Very painful knee

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Permalink Reply by Barbara Helynn Heard on April 20, 2011 at 11:27am

Aloha Therese,

 

I like your plan to work a wide variety of areas. As you know our bodies are complex puzzles composed of interconnected pieces.  Keep exploring and coaxing.

I personally use and make available to my clients and students Grace Harbor Farms MSM cream to relieve joint pains.  I use it as my first line of defence "first aide cream" when my injured shoulder aches and I haven't made time to get massage or chiropractic to get it back into it's best form.  You can read my testimony about this cream on my website:

http://www.lomilomi-massage.org/Massage-Products.html

 

Keep up your good work,

Barbara Helynn Heard

Seattle, WA

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Permalink Reply by Therese Schwartz on April 20, 2011 at 11:36am

Thanks Barbara!  I forgot to mention that I used PanAway on her knee and thigh and recommended that she get Arnica cream from our local GNC store.  I will tell her about the MSM cream.  I give MSM to my horse so I know it works!

 

I told her she was a puzzle I needed to figure out and don't give up.  

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Permalink Reply by Peter Lelean on April 21, 2011 at 2:53am

Hi Therese. Perhaps a pelvic balance, specifically attending to pub symph alignment, and at least one TP in the homolateral gracilis, distal half. Good luck! P

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Permalink Reply by Therese Schwartz on April 21, 2011 at 11:18am

Thanks Peter!  I will check those.

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Permalink Reply by Dawn Lewis on April 21, 2011 at 1:41pm

Hi Therese - I use a technique called SMRT, which is a series of passive contractions.  You can work the psoas muscle without touching it.  Stand at her knee and turn toward her head, pick up her leg in your hand and arm closest to the table, keeping your hand under her knee so as not to hyperextend.  Let her leg roll into lateral rotation toward your body.  Keeping the flexion at the hip and the lateral rotation, gently lean your body weight into her leg.  This will create compression, use enough compression to reach her pelvic area, hold this for about 30 seconds.  When you put the leg down, check the tenderness again.  Also, the medial quad tenderness and calf tension sounds like her meniscus is out of alignment.  If you check each side of the knee joint, you may feel a hole on one side and no space on the other side.  Put mild pressure into the hole, moving the meniscus toward the filled up or swollen side, hold for about 30 seconds, release, and check both the knee and the muscle tenderness.  Hope this helps.  Dawn

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Permalink Reply by Therese Schwartz on April 21, 2011 at 5:57pm

Thanks Dawn!  That sounds fantastic!!  I appreciate your details very much.

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Permalink Reply by Matthew D. Stewart on April 21, 2011 at 6:29pm

Therese,

What is her hip range of motion like? Could this be referred pain from her hip?

What investigations has she had (x-ray MRI etc) from the chiropractor and MD?

You mention she is English professor, what else does she do in her recreation time?

I suggest you check the back of the knee for the tone of the popliteus, which can affected the function of the knee.

 

 

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Permalink Reply by Matthew D. Stewart on April 21, 2011 at 6:45pm

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 21, 2011 at 9:02pm

Hi Matthew, I will have to check those things with her.  I do think it could be referred pain from her hip, given how tight and tender her groin area (palpating for psoas) is.  I do know that the doctors "couldn't find anything wrong" with her knee but I'll need to get specific answers about those.

 

Thanks!

Matthew D. Stewart said:

Therese,

What is her hip range of motion like? Could this be referred pain from her hip?

What investigations has she had (x-ray MRI etc) from the chiropractor and MD?

You mention she is English professor, what else does she do in her recreation time?

I suggest you check the back of the knee for the tone of the popliteus, which can affected the function of the knee.

 

 

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Permalink Reply by Peter Lelean on April 22, 2011 at 2:04am

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?

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Permalink Reply by Dawn Lewis on April 22, 2011 at 8:01am

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 Walt Fritz, PT on April 22, 2011 at 10:56am

Therese,

If she saw her MD, I am assuming she was cleared for any major issues?

I would start with some objective testing. Lay her prone and bend that knee to first barrier (not forced endrange). She should should show at least 115-120 degrees of flexion. Compare the opposite side. Less flexion indicates tightness of the quads. In supine, how much play/wiggle room does the patella have? It should have play in all directions without pain or crepetis. You may also wish to check hip flexor length, which can impact tightness of the quads (google Thomas Test for description).

Assuming tightness of the quad region is the issue, I think you are spot on with myofascial release to the quad region, including the patella. Also, MFR across the pelvis, from psoas to upper quad.

Good luck!

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