An Osteo's approach to knee pain

HISTORY

Age: 31 years old

Sex: Female

Occupation: Full-time, office-based

Physical activity: Running 1-2x weekly; 2-3 high-intensity group fitness classes; 1x yoga weekly

Onset: Noticed right-sided knee pain whilst doing lunges at the gym approximately 3 months ago. Has noticed similar pain starting in the left knee over the past few weeks.

Site of pain: Inside and lower border of the knee cap, mainly right sided and recently left

Quality of pain: Sharp when aggravated, achey after being aggravated, can experience no pain at times

Radiation of pain: The pain does not radiate, and remains local to the area

Timing of pain: The area might feel more stiff in the morning or after periods of rest

Aggravating factors:

• High impact activity such as running, jumping and/or skipping

• Gym-based / functional movement - lunging, sometimes squatting

• +/- Going up or downstairs

• Long periods of immobilisation

Relieving factors:

• Ice

• Rest

No effect:

• Bike riding

Other musculoskeletal complaints:

• Can get a sore lower back: generally from sitting at a desk all day

• Has had a previous history of right sided ankle sprains / instability

OSTEOPATHIC IMPRESSION

Physical assessment:

• Decreased mobility: right foot, right sacroiliac joint and lumbar spine (lower back)

• Tight muscles: lower leg, quads, glutes & lower back

• Familiar pain reported with lunging, hopping and deep squatting

• Poor leg alignment is noted through the leg, hip and pelvis with hopping

Diagnosis: Patello-femoral joint syndrome as a result of poor transmission of force / load through the lower extremity which becomes exacerbated with high impact activity. (The left knee may now be becoming symptomatic due as a compensation)

Treatment plan:

• The knee has become the ‘piggy-in-the-middle’ in this scenario - it is placed between a stiff foot and a stiff lower back and pelvis.

• The lack of mobility in the pelvis and lower back is a key area to address as this region is the keystone for force transmission throughout the body. If altered force transmission occurs, weaker areas will become compromised (in this case the knees).

• The lack of mobility in the foot also needs to be addressed as this is the first point of contact for the force to be transmitted through the lower extremity.

Management plan:

• Mobility exercises: for the feet and low back

• Myofascial release exercises: Plantar fascia (sole of the foot), quadriceps, glutes, lower back

• Strength exercises: Feet, knee & glutes

• Footwear - is the patient wearing shoes that are TOO supportive, which will in turn create stiff and weak feet

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