[kylwalsh]

Hi! Apologies in advance for the dissertation…

I’ve been dealing with some fairly specific lower hamstring/outer knee pain for quite some time and am hoping this group could offer thoughts as to what the issue might be.

For a few months (~Dec. to early March) I had a nagging issue on my lower hamstring. In the most extreme ranges of knee flexion/extension I would get pain at my lower hamstring. I first noticed it kneeling on the edge of a mat at a climbing gym. I’d have the leg bent, kneeling, and wouldn’t be able to full straighten my leg when I got back up. A few steps in it would alleviate (some). Likewise, after standing for a while, bending my leg up would cause pain at the knee, particularly the outside of the knee.

I had been running all the while, with a foolish assumption that consistent use and stretching might “work it out”. The pain stuck around, and came to a head on a downhill trail after a particularity steep uphill. At that point, the lateral knee pain started and has been more a problem since, especially when bending my leg after standing. I had to hobble the last couple miles to the car that day, but have only had that degree of pain once since, on a 5-6 mile walk.
I’ve had some treatment and diagnosis from a chiropractor. Their thought is that the cause is hip weakness and imbalance. Specifically, my right leg was weaker than my left – where I feel the pain – and I was overusing my left leg and wore out the tissues. We’ve treated the tendons to my fibula head and IT Band tendon into my knee, but that provides only a bit of pain relief within a normal ROM. I can bike and complete a variety of strength training movements with no pain (e.g. squats, lunges, leg lifts, stairs/step ups), though a straight leg on planks and pushups produces pain.

I’ve been foam rolling my left leg to oblivion for a bit more than 2 weeks on the advice of the doc. It’s helped the outer knee pain, but hasn’t changed the pain at the extremes of my range of motion – full straight leg or full bend.

Does anyone have an idea of what could cause this? The internet points to the popliteus or a hamstring and/or calf strain – but it’s pretty murky information, and the doc was quite sure it’s not a muscle strain.

I would greatly appreciate any thoughts this group might have on the cause/recovery/etc. – or even if this sounds like a familiar overuse issue.

Thank you!!

Kyle

Topic

[Anonymous]

Anonymous on March 29, 2019 at 1:33 pm #19262

Sounds like it could be meniscus related, this can cause issues into end range extension. Try a seated knee distraction. To do this: sit over the edge of a high table or bed, something your legs can dangle while seated and relaxed. Strap a pair of heavy-ish ankle weights (5-10#) on your ankle and let it dangle for 5 minutes. Do this, then do some quad sets, repeat a couple times per day.

I am a PT and use this with patients who come in with this issue and have had pretty good results. I’ve also used this myself as I have had this problem in the past. Very heavy band (EliteFTS has some good ones) TKEs to strengthen the quad at extension; single leg RDLs, nordic HS curls, and glute ham raise for eccentric hamstring strength are key exercises once the pain at extension has mostly resolved.

[kylwalsh]

kylwalsh on March 29, 2019 at 5:29 pm #19265

Thanks for your response – I’ll be sure to give this a try. I was under the impression early on (based on…the internet…) that a lack of swelling in my knee or a traumatic event would rule out a meniscus issue. Specifically a tear. Are there meniscus issues unrelated to a tear? Or maybe just varying degrees of tear?

Thanks again for your thoughts! I’ll give the seated knee distraction + quad sets a try today.

Kyle

[Anonymous]

Anonymous on March 29, 2019 at 6:26 pm #19269

You can get “debris” in the joint that can move around and get the knee to lock up. Not necessarily a full on tear from trauma. Is there any localized swelling near the lateral joint line? Sometimes you can see a tiny bump in that area that won’t be there on the uninvolved side.

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on March 31, 2019 at 9:08 pm #19636

I agree with ahole88 that your symptoms may be meniscal. Locking and catching of the knee are significant meniscus indications. Also, a chondral injury can give similar symptoms without the swelling. If it is a meniscus tear, you need to be aware of the ranges you interact with the tear, and try to train around them at first. Deep flexion is usually a problem (deeper squats etc.) uneven ground activities, and even biking can give you a problem. Try to get as strong as possible without pissing it off. If symptoms continue, see an orthopedist, MRI, scope to get back to full activity. Its the fastest rehab of all knee surgeries.
Pete

[kylwalsh]

kylwalsh on April 1, 2019 at 3:24 pm #19693

Thanks Pete and ahoole88! Would a meniscus-related injury be related to the initial pain in the lower hamstrings? Are these symptoms related? That’s still the area I feel most when straightening my leg. The pain at full flexion is felt more in the knee itself, at the back. The outer knee pain is pretty specific to when the leg has been straightened for a while and is first bent.

I haven’t noticed any swelling compared with my normal right knee, including something very minor like a bump. They look the same and feel the same after testing it pretty closely. I have yet to have any pain doing hip and leg strengthening exercises, or with low-intensity cycling (haven’t tried anything more). Walking no longer hurts, though I haven’t tested it much.

Thank you again!

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on April 1, 2019 at 8:26 pm #19698

Kyle,
A meniscal injury will give pain to the ‘area’ or side its on. As you surmise, there are other injuries in the mix including an ITB friction syndrome and a lumbar radiculapathy. I once had a patient miss diagnosed with a meniscus injur,y when it was a lumbar nerve injury sending pain to the outside of his knee. If you are shut down from training, its time to get some help with it.
Cheers,
Pete