A female patient, 26yrs old, recently came to the practice with pain underneath her left knee cap. It also clicked occasionally and was much worse after the gym or running and walking up the stairs. It had been getting progressively worse for the last 6 months.
On examination the patient’s knee had no obvious mechanical injury to her ligaments. There were signs of a little wear and tear. However what was obvious was that the patient significantly pronated on her left foot and her left pelvis was anteriorly rotated.
The diagnosis was patella femoral syndrome.
TREATMENT – OSTEOPATHY, SPORTS MASSAGE AND THERAPEUTIC EXERCISE
This involved articulation and manipulation to the foot , the fibula head and the SIJ and lumbars to address the rotation. Sports massage to the muscles inserting at the knee including gastrocnemius, hamstrings, tfl, itb and quads and a recommendation to purchase orthotics to help her pronation.
The patient was also given therapeutic exercises to strengthen her core stability, relax and stretch her ilio-psoas and so reduce her pelvic tilt.
After two treatments the patient reported a complete cessation of pain. She had also ordered the orthotics.
LONG TERM SOLUTION
Now I recognise that not every patient will respond in the same way but this global approach to the patient’s knee pain, combining osteopathy with remedial and sports massage and therapeutic exercise is a typical example of how I treat. And for this patient it was very effective at addressing her problem. Long term she will need to use her orthotics and maintain her therapeutic exercises. But now the management of her pronation and potential future knee trouble is within her own control.
