Knee Pain Cure: How I Helped My Client to Reduce Knee Pain
Hey coaches athletes, how you doing Michael Hughes here with also edu, we’re starting a new series of client case studies, true clients, actual clients that we’re seeing on a weekly basis and the successes and failures that we’re having. So you can learn from what we’re literally doing in our facility, and we can share it with you. So you can learn and share with your own clientele, and athletes. So in these case studies, we’re going to be talking about who the athlete is, what they’re going through the strategies that we’re working with the treatments and how we actually do them. And then of course, was it successful or not, so excited to have you in and like, subscribe, hit the notification bell. For these particular case studies are going to be gold, as you can literally see what we’re doing. And again, share with your own clientele so you can bring your practice to greater heights as we’ve been working through this for the last decade. The clan that we’ll be talking about today is a veterinarian doctor who first came to me because of shoulder arm, and even tingling down into her fingertips this would affect her surgeries, and not have the feel and the responses that she really needed as she’s an ER veterinary doctor and need to be on point all the time. This case was about her left knee. And this is a kind of a duality case, because she has two loves animals in boxing. And she actually sees a boxing specialist. And this is really interesting, because when she would ape go to work and need to pick up animals from the floor, as they would get them up onto the operating table. Her left knee would bother her and that is something that we knew about. But her right shoulder was her prominent issue, something that we’re working on. But it wasn’t until she went to her boxing coach and was in her left foot in front or what we call an L xx foot position. Because she is right handed cross in this. That’s how she punches with her power. She was doing an uppercut. And as she was going into her squat to come up her left knee just didn’t like it and almost incense gave out on her. So it was because work. And her love of boxing her two loves costs her left knee pain. She said, Michael, I would love to just focus on that today and let this successful arm just have the week of non focus to really focus on that because I want to box and the greatest thing was boxing did not affect her punch. It was more in the fine intricate details. So we put the shoulder aside, and we started to focus on that left knee. So what I want to show you is what were my strategies, what my assessments and wasn’t successful or not. And what I did is I want to assess what when did the when did the knee hurt? When at what motion, right physics biomechanics? How does the body movement affect the left knee? So this is what I did. I said, let’s just go in squat form because squatting hurts. So as she went to a squat, I said, Well, let’s assess movement because we know the verticality hurts. Well what about the subtle movements in that verticality? So as we went into a loaded squat, I said, shift your weight forward and back for me, shift your weight side to side for me, and rotate through that knee and I said Does any one of those three movement patterns causing more or less pain and she looked at me says all of them hurt. I said equally, she says relatively speaking equally. It all hurts. I said, okay, that really didn’t give me the information that I wanted. And here’s what I want to share with you. This is a profound thought and I have a little tool to help us think about how the body and biomechanics works and this is called a tensegrity model. This 10 second model shows a very different rubber bands, all the texture would Dallas and you can see how none of these wood dowels are actually touching each other. Right, that’s just the same way that the bones in our body there’s not a single bone in a healthy moving body in a sense, that’s touching another bone. That hurts a lot. They’re floating in between and there’s cartilage and other types of connective tissue that’s keeping them pulled apart. Well the rubber bands show this in this tensegrity model. And each one of these rubber bands is pulling these dowels to be in a nice alignment, very symmetrical in essentially appearance. What happens when a few of these rubber bands start to over tighten and start to bring we can see how again this my hand will be the kind of the staple position is it starts to move all of the bones even if I only pull on one rubber band. I’m going to shorten one rubber band you see how the entire model starts to shift ever so slightly, ever so slightly?
