knee pain

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Alex J

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Hi folks,

A client of mine had ACL surgery over ten years ago... these days his knee hurts often, and he experiences some swelling at and below the joint. He would like to avoid surgery if possible, or for as long as possible at least.

I've been doing some subtle shiatsu and myofascial work, and it seems to help him feel somewhat better, at least for a day or two. I'm curious though to know how others would work with this.
 


With knee pain, I always first check the mobility of the patella. It should be quite mobile in all directions. If it doesn't want to move distally, check for trigger points/fascial restrictions in the quads, sartorius and adductors, especially at the ASIS. Releasing those can allow the knee to track properly again, freeing the lymph fluid and reducing swelling and pain. Ditto, only different muscles, if it fails to move freely in any other direction. Just follow the muscles that attach and cross at the knee.

A bit of lymphatic massage at the pelvis/thigh and then up the knee can help to reduce the swelling. And of course, RICE is good at-home care.
 


I agree with the patellar tracking issue and treatments mentioned above.

If it is a tracking problem, PT can be very helpful but he should find someone skilled with McConnell taping and retraining the VMO. Of course, that will only go so far is he has lateral issues that aren't also addressed.

It sounds like he may have hardware that is irritating things. I speak from experience. I had a grade three rupture, patellar tendon graft and hardware removal two years later. I never really got rid of the tendonitis in my hamstrings until that screw came out. What a relief!

Still aches from time to time, but I'm no spring chicken anymore!
 
knee pain

EgoMagickian said:
Hi folks,

A client of mine had ACL surgery over ten years ago... these days his knee hurts often, and he experiences some swelling at and below the joint. He would like to avoid surgery if possible, or for as long as possible at least.

This will sound crazy and I'm only mentioning it as a thought, not as a remedy.

I have a client with old knee surgery and didn't want to have new re-construction, but the pain was becoming more and more unbearable. She's in her 40's and the injury and initial surgery was in her late 20's.
She began doing some yoga and in particular a "pigeon" pose. I don't know yoga, so I can't tell you what it is. She had surgery scheduled a week out, and because of the yoga cancelled the surgery. It's been 2 months now and she is still feeling good.
.
 


I Love pigeon! It really helps with my SI/piriformis issues, but additionally helps to increase flexibility in the lateral knee structures. It hurt like heck when I first started, but wow, what a difference!


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Ego,

What condition is the back of the knee joint in? Is the musculature that crosses the joint posteriorly is spasm at all? How about the muscles above and below the joint posteriorly?

Have had clients with chronice knee pain find a great measure of relief by my working to relieve spasms, hypertonicity, etc at the back of the knee and/or above and below the knee posteriorly. Perhaps that would help your client to some degree..............
 


HI EM -

Did you continue to work with this client? If so, what therapies did you find were best?

I have a client with both knees post ACL surgery two years out coming to see me in a couple of days. She is dealing with scar tissue and hoping massage can help. I let her know that we can work with some cross fiber friction but at this point 2 years out the scar tissue is probably there to stay.

She is not up for another surgery to remove scar tissue.

Thanks,
crystal_compass
 


I have heard great things about knee problems relieved or remedied by Egoscue (http://www.egoscue.com/) which works by giving the client exercises that, done regularly, resolve overall alignment issues that are causing or contributing to the pain.

i also wanted to second the yoga suggestion (in addition to the other remedies)! Yoga CAN be great--amazing--for some knee conditions, so long as you know what poses to do, how to modify certain poses for your condition (ie. to make less strenuous--for instance, there's a full pigeon and a modified pigeon) and what poses to avoid (several of my clients have hurt their knees lunging into yoga positions).

(Knowing what to modify is true in any workout, but yoga sometimes seems to get a bad rap because it's supposed to be so healing, yet for many reasons it can be hard for students to distinguish btw what the teacher is doing and what will be okay for their own body.) If the client has a very good sense of how their body is being affected by the workout, a group yoga class may work; otherwise I always recommend a private session with a yoga teacher trained in rehabilitative yoga.
 


a) what type of ACL surgery? if it was a patellar tendon graft, there is usually some knee pain (especially if the rehab was post-op)

b) with knee pain....don't always look at the knee. we have been fixing a lot of knee pain by evaluating hip strength (especially glute med. firing) and ankle mobility (if ankle mobility is poor and movement is restricted there, then the individual will get movement at other joints...ie, the knee).

c) look at overal movement. what is the gait pattern like, etc....do some manual muscle testing and look at muscle length of specific muscles, etc....figure out WHY it is hurting.



