Name My Pain

Chronic Knee Injuries (Back) Name My Pain
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Iliiotibial band friction syndrome
Presents as pain on the outside of the knee, as a result of chronic overuse and tightness of the Iliotibial band. Activity particularly running flares it up and generally pain presents after the athlete has cooled down, but if not addressed, then pain can come on earlier and earlier with activity until it becomes constant and not exercise dependent. Longer runs, hills and running on a camber can cause increased pain.

ITB

Biceps femoris tendinopathy
This commonly presents in the athlete that is required to accelerate and decelerate continuously within their activity.
It presents as pain at the back of the knee on the outside, after exercise initially, but as the condition worsens so does the frequency of the pain, until it can’t be ignored and is more frequent, where the pain may decrease with activity, but be worse when the athlete cools down.
Tendinopathy’s result from overuse of the muscle and the tendon that attaches that muscle to the bone. When the tendon is overused it sustains small microscopic tears. In order for the body to repair these tears it creates inflammation, and that inflammation can cause pain, stiffness and swelling.
These types of injuries typically are ignored at first. As the pain initially decreases with warming up, and then is not present during activity. But the discomfort returns when the athlete cools down. If not addressed this process continues and worsens the condition, so that pain becomes more present during activity, and worsening more after finishing, until ultimately there is constant pain, and limitations to all activity.

The best test to perform to confirm the diagnosis is resisted knee flexion. (Seen below)

Resisted Knee flexion, in this picture the right leg in pulling back against the left legs resistance, pain will be reproduced at the back of the knee on the outside.

Knee

The knee continues to bend (flex) against resistance, and if the pain is reproduced at the back of the knee on the outsdie then this injury is indicated.

Knee

Popliteus tendinopathy
This condition traditionally causes pain on the back of the outside of the knee, and can occur as a result of being overstretched, or overused. This generally results from excessive acceleration/deceleration activities.
Tendinopathy’s result from overuse of the muscle and the tendon that attaches that muscle to the bone. When the tendon is overused it sustains small microscopic tears. In order for the body to repair these tears it creates inflammation, and that inflammation can cause pain, stiffness and swelling.
These types of injuries typically are ignored at first. As the pain initially decreases with warming up, and then is not present during activity. But the discomfort returns when the athlete cools down. If not addressed this process continues and worsens the condition, so that pain becomes more present during activity, and worsening more after finishing, until ultimately there is constant pain, and limitations to all activity.

The test below of prone resisted knee flexion with foot turned outwards(Tibial external rotation) will reproduce pain if this is the injury.

Prone resisted knee flexion with foot turned outwards.
View from behind shows, right leg turned outward, pulling the leg back towards the buttock against the resistance applied by the un affected left leg. This will cause pain.

Knee

Prone resisted knee flexion with foot turned outwards. View from behind again shows, right leg turned outward, pulling the leg back towards the buttock against the further resistance applied by the un affected left leg. This will cause pain behind the back of the knee.

Knee

Prone resisted knee flexion with foot turned outwards. Side on view showing right leg turned outward, pulling the leg back towards the buttock against the resistance applied by the un affected left leg. Will cause pain if indicated on the back outside of the knee.

Knee

Prone resisted knee flexion with foot turned outwards. Side on view showing right leg turned outward, pulling the leg back further towards the buttock against the resistance applied by the un affected left leg. Will cause furhter pain behind the knee.

Knee

Gastrocnemius tendinopathy
Traditionally pain presents at the back of the top of the knee, and can be reproduced with a calf stretch, jumping, hopping or with a calf raise with knee in extension.
Generally results from excessive hill running or a sudden increase in running mileage.

Tendinopathy’s result from overuse of the muscle and the tendon that attaches that muscle to the bone. When the tendon is overused it sustains small microscopic tears. In order for the body to repair these tears it creates inflammation, and that inflammation can cause pain, stiffness and swelling.
These types of injuries typically are ignored at first. As the pain initially decreases with warming up, and then is not present during activity. But the discomfort returns when the athlete cools down. If not addressed this process continues and worsens the condition, so that pain becomes more present during activity, and worsening more after finishing, until ultimately there is constant pain, and limitations to all activity.

To confirm diagnosis a calf raise with knee in extension will reproduce pain where it is marked.

Knee

Calf raises with knees extended will cause pain.

Bakers’ cyst
Presents with a swollen, tender mass at the back of the outside
Knee. The amount of swelling at the back of the knee may fluctuate. Often occurs in combination with a degenerative or meniscal abnormality.
MRI is the best diagnostic tool to confirm condition.

Bakers Cyst

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