[kylwalsh]

Hi Everyone,

This is both a follow up and request for new ideas/tips in recovery from an ongoing issue.

The gist: I’ve had pain at the outside/back of my left knee when at full extension or flexion. This pain was in response to running with a lower hamstring and limited ROM in knee for a few months. About 2 months of foam rolling and light hip exercises cleared up the lower hamstring pain. The pain at the outside/back of knee has remained.

The issue was diagnosed as a peroneal nerve issue by a PT. The PT fully tested my knee for meniscus and/or ligament issues and found no problems there. It was assumed that any meniscus issue was resolved by the 2 months of rest and soft-tissue work. I started a specific stretching, jump squats, and graduated running program. The condition has improved over 3 months, but is still ongoing. (I also visited an orthopedic surgeon who tested the knee joint and simply said I was tight and that it wasn’t a nerve issue. They didn’t recommend xray or MRI follow up.)

I can hike, including steep terrain, comfortably. The running program seems to help more than hurt. However, if I miss a few days of stretching out the area the issue gets a bit worse. Waking up in the morning still involves a stiffer movement to full leg extension. The joint doesn’t feel as “loose” or “free” between extremes as my healthy right leg. As I’ve continued with the PT program I’ve noticed pain at the front of my ankle joint as well. I can now get much closer to sitting on my heels (previously impossible on my left side), but really only after loosening my quads considerably. Working on full flexion usually leads to pain at extension, and vice versa.

The issue has improved, but it’s been 5 months of various active recovery efforts and I’m hoping it’s not going to last forever…does anyone have additional thoughts on the cause or potential solutions? Have you dealt with this before?

Any feedback is greatly appreciated!

Kyle

Topic

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on August 7, 2019 at 7:55 pm #26428

One thought is that it might be a more ‘central’ nerve issue coming out of the lumbar spine, and not just a peripheral issue at the peroneal nerve locally. Treating the lumbar spine with mobility might yield some more positive results. Of course there are fascial issues across the region that also interplay with the nervous system. Finally, I recommend single leg strengthening along the lines of single leg step downs to build better support and control of the knee before venturing into explosive efforts. Also, meniscus does not resolve with rest. Hope this gives some food for thought!
Cheers,
Pete

[kylwalsh]

kylwalsh on August 19, 2019 at 4:29 pm #26981

Hi Pete,

Thanks for some thoughts! Since my post, a chiro pointed me to some specific items in the MobilityWOD universe. Some of the more targeted soft tissue work (e.g. sitting on lax ball on hamstrings, and moving through ROM while on a roller/ball) have been incredibly helpful. I’ve been treating myself with those methods for a couple of weeks and have seen a lot of pain-specific improvement. In particular, my full ROM in L knee extension and flexion has been restored, or even improved, without pain. Hopefully it gets to a point where it feels good even without a lot of daily soft-tissue work.

Interesting to hear that the meniscus does not resolve with rest. The PT I saw was pretty confident that any meniscus issue “would have healed” by the time I saw him. Would I still be expecting to experience pain or limited mobility with a meniscus issue?

Thanks again for your thoughts, Pete.

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on August 20, 2019 at 9:49 am #27008

Great news on your improvement. It will be interesting to see the response to load. The meniscus doesn’t have much blood supply to in (only the outer rim) so that ‘healing’ isn’t really the mechanism of improvement. Small tears you can grind a bit smoother with repeat cycles of movement, but its not really ‘healing’.
Cheers,
Pete

[djcrusoe0929]

djcrusoe0929 on September 3, 2019 at 9:00 pm #27825

First, I wanted to echo Pete’s comments as they are spot on.

Another thing to consider is potentially mobilizing the fibular head along with some nerve mobilizations with a peroneal nerve bias. Has your PT done any of these?

Best Wishes!