Patrick
 
knee pain

Patrick W said:
b) with knee pain....don't always look at the knee. we have been fixing a lot of knee pain by evaluating hip strength (especially glute med. firing) and ankle mobility (if ankle mobility is poor and movement is restricted there, then the individual will get movement at other joints...ie, the knee).

c) look at overal movement. what is the gait pattern like, etc....do some manual muscle testing and look at muscle length of specific muscles, etc....figure out WHY it is hurting.



Patrick

Last week I did some deep tissue work on a former college athlete who has been having a lot of knee pain lately. She recently moved and had been carrying boxes up and down stairs quite a bit. While in college she had suffered from injuries in both knees (torn meniscus in both knees about 7-8 years ago).

During our first session I did most of my deep work on her her gluts, hip rotators, and hamstrings and did a little work on the lower legs too, but avoided working too close to her knees. I also recommended that she do some icing on her knees several times a day.

I thought the session went really well and I'm looking forward to having another opportunity to work with her again later this week. I'm interested in Patrick's comments about "evaluating hip strength" and "ankle mobility" and was wondering if someone could comment further about this and/or suggest some sources of information for me so that I could learn about doing this.

Thanks in advance.
 
knee pain

Nordic1 said:
Patrick W said:
b) with knee pain....don't always look at the knee. we have been fixing a lot of knee pain by evaluating hip strength (especially glute med. firing) and ankle mobility (if ankle mobility is poor and movement is restricted there, then the individual will get movement at other joints...ie, the knee).

c) look at overal movement. what is the gait pattern like, etc....do some manual muscle testing and look at muscle length of specific muscles, etc....figure out WHY it is hurting.



Patrick

Last week I did some deep tissue work on a former college athlete who has been having a lot of knee pain lately. She recently moved and had been carrying boxes up and down stairs quite a bit. While in college she had suffered from injuries in both knees (torn meniscus in both knees about 7-8 years ago).

During our first session I did most of my deep work on her her gluts, hip rotators, and hamstrings and did a little work on the lower legs too, but avoided working too close to her knees. I also recommended that she do some icing on her knees several times a day.

I thought the session went really well and I'm looking forward to having another opportunity to work with her again later this week. I'm interested in Patrick's comments about "evaluating hip strength" and "ankle mobility" and was wondering if someone could comment further about this and/or suggest some sources of information for me so that I could learn about doing this.

Thanks in advance.

If you think about the joint-by-joint approach to the body/movement, the basic format would be that the ankle joint seeks mobility, while the knee joint seeks stability (we don't want to much radical movement here) and the hip joint seeks mobility. And of course this thought process can be carried up the body further.

Really, you are just looking at putting together the puzzle. With knee pain, there is a good chance that movement isn't happening where it needs to happen (perhaps a lack of ankle dorsiflexion, creating more pronation, and translating to great valgus force on the knee), or maybe the individual has poor hip mobility (an excessive anterior pelvic tilt creates creater hip internal rotation, which can affect the knee...or, perhaps a lack of internal hip rotation is creating a need for great hip adduction during movement), or maybe poor hip strength is creating greater movement at the knee, as stability is compromised.

Obviously there are a number of things you can look at, and a number of ways to take it. Having some sort of fully body table assessment to help connect the dots is always helpful. Somethings I'd look at would be:

- Great toe extension
- Ankle dorsiflexion (are we dealing with soft tissue or joint restrictions?)
- Ankle eversion/inversion
- patella mobility (in all directions)
- hip mobility
- hip strength (extension, abduction, etc...)
- breathing patterns

You can learn a lot about the individual from those few basic things.

Hope that helps give you more ideas.

Patrick
 
knee pain

Good comments by Patrick. I agree that assessment is critical to understanding the problem to formulate an effective solution. However, I usually prefer to do some assessment of these structures while the client is dressed and standing. I may even ask them to do simple balancing or walk a few steps or do squats, as the muscles at work will often provide information that muscles at rest may not. It definitely gives a clearer picture of habitual movement patterns.

If you are uncertain how to proceed with evaluating the structures/relationships mentioned above, there are a number of excellent references on assessment methods worth studying. :altwink:

As a personal trainer, I see clients with this stuff all the time. In most cases, we work on their flexibility and body mechanics, then improve strength and mobility with appropriate exercises. The vast majority review cessation of symptoms and increased ability to exercise more vigorously, sometimes in 1-2 sessions. Some go get bodywork as well, but most do not.

