Persistent knee pain can be a really frustrating problem in football.
Not only can the joint hurt during running and kicking, but the way in which we control movement changes as well. There can be a sense of ‘weakness’ and occasional giving way, both of which affect the conﬁdence to move and change direction. Consequently this can become an issue as the player is thinking about his or her knee rather than the game.
Pain on the inner aspect of the knee is often due to the saphenous nerve becoming sensitised. This means that the nerve has become responsive to normal activities, sending danger signals to the spinal cord and then onwards to the brain for interpretation. The more that this happens, the more the ‘volume’ can be turned up in the spinal cord, meaning that normal signals can be modulated and interpreted as representing ‘danger’, and danger signals are deemed to be REALLY dangerous.
The end result is that normal movement, touch and release of chemicals from exercise will excite the nerve and trigger a pain response, and a normally painful response is ampliﬁed. This is very useful in the early stages of an injury when the healing process begins but not so helpful as time passes.
The saphenous nerve can be sensitised as a consequence of an injury to the inside structures of the knee (e.g. medial ligament, meniscus, direct blow) or sometimes post-arthroscopy. The nerve courses down the inside of the thigh, trawls a network over the medial aspect of the knee and in many people it runs a line down the inside of the shin bone (tibia) towards the ankle.
The anatomy means that in addition to the injuries mentioned, it is possible to affect the health of the nerve by an ankle injury.
We can test the health and mobility of the saphenous nerve by moving the leg in a particular way, noting the response. We can also perform some sensory tests to see how responsive the nerve has become. The pain pattern is usually revealing and suggestive of the saphenous involvement as is the pain description (sharp, shooting, burning, sometimes spontaneous).
On detecting that there is sensitivity in this nerve pathway that runs to the mid-lower lumbar spine, we can design speciﬁc movements and exercises to nourish the tissue and set the environment for healing.
Clearly in some cases surgical management is required, e.g. ligament repair or a meniscal procedure, and post-operatively the nerve needs mobilisation as part of a multi-dimensional rehabilitation programme to restore normal movement and control at the knee joint.
* If you are having persisting knee pain or recurring injuries, contact your GP for advice on who to see locally or visit www.specialistpainphysio.com