Sports Rehabilitation | Posterior Knee Pain

Monday 28th March 2022

Hours: 3

Patient presentations:

Reflection Focus

Reflection Model

What Happened?

Patient presented with posterior knee pain and intermittent hamstring pain a few months after sustaining a knee injury.
Knee injury MOI = Trying to stand up for siting on the group with legs still crossed. Pt. reported they felt a pop/crack at the time and he has been having difficulty with his lower limb ever since.
ROM assessment could not provoke posterior knee pain.
+ve McMurray, +ve Ely, -ve Thessaly, -ve Apley,
Pt. presented with muscle guarding, particularly the hamstrings and quadriceps. Palpation revealed increased muscle tone of the hamstring on the affected side and PoP of the popliteal fossa.
Due to uncertainly with a diagnosis, I treated how the patient presented on the day. Stretching and strengthening exercises for hamstrings, quadriceps and calves were prescribed.

What were you thinking and feeling?

I found this case really complex as I was finding it difficult to reproduce the p that was the patients main complaint.
Equally, I am really not confident in my knowledge of posterior knee pathologies and/or injuries. Therefore, this situation highlighted I need to focus on this area.
The clinic supervisor assisted in this situation. They also confirmed that it wasn’t straight forward and could potentially be a number of things rather than just one. On reflection this calmed me slightly and I felt less pressure to come up with a diagnosis.

Analysis and Evaluation

As mentioned previously, this situation highlighted that I am weak in my knowledge and understanding of the posterior knee. Therefore, I need to ensure I include this into my revision.
I feel happy with the initial treatment provided and the patient was really pleased to have some exercises to do at home. Due to muscle guarding and identifying increased muscle tone, I felt it was best to address these muscles acting on the knee incase they were creating undesirable movement patterns – resulting in this patients pain. I would say this is the first instance I have been okay with not knowing or not suspecting x or y pathology/injury.
The patient has booked in to see me again in 3 weeks time. It would have been nice to see him sooner; however, an acute bout of stretching is likely to be less effective than chronic – especially for hamstrings. Page (2012) noted that 6-8 weeks of static stretching can increase hamstring length. Therefore, 3 weeks gives more time for us to assess if the stretching prescription has had, or is having, any meaningful impact.

Conclusion

Considering how overwhelmed I felt at the beginning of the assessment, I am pleased that I was able to focus on just treating the presentation rather than getting hung up on a diagnosis.
However, I need to look at posterior knee pathology/injury as this is something sorely lacking in my notes. I will spend time before the patient comes back into clinic researching to see if I find anything that may be of benefit for the patient.

Revisiting Reflection

References

Page P. (2012). Current concepts in muscle stretching for exercise and rehabilitation. International journal of sports physical therapy, 7(1), 109–119.