“I wanted to ask you about a pattern I’m seeing with some of my patients, when completing 90/90 repositioning exercises I have had several patients experience left medial knee pain at the pes anserine area. Can you share with me why this may be happening and how to address it?”
The Sartorius is an external rotator and the gracilis is an internal rotator and depending on the position of the femur to the acetabulum the semitendinosus and semimembranosus are more of an internal rotator especially when in a 90-90 position. I believe you may be seeing medial knee pain in this position because of the internal rotational direction of these muscles on the distal femur as the tibia is externally rotating possibly from heels that come off the wall or lateral toes that are overused, or when performing a posterior pelvis tilt and lift or from some other reasoning that contributes to transverse torsion at this joint. You may want to try to keep feet secured to the wall and have them hold or lift by pushing their heels into the wall and down as they lift. Shifting the opposite knee upward may help also disengage rotational force on the hip and knee and thus these muscles. Just some thoughts. I know you know most of all this and the importance of keeping the back rounded to avoid unneeded pelvis flexion or anterior rotation on the femurs which orient the femurs inwardly and thus place demands on the Sartorius for external rotational stabilization and thus pull at this site. – Ron Hruska, MPA, PT
