One cause of lateral knee pain that I have encountered in runners, cyclists, and soccer players is an injury to the proximal tibiofibular joint. During sport, torsional stresses originating from the ankle and resistant forces created in weightbearing deliver stress through this joint. Lower limb biomechanics such as a pes cavus foot type and supination on gait may also contribute to increased stresses.
An athlete’s complaint of pain and/or instability can be due to an acute or chronic sprain of the proximal tibiofibular ligament, or to a subluxation of the joint as the fibular head shifts anteriorly in knee flexion.
A simple, yet effective “tip” to manage the symptoms associated with a proximal tibiofibular joint injury is to use a compression type strap (ex. Levy Patellar Strap by Trainer’s Choice) to stabilize the joint and limit stress through the proximal tibiofibular ligament. To apply this strap, I locate the proximal tibiofibular ligament, and place a pen mark on the patient’s skin two- finger- breaths below this point. I position the strap centered over my mark and secure it to the proximal lateral lower limb. This should be snug, but not too compressive to the gastrocnemius or peroneal nerve. I re-test the mechanism that would reproduce symptoms, and assess for clinical improvement. I owe credit to Dr. David Levy who taught me this great tip during my sports medicine fellowship, and I use it with good success today.
