*Disclaimer – This is a description of a SPECIFIC type of knee injury.  Many different knee injuries could present in a very similar manner with very different treatments/severities/outcomes. Please seek the care of a professional.

The Case of the Mysterious Knee Pain

Recently, I have seen several runners complaining of knee pain just to the inside of the kneecap, blending over to the inside of the knee. Although there can be some soreness in the muscles, the pain is generally of a sharper, more pinching nature over the joint. The pain is usually quite severe and, more importantly, will keep the athlete from running.  There isn’t much swelling and those who’ve been through advanced imaging have found nothing structurally wrong. Also, there generally isn’t much trauma to the knee outside of their normal training and the patient usually comes in stating, “I didn’t even DO anything!” 

The athlete will generally take a week or two off running, get on the stationary bike, get some pool work in, etc…which usually calms down the symptoms.  Then once they begin running again, it doesn’t take long for the knee pain to return with the same intensity as it did before.   Often they will try a strengthening program, self-medication, cortisone, and enough gels and creams to imprint the smell of camphor permanently in their brain.  None of these things do much more than provide a little temporary relief.

For these patients, the problem isn’t a lack of strength of the knee and there is nothing wrong structurally (tears, fractures, chips…).  The problem is actually very functional and very specific.  They have a coronary ligament adhesion to their meniscus. 

The coronary ligament attaches the meniscus to the tibia.  It functions to anchor the meniscus but also to allow some “give” to the meniscus as the knee is stressed.  The constant repetition of the training, usually coupled with a valgus stress on the knee (valgus=knock-kneed) caused the ligament to build up scar tissue and prevented the meniscus from moving properly.  This lack of motion now puts the ligaments and meniscus in a tug-of-war, of sorts, when stressed.  This is the cause of the pain.

What is the solution?

Firstly, the adhesion needs to be identified and broken up.  I do this by using Active Release Technique® (a highly specific hands-on treatment method).  This will restore the mobility back to the meniscus and is often successful in just one or two visits.  Secondly, we want to prevent the recurrence of the problem.  Identifying faults with the runner’s mechanics is the key.  Excessive pronation of the foot and tightness in the external rotators of the leg are often culprits. 

The good news is once the adhesion on the coronary ligaments is freed up, the athlete can usually get back to training even as the faulty gait is being addressed.

Dr. Jeff Heddles

Active Body Chiropractic

1509 S. State St.

Chicago, IL 60605

(312) 922-9868

www.activebodychiro.com