Well if I grab a few of these and start to short a few of these you can see actually, the bones are the wood dowels moving from the position Well, that is exactly what happens when we have overly tight fascial connective muscle tissue. And what was happening in her squat, which is a very functional needed position is that her essentially femur, and tibia and fibia, were getting out of alignment, simply put, and the knee joint was having to compensate through its own connective tissue doesn’t matter whether it be the patella or the medial lateral claimant. At this point, it doesn’t matter, the knee joint itself didn’t like it, but it was taking the brunt of the movement. So I have to assess, do I look at the lower leg and the ankle to this issue? Or do we look at the upper leg and the hip as this issue, because here’s the point I want you to take away regardless of what the of whether this was successful or not, is that a bad ankle and a bad hip produce knee pain. And these usually in combination, but it can certainly be one or the other. It’s very important, the knee itself doesn’t cause its own pain, it is an effect of other joints around it. That is a case in a movement to case, right? This is a movement problem. If it’s an impact problem, like someone literally hit my knee, well, then, of course, that’s a different story, the knee needs to be taken care of. But in this case, it was a movement problem. So our strategy is to look at the ankle, foot or hip to be the knees a sense cause to this effect. So this is what I did. I said, let me start with the lower leg first. And my thought process was let me look at the soleus particularly, or the calf region. And why did I go there? What because when we squat, the soleus, particularly but the calf region in general becomes under greater tension, think about that tensegrity model, right, the rubber bands get tough, very tough and tight. And they start to therefore address and connect the bones. So they start to move how the bones and the soleus particularly doesn’t attach to the femur, it attaches to the lower leg bones, right. So it can actually pull essentially, as my squat, my knee wants to go forward a little bit, it’s going to pull backwards, it’s going to actually cause too much braking, too much deceleration too soon. And the knees going to shift in position causing aberrant tension, basically too much tension at the knee joint, and the tissues not going to like it. So that’s my first thought. So what I did is I took a wedge, and I said, let’s decrease tension at the ankle calf. And what it is they had a heel lift. So now when we we squat, in a sense, we go down into that motion, there’s less dorsiflexion at the ankle. And what’s particularly great about that it reduces tension at the tip and fib and therefore the knee joint. And what happens when she did that? She says, Yeah, I have less knee pain. I said, Great. We found the cause it is the soleus being too tight. Let’s go ahead and loosen up that connective tissue, stretch it out, retrain it and the pain should be gone. But what I didn’t do is is go do that. I said no, I need more information. I’ve only assessed one joint. Let me assess the next joint, the hip. So I said you know what, let’s take away that. And let’s just try it again. And what she automatically did, which was great, because I didn’t have to tell you that she put her left leg and back. And she actually automatically I didn’t tell her to do this. She just did it. Because I wanted just to make sure that I was understanding what’s going on. She did a squat. And she says wow, that hurts a lot less, a lot less. I said, then what you just did, then on the wedges, yeah, I’ve actually heard a lot less. So to cover those bases, again, with a wedge, taking soleus tension away, not fully gone. That hurt less. But then what she did again, is put her left foot and back and did a squat, which is if you look at the mechanics, that is actually a lot more alternative way. That’s a lot more dorsiflexion at the ankle. This was less dorsiflexion and or hurt less. This was way more dorsiflexion and it hurt even less. Okay. So to me that says you know what? That wedge test, and our calf is not part of the problem. We just made it a little bit better. Because there would be no way that physics or biomechanics would create less knee pain when I have even more dorsi flexion because my foot is behind me, then that wedge removed. So I had to look at something different. So what’s the difference between left leg in front and left leg and back squats are what we would call our xx foot position versus l xx foot position
because one produces less dorsiflexion one produces more dose dorsiflexion on the left ankle. So what happened is that when she went into an RX X or right foot in front foot stance or split stance, what was the biggest To relieve her of tension, thinking about that tensegrity model, it was the hamstring and the glute. Because it went under less hip flexion. So if you think about my stance right here, if I think about my right foot in front, and I go to a squat, what set of hamstrings has more tension on it? My right or my left side, and it’s my right side, because this hip joint is under more flexion positioning and movement than my left side is. And what she did is she switched her feet without me even asking to her, and she gave the answer to me, because what happens when she boxes, she has a right cross, that’s our power punch. So her left foot always in front. So when she went to go do uppercut, that left foot was in front, therefore, the hamstring and glute or the posterior leg, let’s
