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Three Balls, Two Strikes, One Knee
By
Victoria L. Magown, CMTPT, LMT and
George S. Pellegrino, LMT, CMTPT
Full count, bottom of the ninth and the score was tied. Poised,
ready for the next pitch, Joe couldn’t help wondering if his right
knee was going to buckle as it had in the past. Was his knee
pain going to rear its ugly head and prevent him from running the
bases? Would he even get the chance to run?
The pitch was right in the zone and resulted in a long fly ball
to center field. Joe was in luck. A series of mishandled
relayed throws enable him to run all the way home. As he neared
home plate, the signal was slide. And slide he did! “Ouch”,
two days later and the knee pain that only flared up once in a while
now became constant. The pain was threatening his reputation
as the neighborhood baseball hero.
After two weeks on the bench with his two old friends, ice and
Ibuprofen, Joe realized this was more than just a bump on the knee.
His doctor said it was a muscle injury and gave him a prescription
for muscle relaxers, pain medication and an anti-inflammatory.
Another week of no relief and Joe was suffering baseball withdrawal.
On the recommendation of a friend, he came to MyoRehab for a consultation.
When asked about the history of his right knee pain, we learned it
began a few months after his car accident two years ago. It
only bothered him “now and then”.
Joe had long since settled his case and thought the knee pain
would go away in time. It didn’t. He related the story
of his car accident. While stopped for a light he was rear
ended. At the moment of impact, Joe jammed on the brakes to
prevent hitting the car in front of him.
During this unaccustomed overload, Myofascial Trigger Points (MTrPs)
developed in the thigh muscles.
MTrPs
are hypersensitive points in muscles that when stimulated produce
pain that is referred in a predicable pattern away from the Trigger
Point.
The MTrPs in Joe’s thigh muscles had become latent. Latent
TrPs produce pain only with exertion or fatigue. This explains
why the pain wasn’t constant. When Joe slid into home plate,
he ended up with more than a home run. He reactivated an old
injury which was never completely resolved.
When Joe came in for his initial appointment, an in-depth evaluation
revealed two muscles as the possible cause of his right knee pain.
The vastus medialis (Illustration A) not only causes knee pain, but
has a reputation as the “quitter” due to its ability to cause Buckling
Knee Syndrome.
Another primary producer of deep knee pain, the rectus femoris
(Illustration B), attaches to the knee cap (patella) at one end and
the hip at the other where the MTrP is found. This muscle is
often overlooked for knee pain because the trigger point is so far
from the pain.
After successful treatment, his knee pain was substantially reduced.
Joe was given a Home Exercise Program to maintain the gains achieved
during his treatments. Since he was doing well, he was told
to come back in two weeks for a final evaluation.
Before
the allotted time expired, Joe was back. The knee pain had
returned. Walking into the waiting room to greet Joe, the cause
of his pain became apparent. He was sitting with his right
ankle resting on his left knee.
In this position, Joe was stretching his adductor muscles (Illustration
C) causing MTrPs in that muscle group to activate. The adductor
brevis and longus produce pain similar to the vastus medialis and
rectus femoris. Because these muscles are not located near
the knee, they too are rarely thought of as muscles capable of producing
knee pain.
Joe’s Home Exercise Program was modified to include the adductors.
We also discussed perpetuating factors. These are typically
postural distortions or activities that can reactivate MTrPs.
A review of Joe’s seated posture and his workout routine at the gym
gave us ample opportunity to eliminate perpetuating factors.
Is there a knee holding you back from being the neighborhood hero?
Are old injuries coming back “now and then”?
Give us a call at MyoRehab.
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