Popliteus tendinitis

 Popliteus tendinitis is characterized by inflammation andpain at the knee joint on the back part of the outer side of theknee and the outer side just above the knee at the popliteus

tendon.

Common Signs and Symptoms:

• Pain and tenderness over the popliteus tendon at the outerknee or back of the knee on the outer side

• Pain that is worse when standing on the leg with the kneebent slightly or when walking or running, just as the foot ofthe affected leg lifts off the ground

• Pain that is worse when rotating the leg

• Pain that starts or recurs after running a particular distance

• Crepitation (a crackling sound) when the tendon is movedor touched (uncommon, except when tested just after exercising)

  Causes :

Overuse of the popliteus muscle-tendon unit, usually in anathlete who runs or trains on hills or banked surfaces

Risk Increases With

 • Sports or activities that require a lot of downhill walkingor running, such as with backpacking, cross-country running, and distance running; also, running on a banked

track or next to the curb on the street (a banked surface)

• Poor physical conditioning (strength and flexibility)

• Inadequate warm-up before practice or play

• Flat feet

Diagnostic Test:

1. Garrick Test

Patient seated, hip and knee are both flexed to 90°. The patient actively externally rotates the lower leg and this is resisted by the examiner. A positive test is pain during the maneuver in the location of the popliteus muscle or tendon.

PHYSICAL THERAPY

1. Reverse heel tap

Attach a resistance band on to the forefoot of the non–weight-bearing leg (NWBL).The foot on the NWBL moves behind the stance leg via external rotation of the hip and knee flexion.

The foot of the NWBL continues to move behind the stance leg with increasing internal tibial rotation.Completion of the concentric exercise. The return to start position provides an eccentric muscle effort.

2. Step up and down

Place one foot on top of a small raised platform. Keeping the raised leg slightly bent at the knee, step forward with the opposite leg. Next, step backwards, then to the right and left of the foot planted on the step. Repeat this motion for 20 to 25 repetitions.

3. Leg curls

Attach one end of a resistance band to the base of a closed door or stable surface, such as a heavy table leg, at floor level. Place the other end of the band loop securely around one ankle. Lie on the floor, face down, with both feet toward the area where the band is initially attached. Lift the banded heel up and toward the glutes in a slow and steady motion. For more resistance, move farther away from the door or table. Slowly lower the foot to the starting position and repeat for 20 to 25 repetitions.

4. Gastrocnemius stretching , Standing

 Place hands on wall. Extend right / left leg, keeping the front knee somewhat bent.Slightly point your toes inward on your back foot.Keeping your right / left heel on the floor and your knee straight, shift your weight 

toward the wall, not allowing your back to arch.

You should feel a gentle stretch in the right / left calf. Hold this position for 7_ seconds.

Repeat 3-5 times. Complete this stretch 3 times per day. #behindthekneepain 

5. Stretching of Soleus, Standing

 Place hands on wall.Extend right / left leg, keeping the other knee somewhat bent.Slightly point your toes inward on your back foot. Keep your right / left heel on the floor, bend your back knee, and slightly shift your 

weight over the back leg so that you feel a gentle stretch deep in your back calf.

 Hold this position for 7 seconds.

Repeat 3-5 times. Complete this stretch 3times per day.

6. Stretching of Hamstrings, Standing

 Stand or sit and extend your right / left leg, placing your foot on a chair or foot stool. Keeping a slight arch in your low back and your hips straight forward.Lead with your chest and lean forward at the waist until you feel a gentle stretch in the back of your right / left knee or thigh. (When done correctly, this exercise requires leaning only a small distance.) Hold this position for 7 seconds.

Repeat 5times. 

7. Hip Flexor Stretch

This stretch focuses on the muscles running along the back and outside of your knee, according to the Sports Injury Clinic. Place one leg in front of your with your knee bent. Your foot should be planted on the ground and facing forward. The other leg should be bent with your knee on the floor. Slowly push 

your hips forward while keeping your back straight. You will feel a stretch in your upper leg. Hold this position for a count of 30 seconds. Repeat three sets of three repetitions daily.  

8. Half squat

Stand with your feet about hip distance apart. If you feel unstable, hold onto a wall or back of a chair for balance.Maintain a long spine and lifted chest as you bend gently through your hips and knees. Let the hips bend just about 10 inches as if you're sitting toward a chair. Keep your feet planted, weight in your heels.

Pause for three to five counts and straighten back up to a stand.Repeat 10 to 12 times.

9. Heel Cord Stretch

Stand facing a wall.Place your healthy leg forward and bend the knee slightly.Place the injured leg straight behind you with the heel flat and the toes pointed in a little bit.Keep your heels flat on the floor and press your hip complex forward, toward the wall.

Hold for 30 seconds.

10. Calf Raises

Stand and face the back of a chair; hold on for balance.Distribute your weight evenly over both feet.Bend your left knee behind you and place all your weight on your right foot.Raise your right heel as high as you can and then lower it slowly.Repeat 10 times

11. Isometrics exercise of quadriceps will help to maintain muscle power of quadriceps muscle, Isometrics: Initial isometrics with quadriceps contractions done with the knee fully extended and in different positions at 20-degree increments as knee flexion improves May discontinue isometrics when the patient can sit comfortably.

12. Straight leg raises: 

Sit flat on the floor with the legs straight out in front of you. Raise one leg off the floor keeping the knee straight. Hold for 3 to 5 seconds before lowering back to the ground. Repeat 10 to 20 times. This exercise can be done daily. Progress the exercise by increasing the length of hold and the number of reps.

 

13. Compression: 

This may help decrease blood flow and accompanied by elevation will serve to decrease both blood flow and excess interstitial fluid accumulation. The goal is to prevent hematoma formation and interstitial edema, thus decreasing tissue ischemia. However, if the immobilization phase is prolonged, it will be detrimental to muscle regeneration. Cryotherapy, accompanied by compression, should be applied for 15–20 min at a time with 30–60 min between applications. During this time period, the quadriceps should be kept relatively immobile to allow for appropriate healing and prevent further injury.

Electrotherapy

◾ULTRASOUND THERAPY: UltraSound is a therapeutic modality that generates ultrasound causes deep heat, provides micro-massage to soft tissue, increases flexibility, promotes healing of tissue as well improves localized blood supply to the area, and ultimately pain relief.

◾SHORT WAVE DIATHERMY: short wave diathermy is a deep heating modality that uses heat to provide pain relief, it improves the blood supply to targeted muscle, removal of waste products

◾TENS: transcutaneous electrical nerve stimulation is an electrical modality that provides pain relief by providing pain modulation.TENS closes the gate mechanism at the anterior grey horn in the spinal cord. also stimulates the endogenous opioid system which prevents the release of substance p at the anterior grey horn.

◾Cold therapy: used to relieve inflammation and reduce pain, Ice Massage- Ice on the area of inflammation for anti-inflammatory effects. Use ice in a paper or Styrofoam cup (peeled away) for 5-7 minutes, make sure to avoid frostbite.

◾Use Circulatory Boost TShellz Wraps®:

∆After swelling and inflammation have been reduced with cold compression.

∆Before exercise or workouts to warm up your injury to prevent re-injury.

∆Before and after surgery during rehabilitation to warm up your tissues before exercising or stretching.

∆Anytime you feel the tissue in your leg has stiffened up, is tight and your mobility is reduced causing you more pain.

∆Anytime you have sore or aching tissue around your injury.

∆Any other situation where you need to increase blood flow to your tendon to relax your soft tissue, relieve pain, prevent re-injury and enhance flexibility of your tissue.

Medication

NSAID

Corticosteroid

Muscle relaxer