Urban Wellness Clinic’s approach to one itty bitty muscle involved in major knee pain

8 years ago while training for a marathon I had left posterior lateral knee pain will fullness behind my knee, difficulty bending or fully extending the knee, and an MRI with no abnormal findings. This was prior to my hunger for movement based, muscle compensation, and anatomy knowledge that I have now, thank you David Weinstock and SFMA for imparting your knowledge. So 2006, I had L knee surgery for a suspected lateral meniscus tear, surgeon went in, found nothing, shaved down the back of my knee cap so he could bill chondromalacia patella. Delightful.

What was really happening? My popliteus was overworking, facilitated, hypercontracted, and my gluteus maximus and hip flexors were not firing, weak, and inhibited.  Talk about major compensation for a little muscle causing a big pain in my…..knee, especially in a repetitive motion like running.

Popliteus, take a peak at the anatomy:

Urban Wellness Clinic’s Essential Anatomy take aways:

-Originates on the lateral femoral condyle under the lateral collateral ligament AND the posterior horn of the lateral meniscus. Laymans terms: it attaches to bone, goes under tissue that helps stabilize the knee, and attaches to cartilage that cushions the inside of the knee joint.

-Inserts on the tibia, ie it crosses the knee joint and tends towards facilitation because of this fact.

-Popliteus is a medial rotator and knee flexor. With the foot on the floor or the tibia fixed, popliteus externally rotates the femur on the tibia.

-Popliteus is the KEY to unlocking the knee.  When the knee is in full extension (fully straight), the femur slightly medially rotates on the tibia to lock the knee joint in place. Popliteus unlocks the knee as it begins knee flexion by laterally rotating the femur on the tibia. Layman’s terms: helps bring the knee out of full extension.

-Helps prevent excessive posterior translation of the tibia along with PCL (posterior cruciate ligament).

Most common problem we see with popliteus is excessive use in runners due to poor biomechanics, running surfaces or poor training progression can lead to tendinitis and/or overuse of this little muscle. Second most common problem, yogis that love to find hyperextension in their knees thinking they are getting deeper into their hamstrings without the stability and engagement of the quads or gluts. I fell into both of these categories 8 years ago. Live and learn, and learn some more!

What do we look for at Urban Wellness Clinic with a knee that cannot fully flex where popliteus may be the culprit?

Possible causes:

Pain source and obstructions

Bursitis

Tendonitis particularly one of the hamstrings or popliteus

Cysts-Popliteal or Baker’s

Ligamentous Injury-ACL, PCL, LCL

Hyperlordosis (increased low back curve) with eccentrically loaded hamstrings and/or concentrically loaded quads working its way down the kinetic chain.

Talocrural joint (ankle joint) is locked.

Stiff feet causing dysfunctional movement up the kinetic chain, see this all the time in runners wearing orthotics.

Popliteus will be working overtime to stabilize the knee when the hip flexors, gluteus max, med are not firing or kicking. Correct this problem and, I found for myself, knee pain disappears. Now in yoga I do my correctives of releasing my popliteus  and then firing gluts with some bridges (yes, your gluts are not 2 mangos relaxed swinging in the canopy in bridge) and avoid hyperextension at the knee by engaging my quads in straight legged poses.

We are here to help at Urban Wellness Clinic, lets us be your eyes to help give you the tools to help yourself.

xo,

Dr Emily Kiberd