting with knees hanging down at 90 degrees.in this position take tibia to medial rotation and at the end range ask the patient to try active lateral tibial rotation which you have to resist and see the response.

Thanks for your reply; will do that test. Any ideas re treatment?

hi
make the patient to sit in high sitting position .apply 3-4 kg weight cuff aroung ankle and encourage gentle oscillatory movements of the knee into flexion-extension for 5-10 minutes.reassess and ask for subjective response too
cheers

cheers linbin :)