Tough Case: Knee Pain With No MRI Findings

It isn’t every day that someone walks in to see me for physical therapy with knee pain that is at most a 3/10, bothers him in two different places (anterior and posterior knee) and with two different movements (going down stairs and deep squatting respectively). He tried physical therapy for 1 month with no improvement in pain, though he noted improved strength. Oh, and his MRI only revealed a “slight meniscal tear” that his physician believes is too small to contribute to his symptoms.

What is a physical therapist to do in this scenario?

First, I loaded him with isometrics at about 30 degrees of knee flexion as it is where he began to experience his anterior knee pain. Picture a lateral step down with a band around his knee (pulling it inward) and he holds that position for 5 seconds at a time. LESS PAIN!

Great! So what about the posterior knee pain? I had him perform a bridge with both knees straightened and between two benches (not the ones in a park, btw). SEEMED TO HELP!

So that’s it then. He should be pain-free with exercises such as those, right? Well, he reported that a 1 hour walk over the weekend caused more posterior knee pain, though not more than his baseline 3/10.

Ok. I kept those exercises as they seemed to work previously, but also focused more on soleus strengthening (the deeper calf muscle) along with glute ham raises (probably a machine that your gym has to fire up his hamstrings some more). GREAT RESULTS!

I heard from this patient recently and he is feeling mostly better, though still with an occasional pain, but less than when symptoms started. FEELING GOOD!