The Saga of Knee Pain
A woman came in to discuss her right knee pain. She had been to Physical Therapy and was told one of her legs was shorter than the other. The advice was that her thigh muscles had to be stretched and lengthened and her hamstrings and butt needed strengthening.
The Orthopedist said he wanted her to take Tramadol. She intuitively knew that the Tramadol would mask the pain and the problem would continue and worsen. She followed her friends recommendation to come to The POSTURE Clinic.
She had a history of left bunion surgery (twice) and plantar release surgery to release the right plantar fascia tendon. She had a "couple of sprained ankles", a Trip 'N Fall leaving her with a broken right wrist and left elbow at separate times. She has a Baker's Cyst on the right knee and had dislocated her Patella (knee cap) four times, and tore her meniscus 12 years ago.
She previously had right back pain, currently has right hip pain and right knee pain.
True to form, many professionals are trained to be concerned only with the symptom. At The POSTURE Clinic we work in the completely opposite way.
We know from successfully helping people get out of pain that SELDOM is the cause of the pain where the symptom is. Yes we are concerned with the symptom and health history but we know the various joints and component parts of the body are not islands unto themselves. They are inextricably linked and intertwined.
We also know that the body has positional requirements. The knee joint is shaped and designed to hinge the upper leg (femur) directly over the low leg (tibia/fibula). The knee is not designed to rotate or swivel. But the joints above the knee and below the knee are designed to rotate and to also move forward and back so the knee can work without friction and pain. Muscle balance must exist for the muscles to engage properly to move the upper leg, hip, ankle, low leg keeping the structures mobile, functional and stable. As muscles learn bad habits and start compensating, the joint they operate becomes mispositioned then proper function, and stability or flexibility are impaired and modified. The poor little knee joint is a victim of what else is happening or not happening elsewhere.
During her first session I mentioned that the only decisive way to determine a leg length difference is to X-ray both legs and measure each femur bones. Otherwise without an X-ray, the length difference is likely muscles of the hip/pelvis that have an imbalance of length and tension.
I did a brief functional test. I had her walk across the room and report her pain level. Then I asked her to clasp her hands, put them behind her head, pull her elbows back and take the same walk as before. She reported in 20 seconds that her knee pain (originally a 7-8 on the pain scale) felt less. Did I do anything to the knee?? Absolutely not. Then what happened?
I used common sense. I know that if the rest of her body is out of position with muscle imbalances that any correction or slight positive repositioning of another body part will change her center of gravity and the other parts of her body including her war torn knee would improve it's position and the pain would improve. Try the functional test and see what part of your body might reposition. Everyone's compensations and imbalances are unique so your experience may be different than this client. (This is all the more reason to come for an evaluation so we can assess your individual issues and posture.)
Imagine, 2 bunion surgeries, 2 plantar fascia procedures-1 was a surgery, numerous ankle, elbow, wrist injuries, a Baker's cyst behind the right knee, 4 dislocations of the right knee and a torn meniscus of the right knee......Why does this keep happening over and over and over?? Because her right thigh is too tight and her butt and hamstrings too loose?
Good luck with that incomplete approach since the Physical Therapist was only looking at the upper leg and hip. He/she completely ignored the upper body and other joints, pelvic position and spinal position and function. This woman has all those other parts and joints but they were being completely overlooked as if they have no bearing on the knee.
Answer: the other parts of her body are out of position which deeply alters her center of gravity creating imbalances, compensations and dysfunctions throughout. Years of friction, wear and tear and problem after problem, many compensations and dysfunctions ensue until a POSTURE alignment therapist trained in the Egoscue Method crosses paths with this person. At that point, the clients sees and understands there are FAR more imbalances that exist in her body and her muscles have to be retrained to create the correct biomechanics and motor pathways so her muscles can engage properly throughout her whole body. This will restore symmetry and PROPER function and Center of Gravity restored will enable the joints and her whole body to function without pain, compensation and restriction.
Come in for an evaluation and we'll see if we can help you. We love what we do and we are really good at it. We don't advertise. All of our business is generated by referral. Call for an appointment today 772-559-1532.
A large percentage of clients we work with come to us in chronic pain. Their lives have become very limited and very unenjoyable due to chronic pain. When asked what their goals are for undertaking the Posture Alignment Program they say, not surprisingly say, "to get out of pain."
This is understandable to say the least. But many times clients don't understand that getting out of pain is only half the battle and just a part of the process.
Getting to a place of enormous pain in most cases takes place over time, a long period of time. Think of the timeline of when your pain started and then what events started years before that. Was there a car accident, a sports related accident, years of playing one-sided sports or doing one-sided activity, sitting at a desk for 30 years, any physical injury or surgery. This is a short list of the things that set up compensations in the body where you stopped using a body part for a period of time and overused another body part. Therein begins the problem, years and years ago. That is the beginning of the time line and by the time there is actual pain that can not be ignored, it is late in the timeline. Pain is the end of the process since the problem is at it's most severe state.
Spondylolisthesis, Stenosis, Herniations, torn Meniscus/Cartilage/Tendons etc. etc. etc. are not created in the body quickly. These problems are the result of friction and wear and tear in the body from long standing muscle imbalances, faulty muscle engagement, and poor biomechanics.
Pain is the end point in this process. Pain from Spondylolisthesis, Stenosis, Arthritis, and most all other diagnoses or surgeries or problems as explained above, is the final stage of a multistage process of physical degradation. This degradation is caused mostly from environmental circumstances that set up muscle inactivity and weakness or hyper tension which make muscle pairs become imbalanced. The mechanics of how muscles engage, which ones are getting recruited the way they should and when they should, is compromised. Strengthening activities do little good to correct the imbalances without specific biomechanics retraining.
At The Posture Clinic we are working first and foremost to get clients out of pain as soon as possible. But the process really does not end there. You see there was a long history of physical issues and injuries and environmental circumstances building up and piling up before the client gets to the point of pain or extreme pain. Therefore all those prior muscle and joint imbalances and dysfunctions need to be resolved or improved. This is where clients drop out of the process because they think since the pain is gone they are home free. Not so.
Most clients are not home free because there is more work to be done to get the ankle, knee, hip, shoulder, pelvis and spine functioning fully and CORRECTLY again. We are happy clients jump for joy when they are out of pain; we're joyfully jumping right along side of them.
The analogy that paints a good picture is this: if your house is on fire you want to put out the fire. But after the fire is out you have to rebuild the house- the whole house not just the kitchen or den. You gotta rebuild the whole house.
Call us at 772-559-1532 to discuss your individual situation. We're trained in biomechanics and can show you where you've developed dysfunctional muscle and joint function and alignment.
Catee Ingwersen is an Egoscue certified Posture Alignment Specialist and Licensed Massage Therapist.