Case Quiz: Part 1
Here is a case submitted by a friend of ours, Dr Lance Robbins in Florida. You can see the problem (and a description below). Rather than just give you the answers, we want you to come up with what questions to ask. Tune in later for what we think.
Ivo and Shawn
Dr Robbins notes on the client in the video:
Intermittent left knee pain with a painless limp while walking
Medical History is positive for an ACL reconstruction on the Left many years ago where they used part of the patellar tendon
Currently wears orthotics made by Xtreme Footwerks
Gait showed a lateral knee deviation
Static exam findings showed a marked tibial varus on the left, bilateral external tibial torsion, along with Bilateral abducto-hallux valgus and mild bilateral forefoot varus.
There is a decrease in the right side ankle rocker, mid and forefoot motion is WNL (within normal limits).
She presents with unilateral right sided genu recurvatum. During the exam she explained that before her ACL reconstruction she had bilateral genu recurvatum and during the surgery they corrected the left side.
Static palpation reveals a tight hypertonicity in the posterior knee structure on the left. There is also a moderate a,out of swelling along the upper lateral side of the left knee around the insertion of vastus lateralis and the client indicates that this has been there for along time since the surgery. When she tried to reduce the swelling with a TENs unit her knee pain got worse.
Dynamic evaluation showed normal hip ROM (Range of Motion) and ankle ROM except for the decrease in ankle rocker noted above. The right knee ROM is WNL. The left knee has a very slight reduction in flexion compared to the other side but still falls within normal limits. There is a moderate amount of instability in the left knee during the Varus stress test indicating some LCL (lateral collateral ligament) laxity.
There is a decrease in the Left popliteus, biceps femoris, and glute medius muscle function.
After one session of CMT (chiropractic manipulative therapy) (L5, Left Sacroiliac joint), acupuncture to facilitate muscle function and kinesiotape to support ligament laxity she had an immediate reduction in the swelling around her knee without any occurrence of pain. This lasted for 4-5 days with a return of some swelling after.
The ligament laxity was not majorly effected by the treatment.
Prolotherapy is one alternative we are considering
My hunch is that this has developed as a post-surgical adaptation due to the change in structural orientation of the knee (unilateral correction of genu recurvatum).
Even with prolothery to tighten up ligament structure how do we proceed forward in order to prevent reoccurrence or early onset degenerative processes?