Twisted Knee at Hickory Nut Gap

By

George S. Pellegrino, LMT, CMTPT & Victoria L. Magown, CMTPT, LMT

While hiking in the mountains of North Carolina with her husband and two teenage boys, Rebecca found herself struggling to keep up. She fell twice and landed on her right knee both times.

Last year while camping in the Manzano Mountains she suffered a sprained right ankle that, as she explains it, “put a hitch in my get-a-long”. Although the pain in her ankle was long gone, she’s suffered right knee pain ever since. Landing hard on her right knee just seemed to make matters worse.

The trip to North Carolina was very special for Rebecca and her husband, Ned. About fifteen years earlier, while driving through the Blue Ridge Mountains, they spent a romantic night at the Hickory Nut Gap Bed and Breakfast. They’d always intended to return and share the natural beauty of this special place with their children.

Sitting in their room at the bed and breakfast with ice on her knee wasn’t what she had in mind for this vacation. On a few other occasions where the ground was level and flat she had nearly fallen. As she sat there waiting for the ice to relieve her pain she realized it all began some time after the sprained ankle.

Rebecca came to MyoRehab for a consultation for what she referred to as a “twisted knee” problem. We determined that even though her right ankle was no longer painful, her pattern of walking was less than neutral. That is, while her ankle sprain was healing, Rebecca developed a pattern of walking that avoided the pain. Very often, pain avoidance patterns became a habit that persists long after the pain is gone.

Although subtle, the distorted pattern overloaded muscles of her right hip and thigh. Of the muscles involved, two in particular refer pain right to the knee. This pain is referred from Myofascial Trigger Points that developed as a result of that overload.

On her initial visit to MyoRehab, a Range of Motion evaluation was performed. We tested the suspected muscles for restricted range indicating the presence of Trigger Points.  A Trigger Point is a hypersensitive focus of pain in a muscle that restricts range of motion, referring pain in a predictable pattern most often away from the site of the Trigger Point.  With the results of the Range Of Motion testing and a chart of Rebecca’s pain patterns, we were able to identify the muscles causing the problem.

    Rectus femoris (Illustration A) crosses both the hip and knee joint. The pain produced by its Trigger Point is at the knee while the Trigger Point itself is at the opposite end of the muscle. Because it crosses two joints, this muscle does double duty when walking, standing, squatting, etc.

The vastus medialis (Illustration B) crosses only the knee joint. Although its two Trigger Points also produce knee pain, this muscle is responsible for what many people refer to as their “trick knee”. This reference is to the “breakaway pain” that causes the knee to buckle from time to time when overloaded. Both of these muscles are part of a group of muscles called the quads or quadriceps.

Rebecca said she lost her footing more than once during her hike at Hickory Nut Gap. She showed us the nearly healed scrapes and bruises that resulted from her two falls. She was sure she had become clumsy and blamed it on everything from her age to her eyesight.

Since the symptoms of Trigger Points are so diverse and unfamiliar to many care givers and their patients, more familiar causes of pain and dysfunction are often assumed. There was nothing wrong with Rebecca’s eyesight and at forty-eight, age was hardly the issue

Treatment of the Myofascial Trigger Points in these and other muscles resulting from Rebecca’s sprained ankle resolved her knee pain. To insure her pain and dysfunction wouldn’t return, we gave Rebecca a muscle specific Home Exercise Program.

The first phase consisted of stretches to help maintain the gains achieved during treatment. This was followed by exercises specifically designed to increase function and eliminate the dysfunctional patterns of walking that were no longer needed.

Is there a hitch in your get-a-long? If there is, give us a call at MyoRehab.