Question
QUESTION: HI, I have had right medial knee pain that cannot be diagnosed for the past 9 months.  My ART man tried the Graston technique on my calf, and that did not seem to help.  I am going back to him, and I would like an opinion about the location for the Graston technique that others have used for pes anserine bursitis, which I really think I have.  Thank you so much.

ANSWER: Michelle,

If you really do have pes anserine bursitis and clearly do not have any other issue, e.g. arthritic joint, meniscal tear, etc., then you should get a few sessions of Graston Technique (GT).  See if your DC can prep the pes anserine area with ultrasound first (at either 3 MHz instead of the standard 1MHz, or at the 1MHz but at low wattage).  Then, work the entire region with GT.  Including the interface between medial thigh muscles, e.g. sartorius, and the medial hamstring, along with their corresponding tendons, and also directly over the bursa.   If there are no changes at all after about four sessions in two weeks (2x/week), then consider consulting an orthopedist for cortisone injection.  

'Hope this was helpful.

Dr. G'

---------- FOLLOW-UP ----------

QUESTION: HI Dr G-
Thank you for your answer.  My MRI showed a meniscus tear, but not even significant enough to tell me about.
(I looked up my results).  I did have a cortisone injection which helped for about 3 weeks, and left a huge divit
below my knee cap.  Have you personally seen meniscus pain that mimics pes anserine? I can't seem to get a definite diagnosis anywhere.  What do you think of prolotherapy for pes anserine/meniscus?  Last question, why do you suggest the ultrasound first?  
Michelle

Answer
Michelle,

If you really have pes anserine bursitis, it would have shown on the MRI and one of your symptoms would be pain when your knee is at rest (not moving) and pain at night (again knee not moving).   If it is meniscal pain, then it will be pain during knee flexion, rotation, and other movements especially when in weight-bearing. This would include squatting or pivoting on the knee.  Ask your DC if he learned how to check for loss of anatomic extension locking of the knee and the procedure called "Zindler double thumb thrust" technique that has been taught by Dr. Charrette over the last ten years or so. He can email me or call me if he wants to learn about it.  I'd highly recommend he do so.  Also, if he is an ART guy, he should be able to try to release the posterior meniscal/capsule tissues in case that is an issue.  If you have asymmetric ankle overpronation, that also will affect your knee (go to YouTube and search "sole supports tv" to see what I think are one of the best orthotics out there).    I would not recommend prolotherapy at this point because you don't know what the problem is yet, what the parameters are for making improvements, and what targets there are for the Prolotherapy.   And, yes, do the ultrasound first as a prep to the tissues before doing Graston Technique.

'Hope this helps.

Dr. G
www.drgillman.com