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Popliteus Muscle and Knee Pain

My left knee issue does not involve and behind-the-knee pain, but this note from reader John S was so interesting and well writen that I thought I’d share it with readers.

John S writes:

Interesting what you describe is very similar to an injury that I had.

About 30 years ago, I blew my ACL. Faithful care and wearing of a knee brace during athletics meant that I was able to preserve the integrity of my knee, meniscus etc… This was the only choice since ACL repair was not very good back in the day.

Two years ago, while eating at an outdoor restaurant on a sunny day, I went inside and stepped off of a step that I was not able to see since my eyes had not adapted well to the dim light. I landed with a stiff leg and instantly knew I had hurt something in my knee. From that time on, walking and other activities caused as snap and pop in my knee that was really uncomfortable. I thought I had torn the meniscus or done something else.

Two trips to sports medicine docs showed led to treatments that were not effective. An MRI reviewed by my ace ortho surgeon showed a knee and meniscus that were "pristine" to use her words (other than the vanished ACL). I was told to come back in several months if no change.

Finally I went back to my family practice doc (also a friend) and told him I wanted to see the very best knee PT that they had. He asked around and set me up with just such a person. She looked at my knee, examined it and told me to come back in a week after she had done some research.

Turns out the pain in my knee was the popliteus muscle- a little known muscle that helps the knee to twist and helps stabilize my knee . What I had apparently done was to stretch the iliotibital band (ligament) which was being compensated for by the popliteus muscle which subsequently was getting over used and was becoming quite painful. This injury is one that could only have come about in a patient without an ACL but other intact structures in the knee - unusual. It can be fixed by surgery, but it has a low success rate.

What she did note - and what you might find very useful, is that due to all my cycling, there was a misbalance in the muscles in the front of my leg compared to the muscles in the back of my leg (hamstrings). She set me on a regime of strengthening the hamstrings and other muscles in the rear to help stabilize and better balance the knee. After about 4 weeks of this, the pain suddenly decreased and after another two weeks all the clicking and clunking stopped. I'm wondering if with all your cycling, if you are not suffering from a similar problem (misbalance). Mine was brought on by the injury and then exacerbated by the cycling (pre and post injury, it seems). Now I'm wondering if had I balanced the groups better, I might have avoided the injury entirely.

Your clicking problem sounds like mine. Your MRI is similar to mine (no problem). So I'm wondering if you might not want to take the path I did with the PT and have them look at similar clues to mine. It's also worthy to note that the pain from my popliteus muscle was really quite debilitating and, interestingly, non specific. My whole knee felt quite sore and tender not just at the site of the muscle. I attribute this to the fact that it's so deeply buried. My doc found it by using his iPad anatomy app, asking me to point at where it hurt and then peeling back "layers" in his software until it's clear that that was the only thing there.

WIND: maybe I should resume my inline speed skating and Olympus squats.

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