As a therapist, I often discuss any dysfunctional body mechanics I see in their movements with them, and attempt to educate them on ways to retrain basic movements patterns. More often than not, I refer them to speak with the personal trainers at whichever gym they go to.
 
knee pain

Just wanted to throw in that James Waslaski has a really great new DVD out called 'Complicated Knee Conditions' and there's some great info on there. When I took the 40 hour intensive in TX, he taught us a lot of what was on the video and it was some good stuff. You can order it off of http://www.orthomassage.net
 
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    Tomorrow's sneak peek: On Thursday May 22, 2025, our attendants will be Vicky ๐Ÿฅณ, Monica ๐Ÿ˜, Ada ๐Ÿ’œ, Cici ๐Ÿฅฐ and Sophie ๐Ÿ˜˜. Call us at โ˜Ž๏ธ(905) 479-6668โ˜Ž๏ธ to book!
  31. SL East Spa:
    ๐Ÿ’†โ€โ™€๐Ÿ’–WooHoo Wed๐Ÿ’– Ultimate destination for Asian massages๐ŸŽ‰ Two fab spots: Richmond Hill & Oakvilleโœจ Your passport to paradise with 9 enchanting girls fr China, HK, Japan & Korea โ€” ๐Ÿ†•Luna, Cindy, Coco,Cici, Amber, JPN Yui, Akino, Jasmine & Lucyโ€” ready to pamper you๐ŸŽ๐Ÿ Ring us ๐Ÿ“ž647-695-6354 or text us ๐Ÿ“ฑ647-578-8169โœจ 160 East Beaver Cr., Unit 12, RichmondHill ๐Ÿ’ฐWhere Eastern charm meets Western comfort - your bliss awaits๐Ÿ™Œ
  32. SpringGreen.:
    The weeked is here Downtown toront 72 gerrard st west . Bunny miya,angel Lisa and tina are available today.These busty attractive girls provide a high level of service with a smile. call and text message 647 891 069 9 ask questions thanks ๐Ÿ’‹๐Ÿ’‹
  33. wilson holistic centre:
    ๐Ÿ’•๐Ÿ’•Beautiful Korean girl working at 382 Wilson Ave ๐Ÿ’•๐Ÿ’•โ˜Ž๏ธโ˜Ž๏ธ416-840-0071โค๏ธโค๏ธ
  34. DareDevil:
    ARIA WELLNESS โ™ฅ๏ธโ™ฅ๏ธADDRESS: 360 HWY 7, UNIT #6, RICHMOND HILL,647-222-5683 โ™ฅ๏ธโ™ฅ๏ธ(PHONES CALL ONLY, NO TEXT'N AVAILABLE) โ™ฅ๏ธTODAY'S Schedule!โ™ฅ๏ธ Loaded lineup with Beautiful Girls : New Girl Deep Tissue Lily, Fun Girl Apple, Young RMT Student Helen, Magical Mia and Work out๐Ÿ‹๐Ÿšด๐Ÿ’ช Babe Amy! SPECIAL PROMO 30 MINS 2 GIRLS $70 ๐ŸŒน๐ŸŒน**TODAY'S PICK OF THE DAY IS ๐Ÿญ๐ŸฌHELEN AND APPLE๐Ÿฌ๐Ÿญ**
  35. Soul Relax Spa:
    โœจ Looking for a relaxing escape? โœ… Click Here Meet๐ŸŒธTina๐ŸŒธJessica๐ŸŒธKimCall us today for the best treatment and service experience. Click on our Username and FOLLOW US for updates ! Call now โ˜Ž 289 - 298 - 5662โ˜Ž๏ธ Your ultimate relaxation awaits! โœจ
  36. Nu spring spa888:
