Tbh am frustrated myself, tho probably not as much as you are, while also being driven by the challenge of finding out what’s up.
Adding Arthrofibrosis or Stiff Knee Syndrome to the List
Could be anything we’ve mentioned previously if missed on the Knee MRI or not looked for. Also am assuming you didn’t get a full body or full LL MRI?
Should’ve asked this before but is your tightness restricting the straightening, bending or all movements of the knee?
Maybe reevaluate swelling/edema = stiffness + pressure and greater physical feedback/sensation of these
Medical History & Family History
Is personal stuff so shouldnt share if you don’t want to:
Joint Diseases e.g. Rheumatioid Arthritis, Ankylosing Spondylitis, Gout, Osteoarthritis or other
Back Pain: Wut was Diagnosis? Treatment/Management and Timeline
Other musculoskeletal injuries & Treatment/Management and Timeline
Systemic: Fatigue, lethargy, generalised weakness, unexplained weight loss, recent infection, cancer history
When referring to nerve we aren’t talking about what you’d usually think when it comes to nerve injury such as peripheral neuropathies (nerve injury outside the spinal cord cord and nerve roots) or radiculopathy (irritation to the nerve roots e.g. slipped disc) but to altered neurodynamics.
Sounds fancy and complicated but is actually much more straightforward than other nerve related injuries. Nerves are physical structure like muscles, bones or ligaments and some are quite large. When you move your nerves slide, glide, stretch and tension like other physical structures. Hence neuro (relating to nerves) and dynamics (movement). This is part of normal movement.
Normally this occurs smoothly and the stretch of your nerves is almost imperceptible due to the extra slack in the nerves or the sensation of your other structures e.g. muscles being stretched out mask this.
Adverse or abnormal Neurodynamics can occur. As a nerve courses through the body, innervating and branching off, it passes by and around structures as well as thru natural tunnels, spaces, muscles, etc.
These are multiple opportunities or locations where a nerve’s movement can be limited or trapped. For example following a hamstring injury layering of new tissue and scar can lead to proximal tendinopathy-related sciatic nerve entrapment.
Now since the nerve has been caught at one or more points along its length an attempt to stretch or tension the nerve will generate a much greater sensation of stretch because you don’t have the slack of the full nerve to work with. You can feel the abnormal stretch/tension of your nerve.
Importantly the stretch felt and other neurological symptoms (neurological pain behaviour, paresthesia or numbness) do not necessarily occur together in these cases. Adverse neurodynamics can occur with or without irritation or injury to the nerve itself which is what causes the neurological symptoms.
Nerve Tension Testing
Kind of bad practice but if you can be fucked try some nerve tension tests out yourself or with a partner. The videos may to about pain or numbness or tingling but we are concerned about your symptoms namely tightness and pain, their location and how/if they respond to testing and sensitizing movements. Symptoms & change in symptoms should be recorded after every change in position.
Take the straight leg raise test for example. You should be able to SLR quite high before feeling a stretch in your hamstrings, any lower and this should be recorded.
Once you are at this position you can do sensitizing/tensioning (tensioning the nerve further) or differentiating movements (to differentiate between hamstring/musculoskeletal tightness and nerve tightness)
e.g. In the max SLR position if you nod your head forward or flex your neck as far as you can it should not have any effect on the stretch felt in your hamstrings. However this movement lengthens and tensions the nerve.
Does the sensitizing movement change (increase, decrease, bring on etc.) your symptoms?