Pain Behind the Knee: A Case study
So this blog post is more of a case study really about pain behind the knee – but bear with me I talk about how sometimes having a diagnosis is not the most important thing about getting better.
Pain Behind the Knee: Bakers Cyst?
I recently saw someone who’s been told by their GP that they have a Bakers Cyst (pretty much an abnormal collection of fluid behind the knee) and shouldn’t continue training.
I don’t want to go against another health professional, and I understand that there might also be some communication mismatch between said health professional and patient, however – I hate it when someone says “you have (insert diagnosis) you need to stop doing (particular task)” without explaining much, and without having an action plan to get the person back to what they love!
I thought this case was interesting, this person was given a diagnosis, and a blanket way of dealing with this issues. A diagnosis that was given just because of the location of pain behind the knee!
Upon further assessment:
I found out that she has dislocated her patella 10 years prior and she has been getting patello-femoral pain since!
Her PCL (posterior cruciate ligament) was loose/little bit sloppy on ligament testing – however non bringing up any symptoms.
(For the geeks out there your PCL stops the tibia translating posterior to the femur)
So my first thought was – What does this all mean? Initially I thought the shearing forces from this PCL laxity may be causing more overall fluid buildup in the knee, inflammatory markers and possible Bakers Cyst.
On further assessment, she had trouble doing a straight leg raise! 
This is a girl who can squat >100kg. It never ceases to amaze me how well the body can compensate, and perform a function.
So we’ve been slowly working on quad strength, as well as overall glute, hamstring, calf strength and proprioception. Basically addressing her muscle imbalances, and overall strength deficit on that leg
Her pain has reduced significantly, and the pain that was associated with the “bakers cyst” is now gone, in fact her patello-femoral pain continues to improve.
So was there inface a bakers cyst? And does it matter if there was?
I find it can sometimes be harmful to give someone a diagnosis like that (unless of course it is something that may need different intervention like surgery) – after all, if there was a bakers cyst, why was it there, what actually lead to that – isn’t that what we need to deal with too!
This person actually kept training through the course of me treating her (we had to modify some things at different stages eg box squats instead of normal ones for a while). You do not often need to completely stop doing your activity, there are times that you do don’t get me wrong – and it’s important to listen to the health professional advising you.
So now that I’ve worked with this client for a while I have a clearer picture in my head.
Maybe the initial dislocation wasn’t rehab-ed as well as it could’ve been. She then learned to move differently, her quads and overall strength on that leg reduced over the last 10 years (due to a learned movement pattern that was non-optimal).
Unfortunately this lead to patello-femoral pain, she continues training – however non optimally. Her patella, tibia and femur were not well controlled. Perhaps that PCL laxity has developed over time, if her quads (which actively do a similar function to the PCL – stops the tibia translating posterior to the femur), then her PCL has copped it over the last 10 years – and over time, some laxity (looseness) has developed.
In fact this may lead to a risk of injuring her PCL if she were to play sports that involved a fast changes in direction. (She mostly does strength training – but it’s still a possibility)
What do you guys think? As a health professional do you think it’s important to give a name or diagnosis to a client? And as a patient – do you feel that it is necessary to get a diagnosis??
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