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Knee
Pain and the pes anserinus tendons
The most common cause of knee pain is not
ligament
injury. (We realize
that this is shocking, since we have been explaining in past newsletters that ligaments are normally the cause of
chronic pain.)
The most common cause of
chronic knee pain is weakness in the pes anserinus tendons.
Below the knee
cap, on the inside of the knee, are the attachments of three
tendons:
semimembranous, semitendinosus, and gracilis. Together, these tendons create the pes anserinus area.
Ross remembers coming across a classic pes anserinus case while on
rounds as a new doctor in the hospital. A 35-year-old nurse, told him her rheumatologist diagnosed her with arthritis and had prescribed
anti-inflammatory
medication. When he examined her knee, he found that she had full range of motion. Full range of motion of the knee makes it unlikely
arthritis is the cause of knee pain. On further examination, Ross was able to elicit a positive "jump-off-her-chair sign" when he pressed his thumb into
the pes anserinus area showing pes anserinus tendonitis. Ross told her about
Prolotherapy but she never chose to have treatment. She probably still
suffers from the pain, because "arthritis" was not the cause. Even in cases where arthritis is the cause, it is never caused by an anti-inflammatory
medication deficiency. Interestingly enough, if someone takes
anti-inflammatory medication long enough they will probably get arthritis.
Maybe her rheumatologist was talking about the future?
When Ross gives a presentation, he enjoys asking the audience, "What
is the number one reason for severe knee pain in the elderly?" The overwhelming
response is arthritis, which is incorrect. The number one reason for severe knee pain in the elderly is pes anserinus tendonitis which, when left
untreated, may contribute to developing arthritis. Even in cases of significant arthritis, crippling knee pain is most often due to pes anserinus
tendonitis or
bursitis. This condition is easily treated with Prolotherapy.
The pes anserinus tendon, also known as the inside
hamstring muscles,
flex the knee and stabilize the inside of the knee. Most of us have very, very, very weak hamstring muscles that are very short because we sit for a
large portion of our day. Many patients, especially those with
fallen arches are prone to strains in these muscles. The tibia tends to rotate outward to
compensate for the fallen arch. This outward rotation of the tibia places additional stress on the pes anserinus tendons. Eventually, these tendons
become lax and are no longer able to control the tibial movement, adding to the chronic knee pain. An arch support may be prescribed to
reestablish the arch.
Prolotherapy injections,
(Watch where do
Prolotherapy injections go and do they hurt?)
along the arch of the foot will also prove beneficial. Prolotherapy injections into the pes anserinus attachments to the
bone strengthen the tendon attachments and resolve the chronic knee pain.
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