In December of 2001, I was rear-ended going about 30mph; five cars were involved, and I was the first car hit from behind. My knee hit the dashboard when I was hit from behind and my head was jerked backwards when I hit the car in front of me.

My knee started hurting soon after, although I never got it checked out. It’s now become a sharp pain and a constant, dull ache as well with weakness on stairs and squatting-type positions especially. In addition, there are tender areas, on the outside and top of the knee, that cause extreme pain when I am bending, squatting, lying down, or sitting down for too long. My hip has also been affected, also aching constantly. My right leg and knee also hurt and knot up easily. The surrounding muscles are very weak with several knots in them, and I also have a very tight iliotibial band. Any ideas what might be going on?

I thought “PCL” (posterior cruciate ligament) the second I saw the word “dashboard;” it’s the most common injury mechanism with this injury. I’m really surprised that they didn’t check you out for this right after the accident; you might actually be a candidate for a surgery to clean things up. Things to consider:

1. They aren’t as good at PCL surgeries as they are with ACL surgeries, as they’re only 1/10 as common. As such, they screw up a good 30%, as I recall – so make sure you find a good doctor who is experienced with this injury to assess you and, if necessary, do the procedure.

2. It’s believed that isolated PCL injuries never occur; they always take the LCL and a large “chunk” of the posterolateral complex along for the ride. That would explain some of the lateral pain.

3. The PCL works synergistically with the quads to prevent posterior tibial translation. As such, quad strengthening is always a crucial part of PCL rehab (or in instances when they opt to not do surgery). A good buddy of mine was a great hockey player back in the day, but he has no PCL in his right knee; he has to make up for it now with really strong quads.

4. Chances are that a lot of the pain you’re experiencing now is related more to the compensation patterns you’ve developed over the years than it is to the actual knee injury. For instance, the tightness in your IT band could be related to you doing more work at the hip to avoid loading that knee too much. Pain in the front of the knee would be more indicative of a patellar tendonosis condition (“Jumper’s Knee”), which would result from over-reliance on your quads because of the lack of the PCL (something has to work overtime to prevent the portion of posterior tibial translation that the PCL normally resisted).

5. From an acute rehabilitation standpoint, I think you’d need to address both soft tissue length (with stretching and mobility work) and quality (with foam rolling). These interventions would mostly treat the symptoms, so meanwhile, you’re going to need to look at the deficient muscles that aren’t doing their job (i.e. the real reasons that ITB/TFL complex is so overactive). I’ll wager my car, entire 2006 salary, and first-born child that it’s one or more of the following:

a) your glute medius and maximus are weak
b) your adductor magnus is overactive
c) your ITB/TFL is overactive (we already know this one)
d) your biceps femoris (lateral hamstring) is overactive
e) your rectus femoris is tighter than a camel’s butt in a sandstorm
f) you might have issues with weakness of the posterior fibers of the external oblique, but not the rectus abdominus (most exercisers I know do too many crunches anyway!)

Again, your best bet is to get that PCL checked out and go from there. If you’ve made it from December 2001 until now without being incapacitated, chances are that you’ll have a lot of wiggle room with testing that knee out so that you can go into the surgery (if there is one) strong.

Eric Cressey