POPLITEUS INJURY

Popliteus Injury is a common sports injury that occurs in athletes and runners who are associated with downhill running or other deceleration activities. Popliteus is a small muscle, located in the back of the knee, which attaches from the lateral distal femur to the posterior part of the tibia. It acts as a primary internal rotator of the tibia and helps with the initial flexion of the knee from an extended position (“unlock” the knee). In addition, the popliteus assists the quadriceps and posterior cruciate ligament to maintain normal tibial and femoral orientation.

Common causes are either a direct varus force, while the tibia is externally rotated, or a sudden forced knee hyperextension with the tibia internally rotated.

• Overuse of popliteus, especially when athletes who run or are trained on hills or inclined surfaces, and require downhills running or deceleration activities
• Some researchers suggest that fatigue or overuse of quadriceps may lead to inflammation of the popliteus for overwhelming the popliteus muscle. On the other hand, over-pronation provides post-lateral stress to the popliteus tendon.

• Pain, swelling in the posterolateral corner of the knee
• Able to run for short distances, but with continuous running, posterolateral knee pain develops.
• Sports that require frequent deceleration or downhill running exacerbate the symptoms
• When the knee is flexed in 90 degrees, resisted external rotation of the tibia will provoke pain

Most of the popliteus injuries do not require surgical intervention. Popliteus injury can be managed by “RICE” -- Rest, Ice, Compression bandage, and Elevation, combined with NSAIDs and physiotherapy for swelling and pain control. Most patients respond quickly and recover in a few weeks. Ultrasound, acupuncture, specific soft tissue release techniques, and shockwave are effective in reducing swelling, pain, tightness, and inflammation of the popliteus.

When the pain and swelling subsided, a supervised physiotherapy program focusing on eccentric strengthening of quadriceps and popliteus is essential for returning to play. When the strength of the popliteus and quadriceps resume, athletes can return to play. However, due to the different severity of injuries, the rehabilitation time frame is different. If the patients do not respond to conservative treatment, patients may receive corticosteroid or PRP injections.

*Photo description: Step forward and backward in each position 3 times, and return to the starting position (Figure 1), after finishing all positions, change to another leg. Please exercise under proper supervision.

• Adequate and correct warm-up before exercise
• Static stretching exercises before and after the training to improve the flexibility of lower limbs
• Improve the strength and endurance of quadriceps muscle, to prevent excessive overloading of the popliteus
• Improve the knee stability
• Correct shoewear to fix the hyperpronation of the foot

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