Thoughts from the journey… Excerpts from a day in the life of Sherry McLaughlin

12Oct/090

The origins of anterior/lateral meniscal pain

I've seen this three times in the last week, so I'm taking that as a sign that I am supposed to write about it.

Have you ever had a knee patient who complains of anterior knee pain with end range knee extension? They will either describe a pain at the anterior knee joint line or deep inside the knee. This is common, especially in post-surgical knee patients, and will delay healing time or possibly be the reason for a lack of terminal knee extension.

There are two primary scenarios that will create a pinch in the anterior/lateral knee with end range extension:

1. A femur that is internally rotated (check for t.p. in the anterior fibers of gluteus medius and TFL and/or in the medial gastrocnemius)

2. A tibia that is externally rotated (check for t.p. in the bicep femoris tendon and check for a posteriorly displaced fibular head)

Lat men t.p.

The trigger points may be treated with counterstrain and/or deep trigger point massage. The posteriorly displaced fibular head may be treated with MET. All of these aforementioned techniques take less than  two minutes!

Make sure you re-check end range extension after you treat the trigger points you find. Normal extension end-feel should yield a stretching sensation in the BACK of the knee.

Then make sure you address the offending tender point with exercises in the gym:

1. Gluteus medius - try medial reach with contralateral arm at waist level, heel-toe walking or carioca walking

2. Medial gastrocnemius - try gravity drop, downward dog, long strides in the ladder (make sure the toes stay pointed straight ahead) and balance board or foam roll rockers.

3. Bicep femoris - try the revolving triangle, anterior cone touch with the opposite hand or an anterior pulley low row with the opposite hand as the stance leg.

It sounds like a lot to get knee extension, but I assure you, it is the fast track to achieving a normal gait pattern and normal functioning of the lower extremity.

Until next time...

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