Daily Mobility Exercises by Dr. Kelly Starrett › Forums › Knee › Non-Trauma Posterior Knee Pain

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    • 06/01/2014 at 4:12 am #70966
      AvatarAdriana Culmone
      Participant

      I need advice if I would need to go for surgery for this knee issue or how do go about resolving it.

      About 8 weeks back, my left knee swell up after standing and walking during work. My last workout was deep squats two days before onset of injury, and there was no indication of any injury prior to the swell.

      Subsequently, after knee swell has subsided after 4-5 days, I have aching pain felt at the back of my knee during terminal knee extension (weighted & unweighted) and full knee flexion (hamstring to butt). 

      4 weeks after first onset (last week), my knee swell up the next day after I did light weighted squats (trying out). This time, I bought a knee sleeve, which resolve the swelling after 2 days. Compression seems to help for this instance. Since then, I have been wearing a knee sleeve most of the time.

      Last week, I visited an orthopaedic and did an MRI. Doc suggested keyhole surgery after the Findings on the MRI report states:

      “There is horizontal tear present at the posterior horn of the lateral meniscus. This reaches the inferior surface of the meniscus.”

      The Impression in the report states:

      “Suspected horizontal tear present at the posterior horn of the lateral meniscus reaching the inferior meniscal surface”

      To get second opinion, a visit to a Physical Therapist suggested that it may be popliteus-related or posterior muscle imbalance related issue; after I tested negative for meniscus tear from his functional tests.

      I am in my mid-30s and no prior injury to knee before. I have been doing squats with no issue for about 20 months and also complement with runs.

      Right now, I am able to have full knee flexion with negligible discomfort. However, I am still experiencing a painful-ache at the posterior and more lateral side of the knee when I do terminal knee extension. In fact, I am losing some terminal knee extension sometimes.

      Do I necessarily need surgery for this? Or it may just heal on its own? Anything I can do other than not squatting for now, to promote healing? 


      Since then, I have been doing alot of mobility work upstream, downstream and also recommended knee mobility exercise for managing terminal knee extension. The outcome is that it has provided temporary relief after mobility work, but has not solve the problem yet.

      Appreciate your kind helpful opinions on the above; even if K-Starr himself can help would be really appreciated.
    • 06/08/2014 at 9:20 am #74749
      AvatarKatie Hemphill
      Participant

      Hey Cleve,

      Did your doctor give you no indication of whether the conservative (non-surgery) approach was realistic? The inner two thirds of the meniscus is termed the “white zone” because of it’s lack of strong blood supply, and tears to this area generally are not repairable without some sort of concurrent bleeding damage (like also getting your ACL reconstructed). Whether or not your tear occurs in a portion with good blood supply will determine if it has the potential to heal. 
      Though whether surgery is necessary or not may depend on the severity of the tear, and whether the symptoms it causes are debilitating (they seem to be messing up your training pretty bad, at the very least).
      The nice thing is that the surgery is pretty non-invasive. They don’t need to open you up, so the recovery time is actually pretty good. I had a partial meniscectomy of my medial meniscus a couple years ago, and I was able to walk reasonably well within a week or two, and make a slow return to activity at like 5-6 weeks. It did take a while for me to achieve full range of motion in my knee again, but now that sucker is stronger than ever, and requires only a little bit of extra upkeep to keep healthy.
      I know surgery is a pain, but I waited forever to get under the scope, and that whole time my knee would randomly fetch up a few times per week and leave me limping. If your doctor and physio think it’s realistic, try the conservative approach. Be cool on that thing for a while, give the initial injury time to chill, and see just how much it actually affects you.
    • 06/11/2014 at 8:11 am #74769
      AvatarAdriana Culmone
      Participant

      Thanks for the response iron_tiger!

      Currently, I’m adopting the conservative approach. Knee can be in full flexion under body weight, with no prominent ache. Knee almost functions normal when standing, with occasional discomfort or ache half the times, when in full extension.

      Rehabbing it with body weight and box squats till just below parallel. Mixing it with a few jogs so far. No recurring swell post exercise.

      I have not do any form of barbell squats yet. Slowly getting there. Aiming to get back full functionality in e next few weeks.

      Am also cautious and suspect maybe I am shoving the knees out too much during full flexion squats, and maybe caused some knee dysfunction in the popliteus or even he meniscus tear reflected in the MRI.

      Anyway, only reminder of the injury for now is when I experience some form of tender ache at the posterior lateral side when the knee is cold, in terminal knee extension when weighted or unweighted. Still perplexed is it is meniscus or muscular related.

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