Patient: 36 year old man 

Background Information:

36 year old man who used to be a very competitive volleyball player, surfer and runner. He was ex-marine corp and was accustomed to rigorous discipline and exercise.  Over the last several years he developed severe bilateral knee pain and could not even park his car in front of his house because he had to take stairs.  He had two young children and could not play Frisbee or soccer.  He noticed when he tried to swim his shoulder was jamming.  His brothers, parents and wife were very frustrated because they thought he was just letting himself “go”. He saw several orthopedists that offered no hope and said eventually he would need bilateral total knees.  He was on no medications and was otherwise healthy. 

Diagnosis:

Detailed physical examination revealed poor patellar (knee cap) tracking and severe muscle imbalance.  The left quadriceps and calf were smaller than the right.  The right buttock was larger.  He had very very poor flexibility.  He was diagnosed with a short leg which was confirmed by leg length x-ray.

 
Treatment:

He was treated with integrated injections and manual therapy.  He was fitted with an orthotic for flat feet and a lift.  Muscle imbalance was corrected. 

Resolution:

He now power-walks five miles at a time, plays competitive sand volleyball and is faithful to his home exercise program. 
 

Patient: 46 year old woman 

Background Information:

A healthy trim woman in her mid forties who had been a competitive athlete all her life. As a teenager and young adult she had several arthroscopic operations on her right knee.  She played competitive tennis as an adult and had to have a right total knee replacement because of intractable pain in spite of pain killers. She had a total knee replacement by a very good surgeon and the x-rays showed excellent placement. Everyone expected her to recover quickly and she went to physical therapy several times a week. 

At eight week follow up the joint was contracted and she was steadily losing range of motion.  The surgeon was very concerned and immediately took her to the operating room for mobilization under anesthesia to break the adhesions and continued physical therapy.  She failed to progress and was sent to the Injury Specialists Clinic.  

Diagnosis:

The patient was trim, flat affect, in obvious pain with a swollen contracted right knee and a hypersensitive anterior right thigh.  She had 50% flexion/extension of the knee and minimal right ankle flexion as well.  She could not stand up straight. The pelvis was twisted and she was rotated in the spine at several levels.

 
Treatment:

She was treated with injections and manual physical therapy which 1st focused on mobilization of the spine and sacrum to reset the “nervous system”. She was treated with antidepressants to stabilize brain chemistry. She then underwent extensive trigger point injections during physical therapy until she had full range of motion. 

Resolution:

She is back playing tennis. 

Patient: 72 year old man

Background Information:

72 year old man generally healthy that had a 5 year history of severe low back pain that was worse on his right side.  He prided himself on his self-care and saw his internist regularly.  He took medication for hypertension, hypothyroidism, cholesterol, and watched his weight and diet. He was widowed and eventually married his high school sweetheart but was constantly struggling with this low back pain and it was ruining his fun. 

Diagnosis:

Physical examination revealed two scars over the knees and he had undergone bilateral total knee replacements.  His spine x-rays DID NOT show severe spine disease but his physical examination showed his sacrum (tail dome) area was twisted and with further examination his sacral iliac joints were not moving properly and he was getting referred pain.

 
Treatment:

He was injected in both SI joints with local and steroids to mobilize and correct torsion in therapy.  Trigger point injections gave him fluid hip range of motion.  With these corrections on repeat examination it became evident that during the total knee operations one leg was shorter than the other and he was given a lift. 

Resolution:

He is now pain free and having fun.