Dan's Story - Resolving Knee Pain to Get Back In Action

DAN HAS BEEN PLAYING SOCCER FOR YEARS AND LOVES THE GAME. KNEE PAIN WAS THREATENING TO TAKE THAT AWAY.

Dan has been playing soccer recreationally for many years. It is his social outlet, stress relief, source of fitness, but also - and more importantly - his passion. He plays in an adult league and is one of the older guys in his age group, but he still kicks some serious butt as a midfielder on the pitch. He really is a bad ass on the pitch and some of his team mates are retired Olympians and US National players. Awesome. Several years ago he had a severe knee injury which tore 3 ligaments and likely his meniscus. That injury had required surgery and rehab to get him back.

But…

Dan had been experiencing worsening knee pain for a few weeks. The pain got so bad that he couldn’t walk up the stairs at work or carry and play with his grandson, let alone run and cut on the pitch. With the memories of his two previous surgeries and rehab process, the worst case kept running through his mind.

Will I need surgery again?

Will I have to retire from soccer?

Will I be able to play with my grandson like we want to?

We had helped his wife through her own injuries, so she recommended our office.

THAT’S WHEN HE DECIDED TO TRY SOMETHING DIFFERENT. HE CALLED US.

SCHEDULE APPINTMENT

My Assessment

As a chiropractor in Centennial, Colorado, I see a lot of knee rehab cases. This particular knee had a bit of a longer history than most - and that’s okay! We always meet the patient where they’re at and set goals and a treatment plan that’s relevant to them.

I performed a thorough assessment which included a movement evaluation, orthopedic evaluation, and chiropractic evaluation We found a few interesting findings.

First the orthopedic evaluation showed that there appeared to be a tiny bit of meniscus injury, but that probably was not the main pain source. It was likely remnants of an old injury. His knee was pretty much structurally intact. His ACL, and other ligaments were not injured - great!

The most substantial finding from Dan’s movement assessment showed what’s called Trendelenburg’s sign. This is a dropping of the hip when standing on one leg. This means that a few of the hip muscles, primarily the glute medius, are relatively weak and/or inhibited. This places a lot of stress on the knee when running.

DOCTOR’S NOTE: If you are experiencing pain, always get checked out by a qualified healthcare provider. This blog is for informative purposes only and cannot diagnose or treat any illness or injury you may have. It does not establish a doctor-patient relationship.

My job was to figure out what the heck was going on. Was this a muscle strain? A meniscus, ACL, or cartilage injury? Something else?

SCHEDULE APPOINTMENT

What was wrong:

Dan came to us with a noticeable limp. He was clearly favoring his right knee. Given Dan’s previous knee pain and surgical history, we knew there were probably a few things wrong. Dan had a clear case of patellar tendonitis, but probably also had a bit of degeneration (arthritis) and likely a bit of a meniscus tear and /or cartilage damage. We had our work cut out for us.

Taking his entire history and assessment in mind, I determined that the patellar tendon was the primary pain generator. This tendon is really a continuation of the quadriceps (the main muscles on the front of your thigh) tendon that attaches to a little bump on the bone just below the knee. You probably remember a doctor tapping that tendon with a reflex hammer as a kid.

This tendon was being stressed. Just like all of us, when tendons become over stressed, they get angry. This process involves inflammation and pain as a messenger. We call this a tendonitis. If these messages are ignored, the tendon can fray over time and then the gaps caused by the fraying can get filled in by scar tissue and other inflammatory things. We call this a tendonosis. What’s interesting is a tendonosis is not necessarily painful and the tendon can become weaker over time.

Our treatment journey

Luckily I have seen knee pain like this a few times, and there wasn’t substantial physical damage. We focused on calming down the patellar tendon and strengthening the hips so that they can take some stress off the knees. After our initial evaluation, we did some gentle adjustments focusing primarily on the pelvis and even to the knees! We used quite a bit of. Active Release Techniques to the muscles around the knee and some of the tendons in the area including the patellar tendon.

As Dan progressed, we added in some Graston Techniques and progressively complex and more difficult rehab exercises. Here are a few of the movements we chose to help Dan rehab his knee pain without surgery

This is a staple exercise in many rehab programs and gyms. The Monster Walk - when done correctly - targets the glute medius muscles (side butt) in a weight-bearing position. This is helpful to retrain movement patterns and strengthen the hips. I use this one in low back pain rehab, athletic performance (squat) improvement, and knee pain cases. Be sure you do this one correctly since very few people do. Watch the video to see my ques and helpful tips to get the most out of this exercise!

VIDEO - PLATE STAR TAPS AND REACH

Often times we lose balance and stability as we age, and injury can make only reinforce this issue. What’s crazy is that this becomes a vicious cycle - someone loses balance because of injury or fear of injury, and then they become injured, and then they lose balance and then…

We looked to help break that cycle. Dan and I used this series of movements to retrain balance, hip stability/control, and to build his confidence in the middle phase of care.

VIDEO - RING SUPPORTED LATERAL HOPS

Dan approved! This was his favorite rehab exercise. We used this exercise in the final stages of rehab to help retrain control of the hip and knee when cutting laterally. Many rehab programs miss this crucial step. Since Dan was set to return to the pitch soon, we wanted to be sure that he had proper control over his body so that he can focus on his game and not his knees.

Be sure that the knee stays in line with the foot. Do not hop too far - a little goes a long way here. The point ot to see how the hips and knees play together to create stability. The goal is not to hop 10 feet away.

Now…

Dan is back to kicking butt on the pitch. He often comes in and brags about scoring multiple goals and having a few assists each time he plays. He is confident in his knees again and is looking forward to continuing his soccer career for years to come.

Most importantly, Dan is able to go on walks with his grandson. He is able to get down on his level and play with him.