{"id":282,"date":"2009-06-25T10:05:40","date_gmt":"2009-06-25T17:05:40","guid":{"rendered":"https:\/\/blog.brianschiff.com\/?p=282"},"modified":"2009-06-25T10:07:40","modified_gmt":"2009-06-25T17:07:40","slug":"medial-knee-pain-meniscus-or-patello-femoral-pain","status":"publish","type":"post","link":"https:\/\/blog.brianschiff.com\/?p=282","title":{"rendered":"Medial Knee Pain – Meniscus or Patello-femoral Pain?"},"content":{"rendered":"

Have you ever experienced sudden intense anterior knee pain or pain along either the medial or lateral joint line?\u00a0 What about catching, popping or locking?\u00a0 Well, if so you are not alone.\u00a0 Many people suffer from patello-femoral pain and meniscus tears.<\/p>\n

I am currently working with a marathoner who recently\u00a0ran her own\u00a0personal best\u00a03:34 at the Boston Marathon.\u00a0 She has had various overuse injuries over the few years I have worked with her as distance runners often do.\u00a0 However, after I came back from vacation the second week of this month she had an increased pain along the medial part of her knee.\u00a0 It all began after running hills 5 days in the same week.<\/p>\n

My initial thought was she probably had increased inflammation of the patello-femoral joint as all the downhill running creates a more compressive load between the back of the knee cap and the femur.\u00a0 Not to mention 5 days in one week was simply too much.\u00a0 Needless to say I did not advise her to do as much.<\/p>\n

Her initial exam revealed some mild medial joint line tenderness, no swelling and no gait deviation.\u00a0 Her biggest issue was with squatting below 45 degrees and pain near the medial border\u00a0of the patella.\u00a0 She also had no pain with rotation of the knee with that foot fixed on the ground (I was particularly looking at valgus loading with rotation to tweak the medial meniscus).\u00a0 My initial assumption was that the pain would resolve with relative rest and minimizing compression at the P-F joint.\u00a0<\/p>\n

Relative rest really does not enter into the realm of reality for marathoners.\u00a0 So, my client continues\u00a0to complain of knee pain after running (not so much during).\u00a0 Her chiropractor feels she may have torn her medial meniscus.\u00a0 I re-evaluated her yesterday.\u00a0 Findings: mild medial joint line tenderness, no swelling, no locking, negative Apley compression and McMurray testing.\u00a0 But, she did have pain with internal rotation of the femur when standing on just the affected leg.\u00a0 Hmmm???<\/p>\n

Now, most meniscus tears occur with trauma that typically involves twisting and compression or an associated ACL tear.\u00a0 However, in runners, the repetitive nature of running can cause a gradual degeneration of the meniscus particularly if there is arthritis present in the knee.\u00a0\u00a0For more info on meniscus tears click here<\/a>.\u00a0<\/p>\n

So, she will be seeing the sports medicine doc next week.\u00a0 She may have a small tear.\u00a0 She\u00a0may just have an irritated P-F joint.\u00a0 She may have both.\u00a0 The take home message is really this: the most sensitive test for meniscus tears (whether medial or lateral) is joint line tenderness so we need to be sure in her case.\u00a0\u00a0If you work with female clients, you can safely bet most of them will have some form of patello-femoral arthritis by the time they are in their thirties.\u00a0 If they are overweight, the relative chances and rate of progression are simply higher.\u00a0<\/p>\n

I will keep you posted on the verdict with my client as she does not have a straightforward case in my opinion.\u00a0 She exhibits an inconsistent pattern of symptoms so I am not willing to rule out the tear at this\u00a0point.\u00a0 Regardless, this situation calls\u00a0for rest (as much as she will concede to), modification of strengthening to reduce P-F compression, and also evaluating hamstring work greater than 90 degrees as this too will pull on the\u00a0menisci and can potentially increase pain and strain on that tissue.\u00a0 Stay tuned and keep your knees fit!<\/p>\n","protected":false},"excerpt":{"rendered":"

Have you ever experienced sudden intense anterior knee pain or pain along either the medial or lateral joint line?\u00a0 What about catching, popping or locking?\u00a0 Well, if so you are not alone.\u00a0 Many people suffer from patello-femoral pain and meniscus tears. I am currently working with a marathoner who recently\u00a0ran her own\u00a0personal best\u00a03:34 at the […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[32,3,31,26],"tags":[],"class_list":["post-282","post","type-post","status-publish","format-standard","hentry","category-arthritis","category-fitness","category-knee","category-training"],"yoast_head":"\nMedial Knee Pain - Meniscus or Patello-femoral Pain? - Brian Schiff's Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blog.brianschiff.com\/?p=282\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Medial Knee Pain - Meniscus or Patello-femoral Pain? - Brian Schiff's Blog\" \/>\n<meta property=\"og:description\" content=\"Have you ever experienced sudden intense anterior knee pain or pain along either the medial or lateral joint line?\u00a0 What about catching, popping or locking?\u00a0 Well, if so you are not alone.\u00a0 Many people suffer from patello-femoral pain and meniscus tears. 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