I’ve had some medial knee pain for the past 3-4 months, for which I’ve seen a physio a few times. The pain is inferior to the joint line, on the posterior portion of the medial aspect of the superior tibia. I can elicit the pain by digging my thumb into the spot. It is generally a dull achy pain, associated with stiffness but no swelling or discoloration. I can’t remember a specific incident/trauma that started it off.
The physio diagnosed tendinosis of adductor magnus, which seemed to make sense until I remembered that adductor magnus attaches to the femur, which would imply that any pain associated with it should be above the joint line.
I’m starting to think I might have a small tear of the medial meniscus. Here are my reasons for this:
pain on duck walking.
sometimes I can elcit pain by lying on my back and grabbing my shin and pulling my leg to my chest (i.e. putting the knee in hyperflexion). This is sometimes painful, sometimes not. On the other hand, I can do a foot-to-glute quad stretch with no pain.
sometimes when I am standing, the joint feels “tight” (though not locked), and then when I extend/flex the knee, there is a single, audible, non-painful click.
Reasons against:
no memory of trauma leading to onset of pain.
generally no pain at the joint line. Site of pain is inferior to joint line.
no pain on full extension/hyperextension or hyperflexion (except as noted above)
never any swelling or discoloration
Currently I’m able to train through the injury and manage it with some stretching and strengthening exercises, which seem to help.
If anyone has any ideas as to what this might be, or any suggestions as to how to fix it, I’d love to hear them.
Are you doing more breast stroke lately? (throwing in a few sets more or using it as a cooldown)
Change run shoes lately? (going from a heavy stability to cushion, vice-versa, or switch brands?)
Change position or bike equipment? (shoes, pedals, cranks)
Although the knee is not as complex as the shoulder, it’s still difficult to make a diagnosis w/o images. Could be the meniscus, could be the MCL, but w/o a more concrete diagnosis, it’s hard to treat for tri/duathletes- it’s really easy to say “chronic overuse” but for individuals that do 2 or three sports, there are many more factors which compound an injury and make treating the cause difficult. There are more muscles in that region as well which insert in the tibial tuberosity (medial)- gracilias, sartorius. I knew one person that changed every piece of equipment and technique on the sw, bike, and run, and it ended up being a very poor position from an unqualified pilates instructor.
I wouldn’t know a breaststroke from a doggy paddle, as I’m a duathlete. Sometimes I get too scared to take a bath.
I’ve changed shoes a couple of times before and after the pain started, but no change in shoes corresponded to the onset of pain. I started running on a track around the time the pain started and, stupidly, I only ran counterclockwise. The pain is on my inside leg, which is apparently a classic injury for track runners who only go one way. Over the past couple of weeks I’ve started alternating clockwise and counterclockwise and it seems to help a bit.
I changed shoes and pedals, but several weeks after to pain started, in case the pain was related to my old (7 years old) pedals and shoes.
Thanks for your help. I think maybe I need to go to the doctor and start pushing for an MRI. I live in the UK, though, and this is likely to be difficult.
Obviously a dx over the net is not a substitute for time at the MD’s, but I would say that’s your problem there- the track.
Personnaly, I think it’s better to measure out the distance in km’s/mi’s on a flat, straight section of a road and do them there. Du/triathletes tend to do only one thing well- go at their given speed in a “straight” line. The minute you throw a curve at them…
Good luck- hopefully a little R&R will do the trick.
I had knee pain before and after my first IM last year. The pain was around for about 5 months; I couldn’t figure what was causing it. It was pain in front of the knee, hurt to bike and run. My PT/Chiro couldn’t figure it out either thinking it was tendonitis. When I did some super focused hamstring stretching the pain disappeared----No bs! It took a long time to identify this.
I had no clue that hamstring tightness could cause such bad knee pain. Now I target my hams bigtime and if I don’t the knee pain comes back.
Just a thought on something to consider. It couldn’t hurt to work on hamstring flexibility; you might be pleasantly surprised.
Good point, and I’ve been trying to cover all my bases by stretching after training. The physio gave me some glute/piriformis/IT band stretches to do and they seem to help a bit. It may just take time.
Any muscle attaching to or originating on femur or in or around kneecap can potentially cause knee pain, because weakness or trigger points in those muscles can cause the patella to track improperly (which it sounds like what’s happening to you).
Adductor Magnus problems won’t usually refer pain to the knee area.
I’d hunt around in your quads for trigger points (use book The Trigger Point Therapy Workbook and/or go to tpmassageball.com for help), particularly in VMO muscle. Whenever one of my knees exhibits what you are describing, I dig around in the VMO and that’s usually it, and with several days of self-trigger point work I am good to go.
You may not have done anything acute to your legs–you may just have some acute trigger points.
Anterior/medial knee pain can be referred pain from rectus femoris, vastus medialis (VMO) or adductor longus/brevis. Trigger points for rectus femoris are up near the hip; for VMO they are 3-6" above the knee; and for adductor longus/brevis right in the middle of the muscle.
Adductor Magnus problems won’t usually refer pain to the knee area.
My Adductor Magnus currently referring a ton of pain to my medial knee and even into the joint space. Tests were negative for any knee issues and I was told I have “great knees”. Doc pressed on the distal insertion of my AM and I about jumped off the table.