Physiotherapy   [back to the Category]

Chronic pain in the knee   [read the french version]

Author :   Errol Toran, D.C.

A dancer presented to our office with chronic diffuse pain in the knee. The pain gradually intensified over a two year period. The pain started out as an occasional discomfort that resolved when she rested or did a little extra stretching. At first she was able to work through the pain. It primarily bothered her when she would do deep plie in second position and deep fondue on the affected knee. Large jumps also created problems for take off or landing on the painful leg. The pain became more constant and increased in intensity as time went on. She found that small jumps began to hurt and that she could not even demi plie without discomfort. The Limon Technique is a form of modern dance that requires deep and prolonged weight shifts as the dancer moves. This movement became impossible.

She consulted with Orthopedists and a course of physical therapy was suggested. She followed through with the periods of rest, then the gradual strengthening of the thigh muscles. Although the therapy made her legs stronger, it did not significantly decrease the pain. The pain diminished but would reappear to the pre therapy status with activity. She was still unable to make it through a full class. After several months of rehabilitation and no relief from the pain, surgery was suggested. She was at a loss so followed the recommendation. The surgery also proved to be ineffective at relieving the painful symptoms. The dancer was considering retirement.

It was after this point that she presented to our office for care. We carefully went over her history then performed a thorough exam. The knee when tested showed no abnormalities. The key to her case was that the pain came on when she actively used the thigh muscles. We found a tight band of muscle along the thigh (Medial Vastus) when perfoming the examination. This tight band also had a trigger point, a nodule of muscular spasm. The pain that had plagued her for all this time was recreated when the trigger point was pressed. When she used the muscle, the trigger point was the first region to contract, creating the tight muscle band. The length of time the muscular band remained contracted during the injury had caused a chronic tendonitis of the upper knee cap in addition to the trigger point.

Once the diagnosis was established, we employed local friction massage to the region of tendonitis and a regimen of ultrasound and electric muscular stimulation to break up the trigger point. Once the pain with minor activity was diminished specific active exercises were prescribed. It took longer than usual, but this case was more chronic than usual, and within several months she was dancing full out. We are happy to say that five years have passed since the resolution of her injury and she shows no signs of retiring any time soon.