In my 15 years of experience, medial knee pain has either been due to pes anserine dysfunction or medial meniscus involvement. The MCL is also located on the inside of our knee, but typically isn’t the cause of knee pain there unless there was an accident or injury. The good news is that medial knee pain can be treated conservatively with good results. Let’s jump right in and look at these diagnoses for medial knee pain.
Pes Anserine: The junction of 3 Muscles can be so painful!
The area of the medial knee that’s called pes anserine is an area where the Sartorius, Gracilis, and Semitendinosus muscles insert. When there is a change in how you walk or your training routine, these muscles can become irritated because they are being used in a different way.
After undergoing surgery, it can affect the way you walk. You may limp due to pain or unable to use the muscles the way you used to, or not have the range of motion needed to walk normally. With a normal gait pattern, your heel should strike the ground first, your knee should be nearly straight, and then your foot goes flat on the ground and finally you push off your toes, specifically your big toe. You can see how if you’re limited in range of motion or have weakness in your leg muscles, it would alter this pattern and lead to the pes anserine muscles working differently. Over some time, the pes anserine becomes inflamed and you experience pain at the inside of your knee.
Another common cause for inflammation at the pes anserine is when there is a change in your training program or the type of shoes/surface you spend time on. If you normally spend most of your time on flat surfaces and then begin to walk on hills, uneven surfaces, or concrete, this could flare up the pes anserine. The same goes for your training program. If you typically train by walking and all of a sudden you add in stairs, elliptical, lunges, etc, you may experience inflammation of the pes anserine.
Calming down the inflammation is the first step and gentle stretching to decrease any tightness of the muscles involved. There are manual techniques that the physical therapist can perform to assist in this process. The next step is to work on the aspects of your walking that are affecting the pes anserine to bring back your normal pattern and practice it over and over again. Lastly, it is important to strengthen the muscles that may be weak or limited and play a part in your changed pattern.
Medial Meniscus Tears: The Cartilage of the Knee
We have a medial and a lateral meniscus that sit between the bones of the knee and provide protection from the forces through them. Over time the meniscus can begin to degenerate or you can plant and twist on the knee which leads to tears in the meniscus.
Acutely, tears in the meniscus can be painful and lead to feelings of the joint being stuck or clicking with activity like squatting stairs, twisting, kneeling, or cutting. Just like with inflammation of the pes anserine, the meniscus initially is treated to decrease inflammation and physical therapy can assist with finding the deficits in your mobility or strength that may be placing more strain on the meniscus to both calm down the pain and prevent further injury. There are strategies the physical therapist can teach you to decrease the forces through the knee joint as you perform normal activities and return to sport.
Medial Collateral Ligament Strains and Tears Following Injury or Accident
The MCL is the large ligament that protects the inside of the knee. It is less commonly the cause of medial knee pain and becomes torn or strained with sports injuries and other accidents where one received a blow to the outside of the knee. Once the MCL is damaged, it leads to the knee feeling unstable from a lack of control that the ligament provides.
If the MCL is torn through, it usually results in surgery for repair, however, if it is strained then physical therapy will be recommended to work on stability and protection of the knee through strengthening other muscles and learning joint protection strategies.
So How Do I Know the Reason for My Knee Pain?
A general starting point to determining the cause of your pain is to look at the mechanism of injury. Do any of the above scenarios fit the potential reason your medial knee may be hurting? If so, that will assist you in knowing the appropriate course of action to take in getting rid of your pain. However, because these are generalizations as noted in years of practicing physical therapy, it is best if you see a physical therapist, like myself, to assess exactly what you have going on and see what the best treatment plan is for you. Scheduling a free phone consultation to speak with me about your pain is as easy as clicking here and making an appointment for a quick discussion. Together, we can work on treating the root cause of the pain to get you back to your life and preventing its return.