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Sports Medicine

Shooting knee pain

12/05/2007

Question:

I work out 3 times a week (running on a treadmill, swimming, and resistance work) and have recently begun to feel a shooting pain in my left knee. It started during running. The first few minutes are a struggle, but after I warm up the pain seems to subside. I feel moderate pain while doing lunges or other leg resistance work. However the shooting knee pain is now occurring during sleep or when my leg is elevated (say while resting my legs on an ottoman). During sleep I find it very painful to extend my leg fully without pain. If I do it slowly it lessens the pain. While sitting on a couch with my legs elevated, I find the same thing happening - cannot fully extend knee without significant pain. It seems most intense if I am extending my knee from an angle. (If I just straighten up and extend my knees directly in front of me the pain is less intense.) A few years ago I injured my knee while running a very steep hill. With rest and some resistance work I was able to heal and felt no pain in the knee for a few years. I don`t understand this current pain. It doesn`t seem to be related to an injury. Can you provide some guidance as to possible remedies. Will rest help? Thank you.

Answer:

This pain may be due to one of several causes:

1)This may be an injury to the meniscus, or cartilage, within the knee joint.  When you extend the knee, especially at an angle, there may be a small tear within the cartilage that is being caught or irritated. 

2)Capsule tear.  A tear of the joint capsule on the back of the knee can cause these symptoms, as it is stretched with extension of the knee

3)Tendinitis:  The popliteus tendon wraps around the back of the knee and may be causing pain with this activity. Also, the hamstring muscles and calf muscles attach behind the knee and when stretched, can cause pain with knee extension.

A good physical exam will help to differentiate the cause of the pain, possibly with the help of diagnostic testing such as MRI. 

I hope this helps.

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Response by:

Charles Webster, MD
Assistant Professor
College of Medicine
University of Cincinnati