Popliteus

[Back Fade]

Hi,

Anyone have experience with popliteus injuries? Either in yourself or client? And, if so, how was it treated? Healing time?

 

[javier]

ouch! this is a hard one. I am assuming that it was proven to be torn through an MRI. It's major action is unlocking the knee from a fully exteded position. The muscle itself is small and deep to Gastroc/Soleus, but it is very tendenous that merges into the achilles. As for treatment, I don't even know how to approach it due to it's location and size, so isolating it is basically impossible. I would make sure to petrissage the gastroc/soleus to make sure that there is a lot of blood flow to the area, and see if there is any compensating muscles in their stride between heel strike, flat foot and toe up. Also look to see if they are fully extending the knee while walking.

As a side note, my orthopedist originally thought I had torn my popliteus, prior to an MRI. I have a partially torn ACL, cracked L meniscus, and major tracking problems that were corrected by a lateral release, all of which did not show up on the MRI and were noted during surgery.

 

[Bass]

Thanks Muriel. Yes, OUCH is right, lol! The injury is actually my own. The pain behind my left knee started back in May which I paid very little attention to (aside from the intense firey burning pain) because I assumed it was a ligament or tendon problem that just needed some time to heal. It manifested out of the blue after returning home from a normal walk with the dogs...these walks are not intense or a work-out.

No, I cannot fully extend my knee while walking.

The pain has been worsening (directly behind the knee, and increasingly at lateral knee where popliteus attaches as well). It seemed to get better with rest and stretching TFL/ITB. But now even that doesn't help. Nothing is helping to relieve pain (I've been using Arnica gel), or helping it to heal. This week I had myself in a panic, and drove to the ER because I thought I had a blood clot :shock: (starting to manifest nerve problems and my whole leg was aching, couldn't get comfortable enough to go to sleep). After being assured by the ER that it wasn't a clot, they diagnosed it as a knee sprain or baker's cyst. I have not had an MRI, nor have I seen an Orthopedist. My Chiropractor has diagnosed the popliteus injury. My left ankle and foot are both very pronated and he thinks that it is all starting from there. I tend to agree, as initially back in May I thought popliteus but my thought ended there without further investigation. And, adjusting my right SI has seemed to relieve most of the nerve/parasthesia sensations - not all but most.

I've been afraid to massage it because I thought it might be a clot. Massaging the gastroc and rectus femoris feels great. Massaging TFL/ITB is painful. Mild stretching feels good, too but is short lived.

Did your symptoms sound like any of these that I've mentioned? I wonder if there is a way to know for sure if it is the popliteus without an MRI? What healing methods did you use, and are you continuing with?

 

[Sydney]

Well, the SI issues are secondary due to you favoring one side vs. the other, and will keep going out due to compensating for the injury. Even though it doesn't seem to help now, keep stretching the ITB, it will be aggravated with any knee injury and as long as you can keep it from contracting more it will help in the long run. Rectus fem. work will feel good right now because it is having to stay in a lengthened position, but you also have to make sure that gastroc or the hams don't shorten. But mainly I would definitely go for the orthopedic consult and an antinflamitory to be able to get down to what the issue is (but don't let them give you a cortisone injection!!!). I would go especially if you can't fully extend your knee, it could be an ACL issue. My gross anatomy teacher did tell us that there really isn't anything surgically they can do for popliteus, that gastroc and the hams will take over for the action. So you just have to work on keeping them strong and at proper length.

As for myself, I am also an EMT, I was lifting a patient, my knee buckled and hyperextended VERY badly. I knew something was wrong, it didn't hurt right away yet it didn't feel right either, but later on in the day it just got stiff and by the next day had blown up to 2x its size. I ended up having major compensating issues in the hip from circumducting in order to walk. I did 2 months of PT and decided that it wasn't getting any better and opted for surgery, which I am glad I did due to the true injury not appearing on the MRI. I would have gone back to work and really hurt myself. So then another 6 months of PT after that, off for a month and then back on for 2 more. Then a year and a half later went back for a 2nd procedure to get rid of the scar tissue that had built up. My MD originally thought it was the popliteus due to the fact that I also had lateral pain and there didn't seem to be any give when he did the anterior draw test (which with the damage should have had some give). But before the injury I always seemed to have ITB issues from years of sports, and having valgus knees. I ended up going to MT school 2 months after the surgery, massage made it feel sooooooo much better. Having my ITB and my Anterior Tibialis worked on is excruciating but it is needed, and having all aspects of my leg pettrisaged really makes it feel better. Also if you work on the male tonification point (I can't remember if it is ST34 or ST36) but it is right in the tendinous area that connects the Tib/fib. I have found that it will help relieve some of the discomfort.

 

[tatooedpriestess]

Thanks so much for sharing all the wonderful info, especially in regard to your own injury. I think I may make an appointment with an Orthopedist/Sports Med soon. I don't see surgery as an option, and I'd rather stay away from aniti-inflammatory meds (and cortisone injections). I have some concentrated Arnica Montana essential oil (gel was not helping) that I'm going to apply to the back of my knee, apply ice, massage, and keep on stretching as you suggest. For some reason the Sombra is a little too much (it burns)...maybe because of the nerves that run behind there.

 

[Julie H]

Popliteal injuries, or even tendonitis of the popliteal tendon is quite common among distance runners as well. Reasoning? My thought is that during long strides, the hamstrings being a more efficient eccentric muscle than many others will perform mainly hip extension, leaving some of the slack for the popliteal muscle to perform knee flexion. During long distances, it causes problems.

As for treatment, start in a flexed position, apply a light pressure to the belly of the muscle and slowly extend the knee down. Hurts, but works nicely, just flush the area well after.

If you are having SI irrititation as well, it could be a posterior pelvic rotation due to the hamstrings creating pressure on the SI.

 

[Rae-May]

Thanks, Jay. Your thoughts are right on - the stride info makes complete sense to me. I do jog (10min/mile) but not much lately...when I do it IS more distance than sprint. My stride is definitely long with walking, and I walk faster than most in normal walking because of stride. Thanks for the treatment protocols, I will do them. And, pelvic girdle x-rays show posterior rotation, too.

I found this info as well, if others are interested in popliteus injury: http://www.physsportsmed.com/issues/2004/0304/muche.htm

***Directly from website: On examination, the popliteus muscle may be tender in the posterolateral corner of the knee. However, a provocative maneuver that typically provokes pain involves examining the patient in the prone position with internal rotation of the tibia. The patient then flexes the knee against resistance. Reproduction of symptoms during flexion suggests injury to the popliteus tendon.

Treatment of a popliteus tendon injury consists of the RICE protocol, gradual stretching exercises in multiple planes, closed–kinetic-chain eccentric strengthening exercises, such as slow, multidirectional lunges that patients progress to doing on nonlevel surfaces, and gradual return to athletic participation. Since these muscle fibers have a rotational component, rehabilitation should emphasize exercises with rotation.