    โค๏ธโค๏ธโค๏ธsexy hot Germany๐ŸŒธKorean ๐ŸŒธ Filipino girl working at๐Ÿ’“๐Ÿ’“ Nu spring spa โ˜Ž๏ธ416-669-8508โค๏ธโค๏ธโค๏ธ
  37. wonderspa:
    wonderspa: ๐ŸŒบWonder spa,(9421Jane st unit127)call416-5000-800โ˜Ž๏ธbest massage in vaughan,Wednesday RMT available,๐Ÿ’„sexy face young girl Joey natural c cup,very good looking nice body slide,really popular ๐ŸŽlong hair Q Lucy good strong to relax oil massage, Relieve pain and remove stress,more experience,๐ŸŒนyoung friendly new CiCi, back walk,deep to relax,open mind,amazing ending๐Ÿ”ฅ,bring you warm comfortable timeโค๏ธ๐ŸŽˆ
  38. Golden Sunshine Spa:
    โœจClick on our Username and FOLLOW US for updates and special services ! โœ… Click Here Today๐ŸŒธAkame๐ŸŒธChristina๐ŸŒธXuka๐ŸŒธMonika๐ŸŒธLayra Call us โ˜Ž 905 - 265 - 2158โ˜Ž๏ธ Your ultimate service awaits! โœจ
  39. wilson holistic centre:
    ๐Ÿ’•๐Ÿ’•Beautiful Korean girl working at 382 Wilson Ave ๐Ÿ’•๐Ÿ’•โ˜Ž๏ธโ˜Ž๏ธ416-840-0071โค๏ธโค๏ธ
  40. Jennyโ€™s Spa:
    ๐ŸŽ‰๐Ÿ’JENNYโ€™S SPA๐ŸŽ‰๐Ÿ’ โœ…5170 DUNDAS STREET WESTโœ… ๐Ÿ‘ŒETOBICOKE ONTARIO M9A 1C4๐Ÿ‘Œ โ˜Ž๏ธ( 647-893-5196)โ˜Ž๏ธCall or Text โ˜Ž๏ธ( 437-888-3759)โ˜Ž๏ธCall Only (ETOBICOKE) OPEN 10am to 9pm MONDAY to SUNDAY ๐Ÿ”ฅโœ…GRAND OPENING๐Ÿ’ฏNEW GIRLS EVERYDAY๐Ÿ”ฅEXCELLENT MASSAGE + SERVICE QUEENS NOW AVAILABLE AT JENNYโ€™S SPA FOR ALL YOUR MASSAGE AND SPECIAL EXTRA NEEDS๐Ÿ”ฅ๐Ÿ’ฏ๐Ÿ˜˜๐Ÿ”ฅโค๏ธ๐Ÿ‘Œ ๐Ÿ”ฅTWO BEAUTIFUL NEW YOUNG ASIAN GIRLS EVERYDAY๐Ÿ”ฅ ๐Ÿ’ฏREAL PICTURES OF ATTENDANTS๐Ÿ’ฏ ๐Ÿ”ฅ๐Ÿ’‹Limited Time Special Promotion๐Ÿ”ฅ๐Ÿ’‹ โœ…๐Ÿ’ฆ30 Minutes Nude Mass
  41. Spa in Markham:
    GOLDEN FS โ€“ 8380 Kennedy Rd ๐Ÿ“ž 905-258-0777 / 416-688-6886 ๐Ÿ‡ป๐Ÿ‡ณ AMY, ๐Ÿ‡ป๐Ÿ‡ณ JULIE, ๐Ÿ‡ญ๐Ÿ‡ฐ JOJO (9PMโ€“2AM), ๐Ÿ‡ธ๐Ÿ‡ฌ CANDY, ๐Ÿ‡จ๐Ÿ‡ด MEGAN ๐Ÿ”Ž View Schedule: bit.ly/flowers_schedule ๐Ÿ›Ž๏ธ Booking Now: bit.ly/bookinggoldenlove
  42. FLOWER Spa - BLUEXADO | Thornhill | VAUGHAN:
    BLUEXADO FS โ€“ #06-1102 Centre St ๐Ÿ“ž 416-357-9797 / 416-678-8668 ๐Ÿ‡ต๐Ÿ‡ญ๐Ÿ‡ป๐Ÿ‡ณ LUXY, ๐Ÿ‡ป๐Ÿ‡ณ๐Ÿ‡ญ๐Ÿ‡ฐ CICI, ๐Ÿ‡ป๐Ÿ‡ณ SHERRY ๐Ÿ”Ž View Schedule: bit.ly/flowers_schedule ๐Ÿ›Ž๏ธ Booking Now: bit.ly/bookingbluexadolove
  43. FLOWER Spa โ€“ PINK | Scarborough | TORONTO:
    PINK FS โ€“ 3300 McNicoll Ave ๐Ÿ“ž 416-299-5515 / 416-817-3839 ๐Ÿ‡ฎ๐Ÿ‡ท ELINA (Iran), ๐Ÿ‡ญ๐Ÿ‡บ VANESSA (Hungary), ๐Ÿ‡ญ๐Ÿ‡ฐ JOJO (Hong Kong), ๐Ÿ‡จ๐Ÿ‡ด MEGAN (Colombia) ๐Ÿ”Ž View Schedule: bit.ly/flowers_schedule ๐Ÿ›Ž๏ธ Booking Now: bit.ly/bookingpinklove
  44. Annie Spa:
