Understanding Saphenous Nerve Entrapment
The saphenous nerve is a branch of the femoral nerve. It travels down the front of the thigh, wraps around the posterior-medial aspect of the knee, and continues down the inside of the lower leg. As the saphenous nerve wraps around the knee it passes under, through, or around several muscles, including the vastus medialis, medial hamstring, sartorius, and gracilis, and common pes anserine tendon. Under normal circumstances, the saphenous nerve will move and slide along these muscles as the knee moves back and forth. However, If the saphenous nerve becomes compressed or stuck along any of these muscles if can become injured, leading to pain on the inside of the knee. In some cases, neurological symptoms such as tightness, burning, numbness, or tingling may also occur into the lower leg.
Signs and Symptoms of Saphenous Nerve Entrapment
- pain on the inside/medial aspect of the knee
- pain/tightness on the back of the leg above the knee
- pain or tightness is often present with going upstairs
- there may be tightness, burning, tingling, or numbness into the lower leg
What Causes Saphenous Nerve Entrapment?
Saphenous Nerve Entrapment is an example of a repetitive strain injury. Unlike a traumatic injury which is caused abruptly following a trauma or accident, repetitive strain injuries (referred to as an RSI for short) are associated with very small amounts of tissue stress and damage that, if not addressed, can accumulate slowly over time and lead to pain.
Here’s how this works….
As the knee is stressed and over-used it can lead to small scale damage in the surrounding muscles. This damage is referred to as ‘micro-trauma. Although only small this damage still needs to be repaired. The body does this by forming new tissue in and around the injured muscles. This new tissue, often referred to as scar tissue or soft tissue adhesions, is very sticky and acts to ‘glue’ the damaged tissues back together.
In some cases, this scar tissue can form in the muscles around the knee along the area(s) where the saphenous nerve is located. This will restrict the normal movement and sliding of the saphenous nerve on these muscles. When this happens the nerve can become damaged or irritated due to a stretch or traction injury (instead of sliding along the muscles the nerve will be pulled into an over-stretched position).
Why the hip and foot are important with Saphenous Nerve Entrapment
It is important to realize that many cases of saphenous nerve entrapment are actually caused by a problem at the hip or foot. If the muscles around these segments are not working properly it will affect the alignment and biomechanics of the knee. This will force the muscles around the knee to work harder during activities such as walking, running, climbing stairs, or with exercises at the gym. In many cases, this is what is causing the overload and excessive traction on the saphenous nerve in the first place. (“Do you want to know if your knee pain is linked to a problem at your hip or foot? Try a squat test, 1 leg squat test, or lunge test). If these issues are not resolved the saphenous nerve problem may not fully resolve, and will likely come back in the future.
Treatment – Resolving Saphenous Nerve Entrapment
The proper treatment of saphenous nerve entrapment must not only address problems with the saphenous nerve, but MUST also correct any biomechanical problems at the hip or foot as well (remember, these factors are often what is creating the overload at the knee and saphenous nerve in the first place).
For treatment to be effective we have found that there are certain steps that must be followed, and these steps must be performed in the right order if we are to expect the right results. Here is our approach when treating saphenous nerve entrapment in our clinic….
Step 1 – Resolve scar tissue adhesions and facilitate normal nerve sliding
The first step is to treat the scar tissue adhesions. As explained above, these adhesions are essentially gluing the saphenous nerve to the surrounding muscles, preventing the nerve from sliding around the knee.
Scar tissue adhesions do not resolve with stretching or traditional massage or soft tissue methods, but instead must be treated with specialized techniques. One of the most effective methods is to use a technique known as Active Release Techniques (ART). For those who are unfamiliar with this treatment method, ART is a new and highly successful hands-on treatment method that was specifically designed to identify and address scar tissue adhesions that are interfering with the normal movement of the body.
During an ART treatment, the practitioner will first shorten the muscle, tendon, ligament, or joint capsule and then apply a very specific tension with their hands as they stretch and lengthen the tissues. As the tissue lengthens the practitioner is able to assess the texture and tension of the tissue to determine if the tissue is healthy or contains scar tissue that needs further treatment. There are hundreds of specific ART protocols to treat the various muscles, tendons, ligaments, and nerves in the body, including the saphenous nerve.
Step 2 – Correct strength and flexibility
Simply treating the scar tissue adhesions will promote the normal health and sliding of the saphenous nerve, and will often result in a significant reduction in pain. In fact, it is not uncommon to see a significant improvement in just a few visits. However, although addressing the scar tissue frees the nerve and makes the muscles healthier, the muscles of the knee or leg may still be somewhat tight or weak. When this is the case-specific stretches or exercises can be incorporated into a home exercise/rehabilitation routine to help support in-office care. Initially, the focus is on correcting local muscle deficiencies (i.e., at the knee, hip, or foot).
Step 3 – Re-Train Functional Movement Patterns
The final stage with treatment is to ensure proper alignment and movement coordination of the foot, knee, hip, and trunk with functional movement patterns. This ensures movement of the hip, knee, and foot are coordinated and working together as a unit and the stress has been relieved from the saphenous nerve. This is what is required during real-life activities such as running, walking, cycling, and climbing stairs (the key functional movement patterns with respect to saphenous nerve entrapment/irritation include the squat, 1 leg squat, and lunge).
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