just keep it very simple, had more tension to it. And I bet when she goes to pick up animals, because that’s essentially her dominant position, because she loves boxing and does this position so much, I bet she has a left leg lead, and therefore does essentially that same foot position when she picks up her animals. So I put that to the test. So what we do, I said, Well, let’s go after the posterior leg, the hamstring and the glute. And that’s a loosen up the fascial connective tissue. Let’s lengthen it in all three planes of motion. And then Let’s retest it and train it with the exact same test, which is essentially a left leg in front squat. So what we did is being a massage practitioner myself, I was able to get into the soft tissue, put her on a table prone, I actually took her out of function to hyper focus on the connective tissue, and lengthen it out through for various different modalities of my hands and other tools. But if you don’t have that ability, you can essentially have her foam roll or your client foam roll the hamstring and the glute. And there’s very many ways to do that, that are very successful. After the tissue was able to loosen up, we took her and we put her into a hamstring focused stretch. And we use the true stretch here to go ahead do that. But in any way that you can, you want to lengthen that hamstring in that glute. And we do so in the same way of loading it in three planes of motion. And I’m just going to do so in a very common way, I’m going to just put my foot right up here and show you what that means, right? Because you may not have a true stretch, you may not have a means but it’s basically taking any hamstring stretch, whether it be open chain or closed chain, whether it be functional or not. And saying let’s make sure we can move that hamstring in three planes of motion, so we drove the pelvis backwards, that is puts the hip into more flexion, the primary way the hamstring is loaded, right is putting it into more hip more hip flexion. But what we also do is realize that the hamstrings also have an oblique with a wrapper around type of attachment at the lower leg. So if we shift our hips side to side, we get greater stretching at one of the hamstrings versus the other. And then because of the obliquity or that wraparound effect, if we also take the pelvis into rotation, we also get a focusing of that. So we’re able to get a much more dialed in much more three dimensional or 360, stretch to that fascial tissue, muscle tissue, connective tissue, etc. And then what we did is we put herself back into that stance. And we always start with success with our tests, we put her back where she was already successful, versus going right into the unsuccess. Because this is a mental game, not just a physical game that we’re playing. So I put her back in that spot of right foot in front or are xx and I said go ahead and squash this note that feels even better than when I first did it. In fact, then he had a little bit of pain. When I did it the beginning it was much less than the other positions we had, but I felt super great. So okay, let’s go ahead and put yourself in a what we call a square, a neutral stance position and do a squat. She says well, that actually feels phenomenal as well. So now had balanced hip flexion. And that’s okay, let’s go to the next level. That’s put her in L xx foot position, which is the painful position. And she did another squat. And she said, I literally feel no knee discomfort. I said do some more. Let’s actually do 10 to 15 reps. And she said it actually feels better. There’s no pain, but it’s even a better feel as she kept going more and more and more. And so the takeaway is, is that when we have too much tension in a network of connective tissue and bones, we have to understand and reverse engineer where the problem is coming from not where it is super important that we give affirmation that we know that their knee hurts, but then use our intuitive thinking or our understanding of biomechanics. What I like to rely upon more so is where is the problem stemming from? And we have to understand that it’s a tension problem if it’s movement pain versus impact pain. And to understand where tension can come from is the first step in building a great assessment plan, a great strategy, how to fix it, and then a treatment and then ultimately, to have your success or a redirect to a new path. I hope this video was of great value for you. So you can literally take this strategy and technique and apply potentially to a client that you have that has knee pain, and if it works phenomenal, and you can least understand why it worked. If it doesn’t work, hate you tried. As long as you make anything worse, you’re still progressing your thought process and that person’s ability to now have at least better hamstring or post your hip flexibility. So stay tuned for more be sure you like and subscribe, because we have more of these coming. As soon as I have them with my clients. I’ll share them with you. Cheers.
Leave a Reply