knee pain

[Alex J]

Hi folks,

A client of mine had ACL surgery over ten years ago... these days his knee hurts often, and he experiences some swelling at and below the joint. He would like to avoid surgery if possible, or for as long as possible at least.

I've been doing some subtle shiatsu and myofascial work, and it seems to help him feel somewhat better, at least for a day or two. I'm curious though to know how others would work with this.

 

[sky.lilah]

With knee pain, I always first check the mobility of the patella. It should be quite mobile in all directions. If it doesn't want to move distally, check for trigger points/fascial restrictions in the quads, sartorius and adductors, especially at the ASIS. Releasing those can allow the knee to track properly again, freeing the lymph fluid and reducing swelling and pain. Ditto, only different muscles, if it fails to move freely in any other direction. Just follow the muscles that attach and cross at the knee.

A bit of lymphatic massage at the pelvis/thigh and then up the knee can help to reduce the swelling. And of course, RICE is good at-home care.

 

[TSL]

I agree with the patellar tracking issue and treatments mentioned above.

If it is a tracking problem, PT can be very helpful but he should find someone skilled with McConnell taping and retraining the VMO. Of course, that will only go so far is he has lateral issues that aren't also addressed.

It sounds like he may have hardware that is irritating things. I speak from experience. I had a grade three rupture, patellar tendon graft and hardware removal two years later. I never really got rid of the tendonitis in my hamstrings until that screw came out. What a relief!

Still aches from time to time, but I'm no spring chicken anymore!

 

[Danielle P]

knee pain

Hi folks,

A client of mine had ACL surgery over ten years ago... these days his knee hurts often, and he experiences some swelling at and below the joint. He would like to avoid surgery if possible, or for as long as possible at least.

This will sound crazy and I'm only mentioning it as a thought, not as a remedy.

I have a client with old knee surgery and didn't want to have new re-construction, but the pain was becoming more and more unbearable. She's in her 40's and the injury and initial surgery was in her late 20's.
She began doing some yoga and in particular a "pigeon" pose. I don't know yoga, so I can't tell you what it is. She had surgery scheduled a week out, and because of the yoga cancelled the surgery. It's been 2 months now and she is still feeling good.
.

 

[jwhizzle4shizzle]

I Love pigeon! It really helps with my SI/piriformis issues, but additionally helps to increase flexibility in the lateral knee structures. It hurt like heck when I first started, but wow, what a difference!


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[imaghost]

Ego,

What condition is the back of the knee joint in? Is the musculature that crosses the joint posteriorly is spasm at all? How about the muscles above and below the joint posteriorly?

Have had clients with chronice knee pain find a great measure of relief by my working to relieve spasms, hypertonicity, etc at the back of the knee and/or above and below the knee posteriorly. Perhaps that would help your client to some degree..............

 

[MUFFINATOR.]

HI EM -

Did you continue to work with this client? If so, what therapies did you find were best?

I have a client with both knees post ACL surgery two years out coming to see me in a couple of days. She is dealing with scar tissue and hoping massage can help. I let her know that we can work with some cross fiber friction but at this point 2 years out the scar tissue is probably there to stay.

She is not up for another surgery to remove scar tissue.

Thanks,
crystal_compass

 

[??p??pl? p??????]

I have heard great things about knee problems relieved or remedied by Egoscue (http://www.egoscue.com/) which works by giving the client exercises that, done regularly, resolve overall alignment issues that are causing or contributing to the pain.

i also wanted to second the yoga suggestion (in addition to the other remedies)! Yoga CAN be great--amazing--for some knee conditions, so long as you know what poses to do, how to modify certain poses for your condition (ie. to make less strenuous--for instance, there's a full pigeon and a modified pigeon) and what poses to avoid (several of my clients have hurt their knees lunging into yoga positions).

(Knowing what to modify is true in any workout, but yoga sometimes seems to get a bad rap because it's supposed to be so healing, yet for many reasons it can be hard for students to distinguish btw what the teacher is doing and what will be okay for their own body.) If the client has a very good sense of how their body is being affected by the workout, a group yoga class may work; otherwise I always recommend a private session with a yoga teacher trained in rehabilitative yoga.

 

[? ? ? Baby Mumma ? ? ?]

a) what type of ACL surgery? if it was a patellar tendon graft, there is usually some knee pain (especially if the rehab was post-op)

b) with knee pain....don't always look at the knee. we have been fixing a lot of knee pain by evaluating hip strength (especially glute med. firing) and ankle mobility (if ankle mobility is poor and movement is restricted there, then the individual will get movement at other joints...ie, the knee).

c) look at overal movement. what is the gait pattern like, etc....do some manual muscle testing and look at muscle length of specific muscles, etc....figure out WHY it is hurting.



