Ouch My Knee!! [Part 5] From Joe Shmo to Joe DiMaggio

Knee pain in Zone 4a and 4b could mean a few things but the main thing we want to rule out is a meniscus tear. If you watch ESPN or listen to sports radio I am sure you have heard of a professional athlete be sidelined for months because of this issue. I also want to make it clear that you do not have to be a professional athlete to suffer from a meniscus tear; this can affect everyone from Joe Shmo to Joe DiMaggio.

 

What is the Meniscus?

The meniscus is the cartilage in the knee that acts as a cushion and a guide for the knee while it bends and straightens. The meniscus is integral for the structure and function of the knee. If you think of the meniscus as both the shocks and the struts of your car, you could imagine how important they are. The meniscus is made up of two C shaped pieces of cartilage that face each other. This creates a deeper surface for the femur (which is the thigh bone) to connect to the tibia (shin bone).

The front and back of the meniscus are delineated into two different sections; therefore there are actually 4 parts of the meniscus that can be damaged. There is the anterior medial meniscus (AMm), posterior medial meniscus (PMm), anterior lateral meniscus (ALm) and the posterior lateral meniscus (PLm). Each one of these parts of the meniscus can be torn or injured. Please note that all drawings of anatomy are incredibly crude and were done by yours truly. Please look up images online if you are confused by my drawings.

What does a meniscus tear feel like?

• Pain with jumping, running and sometimes walking
• Possible clicking or popping in the knee when putting weight on the knee
• Pain feels like stiffness that you can’t shake off
• Feels like the knee is stuck and won’t unlock
• Knee sometimes buckles
• Pain when bending the knee

What causes a meniscus tear?

A meniscus tear is usually caused by more traumatic means such as slipping or getting your foot stuck while performing a cutting maneuver, performing deep heavy squats with improper form, planting the foot while turning the hips at high speeds. More mundane activities could also result in meniscus tears such as, slipping and falling, stepping down a stair incorrectly.

What is another condition that can be confused for a meniscus tear?

• Patella femoral syndrome (See past posts)
• Patella tendinitis (See past posts)
• ACL,MCL,LCL tear (See future posts)

What are some treatments?

Treatment options depend mostly on injury severity. Minor and moderate tears are usually treated with Physical therapy and conservative care. More severe tears could possibly require surgery if physical therapy is ineffective. Please consult with a professional before running to get an MRI or into surgery. Many times physical therapy can help to restore full function without the need for surgery.  

Ouch My Knee!! [Part 4]

Pain in Zone 3 could possibly be caused by quadriceps tendinitis. Quadriceps tendinitis is not as common as some other conditions, however, this condition could cause some serious pain while running and jumping.

The quadriceps are a very large muscle group which are made up of four different heads (illustrated below). 

 The quadriceps are primarily used to extend the knee into a straight position, but are used in basically all standing or dynamic movements (like jumping, sprinting, running, walking). The quadriceps are literally the most important muscles in the leg. This huge muscle group that is so important to all movement of the knee attaches to a very small bone called the patella. 

We have talked about the patella at length in other blogs so I encourage you to read parts 1-3 of this series. One interesting part of the patella tendon is that it is what is called a “floating bone” meaning that the patella or “knee cap” has no ligamentous connection to any other bone. Most bones are connected to other bones through ligaments but the patella actually just "floats" on top of the knee connected to the body only though tendons [Just as a side, tendons connect bone to muscle, whereas, ligaments  generally connect bone to bone].

Because the patella does not have any ligamentous connection it is a very unstable bone that is affected by outside forces such as the quadriceps. The attachment of the quadriceps on the patella is called the patella tendon (muscle to bone).  

What does quad tendinitis feel like?

• Pain right above the patella with running, jumping, squatting
• Swelling in the area above patella
• Pain when rubbing quad tendon

What causes quad tendinitis?

• Lack of stretching of the quadriceps
• Lack of warming up of said muscle group
• Inappropriate progression of exercise program

What is another condition that could be confused with quad tendinitis?

 A quad strain could be confused with quadriceps tendinitis. A quadriceps strain will cause pain in the thigh could be located anywhere along the quadriceps muscles.

What are some treatments?

Resting and ice are a good first step, but all painful activities should be stopped. Stretching and modification to exercise should be considered when returning to exercise routine. Of course physical therapy is a good option if pain does not improve in 3 weeks.