LATERAL KNEE PAIN

By: Dr. Rida Shabbir PT

DPT KMU, MSPT KMU.
 Pain about the lateral knee is a frequent problem, especially among distance runners.
 The most common cause of lateral knee pain is iliotibial band friction syndrome (ITBFS).
History

 A history of overuse may be suggestive of ITBFS or biceps femoris tendinopathy.

 If there is a history of excessive downhill running or running on an uneven surface,
ITBFS may be implicated.
 If the pain tends to occur with sprinting or kicking activities, biceps femoris tendinopathy
is more likely.
 Lateral knee pain following knee or ankle injury may indicate the superior tibiofibular
joint or lateral meniscus as the site of injury.
Examination
Passive movement—ITB stretch. This is performed
in a side-lying position with the hip in neutral rotation
and knee fl exion. The hip is extended and then
adducted. If the ITB is tight, knee extension will occur
with adduction (Ober’s test)
 ILIOTIBIAL BAND FRICTION
SYNDROME
 With repeated knee flexion/extension, the iliotibial band (ITB) rubs against the
prominent lateral epicondyle of the femur.
 Friction/ impingement occurs near foot strike predominantly in the foot contact
phase.
 Runners have an average knee flexion angle of 2I at foot strike. with friction
occurring at, or slightly below, 30° of flexion.
 Downhill running predisposes the runner to ITBFS because the knee flexion angle
at foot strike is reduced.
 Sprinting and faster running on level ground are less likely to cause or aggravate
ITBFS because, at foot strike, the knee is flexed beyond the angles at which friction
occurs
 Runners with ITBFS have been found to be weaker in knee flexion and knee extension,
with decreased breaking forces.
 Runners with ITBFS have significant weakness of their hip abductors in the affected
limb and have a decreased ability of the hip abductors to eccentrically control abduction
 CIINICAL FEATURES

 Ache over the aspect of the knee aggravated by running.

 Tenderness & crepitus may also be felt.
 Repeated flexion/extension of the knee may reproduce patient's symptoms.
 Ober's test +ve. May be secondary either to tightness of the ITB distally, shortening of the tensor fascia lata or
maximus muscles proximally, or excessive movement of the vastus lateralis, placing increased load on the
ITB.
 Trigger points and focal areas of tightness over gluteal muscles and TFL
 Abduction strength should also be assessed as of hip abductors is associated with ITBFS.
 Excessive pronation may lead to increased internal rotation of the tibia. Increased varus alignment of the
lower limb may lead to varus strain on the knee.
 Excessive lateral tilting of the pelvis may place increased strain on the lateral thigh
TREATMENT

 Activity modification (Avoid Downhill Running)

 Symptomatic relief using ice, analgesics and electrotherapeutic modalities
 Soft tissue therapy aimed at correcting excessive tightness in the ITB and related
structures
 Frequent stretching of the ITB and other tight Muscles
 Strengthening of the lateral stabilizers of the hip/hip abductors
 Biomechanical abnormalities should be corrected.
 Surgery to release the ITB and excise the bursa may be indicated if conservative
management fails.
 LATERAL MENISCUS ABNORMALITY

 Degeneration of the lateral meniscus resent as gradual-onset lateral knee pain.

 A runner presents complaining of lateral knee pain that comes on after 20 minutes of
running and is aggravated by running up hills, the practitioner should not automatically
assume that the patient has lTBFS-the problem may relate to a degenerative meniscus.
 The meniscus is tender along the joint line, 2-3 cm below the site of tenderness in
ITBFS.
 McMurray's test in full flexion should be positive when a
meniscal injury is present and negative in cases of ITBFS.
 A degenerative meniscus can present as a painful or non-
painful lump at the lateral joint line.
 This is sometimes misdiagnosed as an ITB bursa
OSTEOARTHRITIS OF THE LATERAL COMPARTMENT
OF THE KNEE

 Lateral knee pain can also be caused by degeneration of the lateral tibial plateau and
this is often found in conjunction with meniscal injury.
 Early in the disease, the patient often gives a history of increasing knee pain with
activity and stiffness after resting.
 As the disease progresses, the patient experiences pain at night that may disturb sleep
associated with morning stiffness, usually for less than half an hour.
 In the early stages of the condition, examination may only reveal a small effusion.
 A very useful investigation is weight-bearing plain X-ray.
 EXCESSIVE LATERAL PRESSURE
SYNDROME
 Due to excessive pressure on the lateral patellofemoral joint resulting from a tight lateral retinaculum.
 This pressure lead to increased bone strain on the lateral patella, inflammation of the lateral retinaculum
and ITBFS
 The increased bone strain may lead to development of a vertical stress fracture or even separation of the
lateral patellar fragment
 Initial treatment consists of patellofemoral mobilization and soft tissue therapy to the lateral retinaculum
 Taping techniques rarely help.
 BICEPS FEMORIS TENDINOPATHY

 Biceps femoris tendinopathy occurs with excessive acceleration and deceleration

activities.
 This can be produced with resisted flexion, especially with eccentric contractions
 It is associated with tightness of the hamstring muscle
 Stiffness of the lumbar spine may contribute to hamstring tightness.
 Ultrasound examination may confirm the diagnosis.
 Treatment is based on the general principles treatment of tendinopathy: relative rest, soft
tissue therapy, stretching and strengthen especially eccentric strengthening
 SUPERIOR TIBIOFIBULAR JOINT
INJURY
 May result from trauma or in association with rotational knee or ankle injuries.
 Pain occurs with activities demanding rotation (e.g. pivoting, cutting).
 The patient may C/O pain distally in the shin and not localize the superior tibiofibular
joint.
 O/E joint is tender and there may be either restricted or no movement on passive
gliding of the superior tibiofibular joint.
 Manual mobilization is an effective treatment.
 Strengthening of the tibial rotators heIp support the joint.
 Predisposing factors, i.e excessive pronation, which place greater forces through the
joint, require correction
 Referred pain

 Pain may refer from the lumbar spine to the lateral aspect of the knee.
 Referred pain is usually a dull ache and is poorly localized.
 The slump test may be positive.
 The lumbar spine should be examined in patients presenting with atypical
lateral knee pain.
THAT’S ALL FOLKS….