Self-management: Knee Pain

Last week I woke up one morning with significant knee pain on the L side. I hadn't exercise or done any new activity the prior day. I simply woke up with knee pain. The pain was primarily located medially and was increased with any twisting or flexing of the knee beyond 90 degrees. It's one of those occasions where it is good to be a PT, because you can treat yourself and do so quickly!

The typical presentation may lead some to think meniscus tear. While I believe I have meniscus tears in both knees, I think they are asymptomatic and I have had them for years. The fact that there was no mechanism of injury should lower meniscus as your diagnosis as well. Typically if I were to have an evaluation like this, I would check the spine and neural tension immediately even if I suspect local involvement. However, for myself I went straight to the knee due to rapid improvement. The significant findings were lack of knee flexion mobility, maybe a slight loss of end-range knee extension, but the most significant findings was decreased tibial IR on the symptomatic side. You can assess this with the patient seated by having them actively (or you perform passively) tibial IR (watch out for ankle inversion!). Often you will notice a loss of mobility on the involved side.

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To treat this, perform repeated tibial IR MWM into knee flexion, while in a half-kneeling position. What many often forget is that tibial IR is actually a natural arthrokinematic component for knee flexion mobility. As with any repeated motion exercise, the more repetitions, the faster the recovery. Like I said previously, I did not check the lumbar spine, so it is possible the knee would have responded well to treatment there or possibly repeated knee extension, since there was a loss there as well. Check out the video for a demonstration of how to perform repeated tibial IR as an exercise. For your patients that can't get into a half-kneeling position, you can have them lunging onto a step or a chair while maintaining tibial IR.

-Chris

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