Case Study – Eliminating Knee Pain

January 24, 2013 | By READ MORE...

– Dr.Shinee Shanbhag

21 year old Nidhi Guleria (name changed) was suffering from knee pain “ever since she remembered”. Her active, vibrant lifestyle was at a standstill due to her ailment. “I couldn’t dance at my friend’s sangeet without popping pills. I couldn’t do cardio. As a result, I was putting on weight. I was frustrated and depressed because I felt like an old person.”

Knee Structure

Doctor Visits

She went to her family physician, who prescribed routine pain killers. They worked, but the pain always returned. She was then referred to an Orthopedic, who asked her to get x-rays and blood work done. The x-rays were normal and so were the lab tests. He too prescribed pain medications and rest. She was better, but within a week of completing her course of medications, the pain returned with a vengeance.. Then a relative referred her to a doctor who specialized in knee sports injuries. On examination he told her that her problem was more biomechanical and muscle imbalance related, rather than structural. He referred Nidhi to PhysioRehab for further assessment and rehab.

Diagnosis At Last

At PhysioRehab, Nidhi underwent a detailed Biomechanical Chain evaluation. It was noted that she had wide hips with poor hip (gluteus) muscles, which caused poor back and hip stability. This in turn causes the outer group (IT band) of the knee to tighten and pull on the knee. When this happens, the inner knee muscles (VMO) undergo strain. This constant push and pull on the kneecap, causes the pain and subsequently weakens the Quadricep muscles leading to wearing of cartilage under the kneecap (Chondromalacia Patella); a common ailment in young adults.

Knee Inflamation

Pain Free Knee

Nidhi was explained that she needed a structured supervised program of strengthening the core muscles, gluteus group (including the buttock) to get rid of her problem. The program would include the principles of ‘Pilates’ , which revolves around the core, without loading the body. Initially kinesiotaping was done to offload the kneecap and support the weak VMO. She was also asked to restrict knee loading activities like stairs, squats, jogging.

According to senior sports specialist physiotherapist, Dr Anjana Laungani, “People tend to push themselves in the gym focusing on Global Muscles, like the quadriceps, chest, biceps etc. but forget about the core muscles which are vital to hold and move the joints of the body. Mobilty is enhanced only if there is stability!”

Nidhi underwent a gradual progression to loading activities, balance training, slow return to cardio. She also got tips on dancing, as to which were the movements she needed to avoid for now (like pivots). All this was backed by a tailor made home exercise program.

Kinesiotaping for the Knee

“6 Weeks, A New Knee And A New Me”

Within 6 weeks she was pain free and was doing weights and a solid routine of cardio of 4o minutes. She was also well aware of correct footwear to help her enhance her cardio. Much to her delight, she danced in her cousin’s sangeet after 4 weeks of completing her rehab. “I totally rocked it”, she says. “Thanks to the physiotherapists at Physiorehab, for making a tailor made program for my knee and my needs. I have become a confident and fun person!”

Nidhi continues her home exercise program diligently with regular follow ups and progressions at Physiorehab.

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Category: Case Studies

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