Patrick

 

[heaven mclovin]

knee pain

b) with knee pain....don't always look at the knee. we have been fixing a lot of knee pain by evaluating hip strength (especially glute med. firing) and ankle mobility (if ankle mobility is poor and movement is restricted there, then the individual will get movement at other joints...ie, the knee).

c) look at overal movement. what is the gait pattern like, etc....do some manual muscle testing and look at muscle length of specific muscles, etc....figure out WHY it is hurting.



Patrick

Last week I did some deep tissue work on a former college athlete who has been having a lot of knee pain lately. She recently moved and had been carrying boxes up and down stairs quite a bit. While in college she had suffered from injuries in both knees (torn meniscus in both knees about 7-8 years ago).

During our first session I did most of my deep work on her her gluts, hip rotators, and hamstrings and did a little work on the lower legs too, but avoided working too close to her knees. I also recommended that she do some icing on her knees several times a day.

I thought the session went really well and I'm looking forward to having another opportunity to work with her again later this week. I'm interested in Patrick's comments about "evaluating hip strength" and "ankle mobility" and was wondering if someone could comment further about this and/or suggest some sources of information for me so that I could learn about doing this.

Thanks in advance.

 

[max p]

knee pain

b) with knee pain....don't always look at the knee. we have been fixing a lot of knee pain by evaluating hip strength (especially glute med. firing) and ankle mobility (if ankle mobility is poor and movement is restricted there, then the individual will get movement at other joints...ie, the knee).

c) look at overal movement. what is the gait pattern like, etc....do some manual muscle testing and look at muscle length of specific muscles, etc....figure out WHY it is hurting.



Patrick

Last week I did some deep tissue work on a former college athlete who has been having a lot of knee pain lately. She recently moved and had been carrying boxes up and down stairs quite a bit. While in college she had suffered from injuries in both knees (torn meniscus in both knees about 7-8 years ago).

During our first session I did most of my deep work on her her gluts, hip rotators, and hamstrings and did a little work on the lower legs too, but avoided working too close to her knees. I also recommended that she do some icing on her knees several times a day.

I thought the session went really well and I'm looking forward to having another opportunity to work with her again later this week. I'm interested in Patrick's comments about "evaluating hip strength" and "ankle mobility" and was wondering if someone could comment further about this and/or suggest some sources of information for me so that I could learn about doing this.

Thanks in advance.

If you think about the joint-by-joint approach to the body/movement, the basic format would be that the ankle joint seeks mobility, while the knee joint seeks stability (we don't want to much radical movement here) and the hip joint seeks mobility. And of course this thought process can be carried up the body further.

Really, you are just looking at putting together the puzzle. With knee pain, there is a good chance that movement isn't happening where it needs to happen (perhaps a lack of ankle dorsiflexion, creating more pronation, and translating to great valgus force on the knee), or maybe the individual has poor hip mobility (an excessive anterior pelvic tilt creates creater hip internal rotation, which can affect the knee...or, perhaps a lack of internal hip rotation is creating a need for great hip adduction during movement), or maybe poor hip strength is creating greater movement at the knee, as stability is compromised.

Obviously there are a number of things you can look at, and a number of ways to take it. Having some sort of fully body table assessment to help connect the dots is always helpful. Somethings I'd look at would be:

- Great toe extension
- Ankle dorsiflexion (are we dealing with soft tissue or joint restrictions?)
- Ankle eversion/inversion
- patella mobility (in all directions)
- hip mobility
- hip strength (extension, abduction, etc...)
- breathing patterns

You can learn a lot about the individual from those few basic things.

Hope that helps give you more ideas.

Patrick

 

[Atley]

knee pain

Good comments by Patrick. I agree that assessment is critical to understanding the problem to formulate an effective solution. However, I usually prefer to do some assessment of these structures while the client is dressed and standing. I may even ask them to do simple balancing or walk a few steps or do squats, as the muscles at work will often provide information that muscles at rest may not. It definitely gives a clearer picture of habitual movement patterns.

If you are uncertain how to proceed with evaluating the structures/relationships mentioned above, there are a number of excellent references on assessment methods worth studying. :altwink:

As a personal trainer, I see clients with this stuff all the time. In most cases, we work on their flexibility and body mechanics, then improve strength and mobility with appropriate exercises. The vast majority review cessation of symptoms and increased ability to exercise more vigorously, sometimes in 1-2 sessions. Some go get bodywork as well, but most do not.

As a therapist, I often discuss any dysfunctional body mechanics I see in their movements with them, and attempt to educate them on ways to retrain basic movements patterns. More often than not, I refer them to speak with the personal trainers at whichever gym they go to.

 

[Small Fry]

knee pain

Just wanted to throw in that James Waslaski has a really great new DVD out called 'Complicated Knee Conditions' and there's some great info on there. When I took the 40 hour intensive in TX, he taught us a lot of what was on the video and it was some good stuff. You can order it off of http://www.orthomassage.net