One of my clients who is also in the fitness industry (teaches a lot of step) has just found out that her right knee has popliteus tendonitis and was told (by her doctor) that she could never run again and that there was nothing she could do for it. Her doctor told her it was rare and he really didn't know a lot about it. She would really like to start running again. Is there any exercises I should be advising her to do or not to do?
Anatomically, the popliteus:
- internally rotates the tibia
- resists tibial external rotation
- "unlocks" the knee in the first few degrees of during of flexion from full extension
- assists in providing frontal plane stability at the knee
- controls lateral meniscus displacement, and may (according to some) help withdraw the lateral meniscus in knee flexion.
Most important (at least for your client), the popliteus works with the quadriceps and posterior cruciate ligament to control posterior tibial displacement
Popliteus tendonitis is typically linked to downhill running or other sports such as tennis and basketball that require repeated deceleration. Some authors theorize that overuse or fatigue of the quadriceps may lead to inflammation of the popliteus.
When the fatigued quadriceps cannot no longer effectively resist posterior tibial displacement, the popliteus bares too much of the burden.
The logical solution, therefore, is to increase the eccentric strength and endurance of the quadriceps. Of course you must start conservatively and progress gradually to gain the adaptations that you want without exacerbating the problem.
You also need to focus on closed-chain exercises and balance activities since popliteus tendonitis is also linked to pronatory changes in the feet.
Contrary to what your client’s doctor implied, the main physician referenced for this article and former Team Physician for the Miami Heat, Dr. Timothy Petsche, notes, “Popliteus tendonitis … usually responds quickly to appropriate management.”
Let your client and her doctor know they don't have to give up so easily. Her doctor might also consider NSAIDs or even corticosteroid injections.
- Petsche TS, , MD, Selesnick FH, Popliteus Tendonitis: Tips for Diagnosis and Management, PHYS SPORTS MED 2002; 30(8)
- Olson WR, Rechkemmer L: Popliteus tendonitis. J Am Podiatr Med Assoc 1993;83(9):537-540
- Basmajian JV, Lovejoy JF Jr: Functions of the popliteus muscle in man: a multifactorial electromyographic study. J Bone Joint Surg Am 1971;53(3):577-562