Let’s take a look at a client case of left knee pain in clinic.
What would you do? You’re experiencing chronic knee pain or you’re a Practitioner who helps people solve knee pain.
What steps would you take?
There are many different ways to achieve success in this case. There are many valid assessments, therapies, modalities and strategies that could be considered and just as effective as what we did.
But if you’re interested in how we work at The Functional Health Clinic – then read on.
Timeline and Onset
Briefly – The client ‘A’ had been experiencing this chronic knee pain for three months. The onset was sudden, unexpected and when out walking.
It was the medial (inside) part of the knee and it was immediately painful and swollen.
Over the next few weeks they tried many things from pain killers, rest, exercises and various physiotherapy exercises.
The swelling improved for them, but the pain remained.
So when they came to the Functional Health Clinic they described challenges in:
- High levels of pain when kneeling.
- Squatting and getting up out of a chair was a 5/10 Knee Pain.
- Long walks would increase the level of discomfort.
First, we collected a little more history and found that about 10 years prior there had been a significant road traffic accident. This had caused a lot of right hip pain.
Now – thankfully they hadn’t been experiencing pain in the right hip or any real obvious affects from this prior traffic accident.
But there had also been no consideration as yet as to how this may be contributing to the bigger picture. Could this have influenced tissue health, tension, alignment, structural integrity, posture, movement patterns, consciously and subconsciously?
That’s something we were interested in.
We ran some very basic range of motion tests, just as an initial marker and basis for comparison.
There was quite a deficit in the left knee/leg function. Less flexion at the hip and less flexion at the knee.
We would find that after just 3 sessions that these ROM assessments were almost equal between left and right knees and hips.
But these weren’t really the most important or useful assessment markers and insight.
Primary Structural Stressor
What we wanted to do was have a way of identifying the Primary Structural Stressor in the system.
Let’s acknowledge that if you assess pretty much anybody (pain or no pain) you will likely find various imbalances, stressors, tissue restriction, knots, tight, taught etc etc.
That’s a given.
So we need a strategy that tries to put them in some sort of rank order.
What needs addressing first? What is having the most say and influence over the state and function of the body?
Again – We are looking for the primary layer.
Yes – we may have many layers to address, but we want to address them in a logical and effective order.
This creates a direction to the process.
It’s still a process, but one headed towards your goals of better function.
Rather than one that just feels stuck, congested and just going round in circles.
We use an assessment of the Dura Mater. This is the tissue or ‘sleeve’ that surrounds the nerves of the central nervous system.
If you can identify a stressor on the dura mater, you’ll be finding or getting close to these primary structural stressors.
We perform leg length assessments to quickly identify the areas that are presenting this.
These are usually upper or lower dural attachments.
Cranial, jaw, neck, pelvic, sacral, coccyx.
For ‘A’ we immediately found a ‘short’ right leg and an indication that this was being caused by a lower attachment issue!
Asymmetries[*Side note* – This is unlikely to be the case for the next person we work with who has left medial knee pain.]
What we had found was a structural asymmetry that was coming from a lower dural attachment. But which area specifically? There’s a lot going on around the lower back, hips and pelvis!
This is where the palpation skills come in and constant reassessment to check when we have created a change.
The change and response came when we released the right side of the Coccyx.
As soon as we addressed this, the dural drag and leg length equalled.
Crystal Balls and Time Machines
We just don’t have (or perceive the need) for the crystal balls and time machines. And we don’t need to be ‘right’ either.
But – it’s perfectly possible that the rigidity and tension that had manifested on the right side of the coccyx, was related to the Road Traffic Accident a decade ago. The right leg was in a stiff and straight position on impact meaning that a lot of this force and load will have shunted right up the leg into the right hip area.
The levels of pain aside, the unstable and damaged area will likely ratchet up and tense up around these connections and structures to provide stabilisation. A protective measure. Over time the pain may ease, but the tissue quality and pattern may not. The hold pattern could easily continue if it is never identified and addressed in some way.
This may or may not be the case. Yet it certainly fuels the curiosity and interest in working with the body.
And ultimately – the solutions and successes usually come when you are interested, curious, creative and ask questions through a process.
The Next Layers
Over two more bodywork sessions, we addressed three more layers.
Each assessment unearthed the next structural influencer in the new pole-position.
Interestingly, these were both upper and lower attachments. We released the:
- SCM. Sternocleidomastoid on the left side of the neck.
- The Psoas (hip flexor) on the left.
- The Piriformis in the right buttock.
Each correction, brought the body back towards better structural alignment.
Where is the cause of the pain?
Note – that none of these assessments indicated the need to address the Left Knee directly.
If they had, we absolutely would have. But we aren’t chasing pain here.
There had been three months exhausting this, throwing many a strategy at the left knee.
We were satisfied that a great deal had been done in that way – Which paved the way nicely for this quite different perspective and approach.
Despite not having chased the left knee pain, what did we achieve in just three sessions for ‘A’?:
- Kneeling now comfortable.
- No pain getting out of a chair
- Squatting no pain, deeper, improved movement pattern, some tightness still.
- No discomfort on going for longer walks.
If you have any questions, just ask 🙂