Patient No. 7: Knee Pain

Knee pain is often addressed with strengthening and stretching of the quadriceps and hamstrings. Sometimes the pain will be alleviated. If problems persist when strength and mobility of the hamstrings and quadriceps are optimized, then the problem must lie elsewhere.

A 16-year-old soccer player presented with a one-year history of severe knee pain. The right side tended to be worse than the left. MRI and x-ray studies did not reveal any problems in the knees. Previous physical therapy aimed at the quadriceps and hamstrings was ineffective. She rated her pain at an 8/10 after her soccer games.

The patient's initial evaluation revealed good strength and mobility in the hamstrings and quadriceps. There was mild swelling in both knees. Tests for ligamentous laxity and meniscal tears were negative. She had mild postural deficits with some protraction of the head and neck and some increase in forward bending of the upper back. There was some increased sway to the lower back. The piriformis musculature, deep in the buttock, was extremely tight. Activation and strength were extremely poor throughout the trunk and the pelvis muscles. Retraining exercises were started. All of these were found to be very difficult because of difficulty isolating the appropriate musculature.

On the patient's second visit very mild improvement was noted. At that time her exercises were reviewed and minor upgrades were made.

On the third visit the patient had substantial improvement in reports of her knee pain. She found that the exercises had become somewhat easier. We were able to add closed chain hip exercises for the hip musculature. The muscles tired with very few repetitions of these exercises.

The patient's final visit was five weeks after her initial session. She had experienced only mild knee discomfort after playing soccer in a weekend tournament. We reviewed her exercises and made only minor corrections. The patient was then discharged from therapy and advised to continue her exercises on a maintenance basis.

The patient's mother stopped by our office three weeks after the patient's final session. She reported that knee pain had not reoccurred and the patient was able to play soccer without problems.