I wanted to share a case study in this months blog as running season is finally upon us and its very common for me to start seeing knee issues present themselves as we start hitting the roads for those goals over the summer.
In April I has a really lovely lady come into the clinic that wanted my help with some persistent right knee cap issues. The pain started 4 weeks previously and for no apparent reason but came on soon after completing the Brighton half marathon and 5km park run in Black Park.
My primary question was what was the most important thing she wanted to takeaway from our first consultation. Her answer was to understand what the issue was as her goal is to complete the Royal parks half marathon in October 2023.
So I now knew what our goal was and the next part of the assessment was to dig into her timeline of injuries. This is a very important part of my consultation as it gives me some working hypothesis into why an issue has presented itself, especially when there hasn’t been a acute traumatic episode preceding the problem, which this case was.
What this showed up, was that a couple of years beforehand she had an impact injury to her left shin (tibia) bone which took a long time to heal. Also 4 weeks prior to the Brighton half marathon she was getting pain into the front of her right hip but this seemed to go away.
I needed to confirm if these past pain related presentations were potentially some of the underlying causes to her knee pain. We tested her leg strength and it was clear from our testing that she had a lack of strength in her left leg compared to her right, whilst her right hip (gluteal) muscles were weak. When we touched her shin bone she was amazed how much more tender the left side was.
We moved onto some mobility tests but everything seemed pretty good apart from some tightness in the back of the right hip area that traveled down the outside of her thigh compared to her left.
After some testing of balance and stability in relation to running which again highlighted some issues on the left side, I wanted to confirm what I thought might be going on. So I used a squat assessment, as it gives me a good idea of how our ankles, knees and hips are working under load. Each joint has is own axis of rotation, which basically means if any shifting occurs in the squat it might highlight issues. With my client it showed that she stayed shifted onto the right side during the whole squat.
We did check the knee but there wasn’t any issues with the internal structures of the knee which was great. I concluded that its was the knee cap that was being overloaded due to being very right sided dominant when she hit the ground on heel strike and all the was through the running cycle to push off. As her hip muscles at the back were weak, she was dominant in the front side of her hip. This meant that her thigh muscles were essentially doing 85% of the work and thus impacting the force going through her knee cap and creating her problem.
The most important part of this was probably the left leg weakness that after treating muscles around her left shin highlighted that is was most likely the old shin issue that shifted her onto her right leg in the first place. A classic example of if the body and nervous system is perceiving, it will take the path of least resistance and compensate
After explaining my assessment findings to my client, I mapped out the milestones that we would need to hit during her treatment plan, to get her back to pain free running but with better efficiency and balance so the problem doesn’t manifest itself again. The most pleasing thing with this case was that she took ownership of her rehab exercises between our sessions and is now back running 5km runs without any flare ups during the runs.
So to finish my lovely client wrote this review for me.
“What I like best about Mario’s approach is that he treated the root cause of the knee problem and not just the symptoms. He explained the treatment plan clearly every step of the way and I could see progress within just a few sessions. Thank you Mario, for getting me back running pain free!”
Mrs M. Gerrards Cross.
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