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 Knee Pain and the pes
anserinus tendons
Ross
Hauser, M.D.
A 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 (see Prolotherapy research
paper) 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.
I remember coming across a classic pes anserinus case while on rounds as a new
doctor in the hospital. A 35-year-old nurse, told me 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, I 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.
When I give a presentation, I enjoy 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 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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