Tricky posterior knee pain

[joshmeyer]

Symptoms are as follows.

Central posterior knee pain, worse with activity, mainly soccer (running), particularly running backwards, becomes worse after about 20 mins of activity, no history of trauma.
Examination shows no effusion, intact PCL, popliteus NAD, Lumbar spine NAD, normal neurodynamics (slump, SLR with DF etc), PFJ mildly tender anteromedially, no pain with a double leg squat or a single leg squat. Pain reproduced with single leg squat and calf raise together. Taping of PFJ with superior tilt changed pain, less intense with both the above movement and running backwards.
QUESTION - if the posterior knee pain is patello femoral in origin as taping would suggest, how does performing a calf raise with the knee bent reproduce the pain as opposed to a straight single leg squat. If the knee is bent the calf would have minimal effect on the knee, yet soleus which is used when the heel is raised in weight bearing does not cross the knee joint.

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[pjnewt]

Protracted / recurrent pains of this nature could be due to a blood vessel problem e.g. partial occlusion of the popliteal artery. There are a number of anatomical variations which could give rise to this i.e. re the course of the artery & its interface with adjacent soft tissues. Referral to a vascular surgeon may be an idea - possibly for dopler testing & post exercise brachio / ankle pressure testing.

[neilartz]

hamstings? calf acts as a stabiliser in squat, take that away and hamstrings have to work harder to stabilise during your single leg squat.

[perfphysio]

Sounds like a lax or stretched ACL allowing a posterior sheer on the joint line. The action of doing a calf raise involving either soleus or gastrox will co-activate on many occasions the hamstrings as well. In this later case the laxity of the ACL will be more evident in that it will compress already irritated structures. Check for the patients soleus length in a squat, and as for the taping, sounds like it is just stating the obvious tendency to quads dominance in these types of patients. Hence use it as a guide to what to inhibit rather than correct PFJ alignment. rich