Acute knee pain resolved with hip flexor release

Mr M presented with acute onset of left knee pain following an incident at Brazilian Jiu Jitsu the previous day. He now reported significant pain and limitation with walking, moving from sit to stand and transferring in and out of the car. He was also unable to continue with his Jiu Jitsu training.

Mr M’s main goals: (self rated as 10/10 being pain free and full function)

1. To walk without restriction (5/10)
2. To move from sit-stand and in/out of the car without pain and restriction (currently 5/10)
3. To return to Jiu Jitsu unrestricted (currently 0/10)

We performed a systematic assessment of Mr M’s musculoskeletal system and found the following imbalances:

1. No signs of structural dysfunction within the left knee
2. Significant restriction in hip flexion range of movement bilaterally: Left – 85 degrees; right – 80 degrees.
3. Widespread lower limb muscle tension and guarding, particularly of right gluteals, psoas, Iliacus, quads and hamstrings and left psoas, Iliacus and gluteals.
4. Stiffness in the anterior portion of the disc at left L2, 3 and 5 and L3 and 4 on the right.
5. Stiff thoracic segments at T7-10.
6. Significant upper limb muscle tension/guarding at infrapsinatus and subscapularis bilaterally.
7. Restricted to a double leg, ½ squat.

Through a process of treatment directed testing, we found that the primary contributing factor to Mr M’s left knee condition was his left Iliacus (hip flexor) muscle.  Treatment to this improved all of his objective signs significantly and by the end of the initial session he was walking painfree without a limp.  With another 3 sessions over the following week, he had restored all of his movement restrictions to normal and achieved his other goals of sit-stand, in and out of the car and returning to Jiu Jitsu training without restriction.

Mr M was given postural strategies and home exercises to help decrease the load placed on his hip flexor and subsequently prevent the likelihood of a flare up in his condition.  He has been managing well with this and has continued with his training over the past 2 months without any restrictions.

This is another example which demonstrates the primary contributing factor to a client’s condition is not always in the same area as the presenting pain. In this particular presentation, we were able to completely treat the condition without any local treatment to the knee itself.  This gives further indication that without a thorough assessment, we can’t be sure we are treating the main driver of the condition.