There may be altered joint arthrokinematics and other mechanical issue of an adjacent structure, which may contribute to lateral knee pain. So, what will be the best physiotherapy management?
May i know the diagnosis?. If its like a sports injury ( ITB issues) we go for strengthening and stretching positioning techniques after resolving the acute pain with ice, anti inflammatory agents.
What is the cause of the pain? What is the history? What are the findings on the clinical examination? How is the spinal mobility? How is the hip movement? Is the patient's posture acceptable?
All questions have to be answered and manipulation can be applied at the areas of "interest" as well as strengthening of muscle groups or auxiliary treatment with instrumentation.
Given the limited history, here is a totally random guess as to what the problem could be.
The common peroneal nerve runs near the fibular head, splitting into the superficial and deep peroneal nerves. The superficial peroneal nerve could be irritated from whatever is causing the lateral knee pain, I'm just going to guess an LCL grade 1 sprain. This could cause pain radiation down the lateral calf. In this case, manual therapy to the LCL and fibular head could help with this pain.
Of course, this may not be the case for the patient. We really need more information as the other replies have indicated.
Dear George & all,
The patient is 40 years female. There is no history of trauma and the cause of pain is unknown as all physical and clinical examinations are normal except minimal obesity. According to my view, the patient has pain due to altered load on the knee joint because of obesity and long standing habits. Of course in this case, we can strengthen the muscles of the hip and knee. We can also encourage the patient to stand with wide base support to minimize the load over the lateral side of the knee. Regarding this case, I want to know the application of manual technique and other best management. It will be highly appreciated.
High BMI patients and mainly female have the tendency to "create" valgus knees as they are trying to establish wider platform to stabilise themselves (part of this is also the wider pelvis). This valgus position of the joint increases the loads on the lateral compartment (and in this case the symptoms are present laterally) and also the knee has weaker parts of the quadriceps (weaker vastus medialis for example). If this is the case than strengthening of vastus medialis using passive (for example electric stimulation) and active exercises and in the same time stretching of the lateral soft tissues (using manual treatment or splints) and stabilisation of them may help the acute phase but the mainly the patient has to loose weight to help the clinical symptomatology.
Has the patient had X-rays? One possible cause to rule in/rule out is fabella syndrome, which does manifest as an insidious onset of lateral knee pain, and can radiate to the leg. The attached link is to a paper in JOSPT that describes the diagnosis of fabella syndrome and a successful manual therapy treatment for it.
Hope it is helpful.
http://www.jospt.org/doi/pdf/10.2519/jospt.2003.33.1.33
Is the situation of the lumbosacral roots sought out? Is there a varus deformity or a hyperextendable knee in a laxe person? .
when performing a straihgt leg raising test and keep the leg in this end position for a while and the patient experiences her characteristic pain, or maybe only when you add dorsoflexion of the foot , than you know also som origin comes from higehr up, mostly due to a bad sagittal contour of the spine. Not necessarly stenosis, but hinder in mobility of roots. Stretching excesises, postural excesises and I experiences in patients good results with "Neurodynamic"treatment ( Butler , Shackleton) by trained therapists. But in fact simple to understand and perform.
considering the > silent < case history the view of Piet van Loo is likely to be true. If so, the easy and uncomplicated application of the therapy described in the paper attached would be followed by an immediate considerable improvement. It could be necessary to repeat this twice per week for lasting results.
Consider diagnosis of compartment syndrome n. fibular, where he advises decompression of the lateral compartment of the knee. You will be able stretches of the fibular muscles.
Hi Shahnaz.
In my experience, lateral knee pain associated with calf pain is not rare. There are a few common causes which can be looked for in most patients, if just to exclude them from a final diagnosis.
An iliotibial band problem can radiate to the lateral knee and into the lateral calf and foot. There are a few structures attached into the ITB, including the gluteals and vastus lateralis. Palpation would normally reveal tenderness which can be proximal as well as around and below the lateral knee.
Another possibility is peroneal muscle tightness or overuse , which can cause pain just below the lateral knee and pain in the lateral calf. Again, palpation may discover this.
Another possibility is lateral gastrocnemius. This attaches just above the lateral knee. Again, palpation may reveal this.
Any of these issues might respond to manual therapies, as the pain is muscular in origin. However, the benefits may be short term. it is probable that the patient may require exercises to strengthen and stretch the relevant muscles. If overweight, then weight loss may enable their muscles to cope better and without pain.
I hope this helps.
Regards,
Ian
- Badges
- Science topic
- Similar topics
- Biological Science
- Neuroscience