I recently did an online consult of a patient with chronic knee pain of 6 month duration.
The onset of pain started when she began dancing and yoga. Most of the dancing involved rotatory movements and yoga was mostly single limb stance. She had been seeing a PT and done some personal training also at that facility. Her orthopaedic surgeon thankfully did not want to operate, but focused on anti-infllammatories as needed. Her interventions were
- anti-inflammatories, which relieved pain until she danced or did yoga again
- core strengthening which seemed to consist of general conditioning and balance work
Her PT referred her for an online consultation. The first part of the consultation involved a good dose of Pain Science Education, which focused on
- pain as a normal response to perceived threat
- the "arthritis'' in her knee seen on x-rays/MRI was most likely equal on pain free side
- her left and right knee are the same age
- if we restore her ability to rotate/load the left knee without the perception of threat input, the output will change as well
- sev loss of hip IR on the left
- mod loss of tibial IR on the left
- lunge pattern on left showed marked genu valgus compared to right
Here are the self assessments I showed her for hip motion and tibial motion baselines. They are both easy and give your patient a quick way to pre and post test motion, which lets them know when to re-test function - after motion improves to more symmetrical.
Quadruped Hip Rotation
- this was mainly to test hip IR
- patient is in quadruped with hips/knees at 90-90
- have them internally rotate the hip and you see from the front (and they can turn and look as well) how far laterally one foot goes compared to the other
Seated Tibial IR
- this is covered in this post
- patient seated at 90-90
- feet stay flat
- without the knees dropping inward or outward, turn the feet out and then in (expecting the more common pattern of loss of IR for knee pain)
- WNL is 10 degrees turned both in and out
Both of these self assessments are a quick and easy way to show common motion asymmetries to your patients and give them baselines to know whether or not they should more diligent with their resets.
Keeping it Eclectic....