Patient No. 6: Knee pain

A 40-year-old lady presented with a several month history of worsening knee pain. Kneeling and descending stairs had become painful. This pain had forced her to curtail her weekly volleyball games. She had undergone arthroscopic surgery on this knee five years earlier for a torn meniscus.

An inspection of the knee revealed minimal swelling. Tests for ligamentous laxity and meniscal tears were negative. The kneecap was stable and tracked well. She had full knee range of motion and the strength in the quadriceps and hamstrings was good. Flexibility of the thigh musculature was good. Moderate tightness was found in the piriformis musculature deep in the buttock area. She demonstrated moderate postural deficits. She had poor strength and recruitment in the hip musculature. There was almost no isolated recruitment of the abdominal musculature. She was very unsteady with single leg balance exercises. A home program was started with exercises to retrain hip, trunk, and postural musculature. She was to do the lie-down portion of the exercises twice a day and the stand-up exercise five or six times during the day.

When the patient was seen ten days after her initial session she reported mild improvement in the knee pain. At that time her exercises were reviewed and minor corrections and upgrades were needed. Three weeks after her initial session she noted continued gradual improvement. She stated that the exercises had become very easy and was therefore instructed in closed chain hip exercises. She was able to do these well and without knee pain. Several of her initial exercises were deleted in favor of these new exercises.

Five weeks after her initial session the patient noted knee pain only if the knee was pushed into too much extension. The exercises were going extremely well. She requested, and was started on, upper body exercises. The patient's final visit was eight weeks after her initial session. She reported almost complete resolution of her knee pain. She returned to volleyball and other activities. At this time we further reviewed her exercises and instructed her in general progression. She was to continue with her exercises on a three a day a week basis.

The patient was seen informally three months after her last treatment session and she reported that she was doing well and that her knee pain had not returned.