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Very painful knee

I have a new client (2 sessions so far) with a left knee that is very painful at times. She also gets swelling in her feet. In the first session I did massage and found very tight and tender medial quads and adductors. I was able to gently work them and it seemed like it went well. She's been an English professor for 46 years so she's done a lot of standing. Her gastrocs and soleus were also tight. This week her session didn't go so well - the knee was so painful she couldn't lay face down. I did energy work on the knee and got almost no response. The only hint I got is that the psoas is related; I found it to be so tight and tender that I really couldn't work on it. Next session I plan to do an SI release on her (CranioSacral) and some MFR on her leg and knee. Do you have any other suggestions for what I can do to help her? She's done the MD and chiropractic route with no help.

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Permalink Reply by Stephen Jeffrey on April 22, 2011 at 1:33pm

I'm more than just curious about what is happening "on the other side" because my experience is that unless the issue is one of direct trauma then treating the other leg can hold many of the answere's.

why = if the other leg was originally the weak/insidious pain limb, then the client cannot help but addopt a pattern of biomechanical heavier weight bearing on the good leg, which over a long period of time (yrs standing) will become the painfull leg with which they present at clinic. In other words if you do not treat both legs with equal attention all your good efforts may be thwarted by a long established load bearing pattern.

See http://www.massageprofessionals.com/profiles/blogs/misconceptions-a...

You are getting alot of good tips I just hope its not overwhelming you :)

Dawn Lewis said:

Hi Matthew - Most of what you have said about the menisci is true. It is attached via ligaments to the joint capsule, the femur, and the tibia. The ligaments attaching the menisci to these structures, particularly in a knee that is itself out of alignment, can become twisted or overly tight, thereby pulling the menisci to one side or the other. While it will be necessary to release the back of the knee, the quads, the hip, etc., it will be much easier to release all of these structures once the menisci are moving back toward alignment. And, while I agree with Peter about potential fascial issues caused by a misalignment at the pelvis, I would also check the ankle and foot position. A misalignment at the ankle would not only misalign the tibia and the menisci, but throw off the femur and pelvic alignment. Of course then the discussion becomes which came first the pelvic misalignment or the ankle misalignment, and who knows. It will probably be impossible to tell, but to get real relief in the knee, the ankle, knee, and hip will all have to be addressed, and I would be curious about what was going on on the other side. Dawn

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Permalink Reply by Stephen Jeffrey on April 22, 2011 at 6:25pm

http://www.youtube.com/watch?v=KXM_07_kuIo&feature=related

Hi Matthew, this may not be related but J P Barral talks about ligament, meniscus and treatment here:)

Matthew D. Stewart said:

sounds like her meniscus is out of alignment

Dawn,

I have never heard of a mal-aligned meniscus, so would be interested to hear more about that.

My understanding from direct cadaver studies and anatomy texts is that the menisci are attached at their peripheral rims to the inside of the joint capsule, often referred to as the coronary ligaments. This attachment keeps the menisci firmly attached to the tibial plateau. Also, the medial meniscus has an attachment to the deep layer of the MCL.

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Permalink Reply by Therese Schwartz on April 25, 2011 at 8:24pm

Wow everyone - this is great!! I was busy all weekend and didn't get a chance to check in. Thanks so much to all of you! I have a lot to go on tomorrow with her now. The collective knowledge here is really impressive.

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Permalink Reply by Therese Schwartz on April 26, 2011 at 12:15pm

That sounds really interesting but I'm booked for continuing ed for the year! Thanks for the great info though, I appreciate your help.

Peter Lelean said:

Ok, this thread has really got my attention. The various contributors are, I believe zeroing in very well on the different facets. My point is this: everything so far seems to be indicating a classic Migratory Fascia Syndrome case, where the misaligned pelvic bones are overlaid by fascia that has actually shifted position, locking in problems such as those experienced by your client. Doctors don't see it . . in fact not many practitioners of any colour do. I recently did some training re Lelean's ligament and Migratory fascia Syndrome in Kansas, just 2&1/2 hours away from you. Members of this forum Kevin and Robyn Green are now up to speed in these matters. So, perhaps talk to them and, maybe, register interest in a Sept/Oct workshop with me in dealing with clients with similar problems. Alternatively you could attend an advanced class (now in preparation) with Walt Fritz, also a forum member. I cannot emphasise enough how significant these developments are to all bodyworkers. Please follow this up . . I am anticipating a maximum number of 20 wired-up practitioners of all types who want to be leaders in the remedial field. Any takers?