    ๐ŸŽ‰๐Ÿ’ANNIE SPA๐ŸŽ‰๐Ÿ’ โœ…7-1001 SANDHURST CIRCLEโœ… ๐Ÿ‘ŒSCARBOROUGH ON M1V 1Z6๐Ÿ‘Œ โ˜Ž๏ธ (647) 891-9688โ˜Ž๏ธ โ˜Ž๏ธ (416) 291-8879โ˜Ž๏ธ (FINCH & MCCOWAN) OPEN 9:30am to 9pm MONDAY to SUNDAY ๐Ÿ”ฅโœ…NEW MANAGEMENT๐Ÿ’ฏNEW GIRLS๐Ÿ”ฅ๐Ÿ”ฅ ๐Ÿ”ฅGORGEOUS NEW YOUNG ASIAN GIRLS - TODAYโ€™s ROSTER INCLUDES: ๐Ÿ”ฅ Feifei๐Ÿ˜˜Our new Japanese beauty Feifei specializes in creating an intimate and deeply relaxing massage experience tailored to your desires. Her soft, skilled hands glide effortlessly, easing tension and awakening your senses
  45. AliceSpa:
    WEDNESDAY at ๐—”๐—Ÿ๐—œ๐—–๐—˜ ๐—ฆ๐—ฃ๐—” 416-298-0898, 4915 Steeles Ave. E, Scarborough 3 very nice girls here today. Open 10am to 9pm: APPLE (11am-9pm): from Hong Kong, very small body, 5' 100Lbs, petite with natural C Cups, small waist, pretty baby face, smooth skin, very clean. Shaved tight Pu**y, strong professional massage. Available FS bbbj cim cof rim. CLOUDIA (10am-9pm): is Vietnamese, young
  46. HolidaySpa:
    Wednesday at ๐ŸŒด๐Ÿ˜Ž๐ŸŒ…๐“—๐“ธ๐“ต๐“ฒ๐“ญ๐“ช๐”‚ ๐“ข๐“น๐“ช๐ŸŒ…๐Ÿ˜Ž๐ŸŒด3517 Kennedy Rd, Unit 4, Scarborough โ˜Ž๏ธ๐Ÿฐ๐Ÿฏ๐Ÿณ-๐Ÿฎ๐Ÿฐ๐Ÿณ-๐Ÿญ๐Ÿญ๐Ÿต๐Ÿตโ˜Ž๏ธ: FIONA, KIKI & CINDY. FIONA is a slim hottie with long dark hair, great melons and ass, and nice services. Kiki is very attractive, young, about 5โ€™4โ€ and 110 Lbs., slim with a banging body. Kiki is very popular for her great attitude and services. CINDY is slim & incredibly sexy
  47. SugarLoveSpa:
    Wednesday at โค๏ธ๐Ÿ’™ ๐Ÿ’œโŽ๐—ฆ๐—จ๐—š๐—”๐—ฅ ๐—Ÿ๐—ข๐—ฉ๐—˜ ๐—ฆ๐—ฃ๐—”โŽ ๐Ÿ’–๐Ÿ’—๐Ÿ’˜: ELLA, NANCY, SUSAN & TIFFANY. 1270 Finch Ave W (at Keele St), Unit 18. North York, ON โ˜Ž ๐Ÿฐ๐Ÿฏ๐Ÿณ-๐Ÿฏ๐Ÿฒ๐Ÿฑ-๐Ÿฎ๐Ÿฒ๐Ÿด๐Ÿด โ˜Ž ELLA is a lovely Thai sweetheart, 5โ€™1โ€ with C Cups, smooth skin and a very pleasing attitude. NANCY is a curvy and very friendly Spanish girl, who has all the versatile skills you need. SUSAN is a small, slim & sexy Latina girl
  48. bnwellness_wilson:
    We have 4 young girls are working today, young sweet Mia 25โ€™s with curve body and sexy Coco, pretty Ella and flirty GFE Lina are providing deep tissue massage, pls call 4163985777 book appointment and walk in always welcome,back entrance and parking available, 350 Wilson Ave North York
  49. luckywellness:
    Lucky Wellness Center 4379721888 295 Eglinton Ave E,Unit 7,Mississauga We had two girls working today. Niko and Kiki. They are both young, pretty and cute. The massage and back walking were very good.
  50. Lulu1980:
    Phoenix Blossom Spa ๐ŸŒน๐ŸŒน๐ŸŒน2 girls ๐Ÿ”ฅ๐Ÿ”ฅ๐Ÿ”ฅ5124 Dundas St W Etobicokeโ˜Ž๏ธ416-817-3366๐Ÿ‘ Table Shower Sea Salt Bath Body Scrub๐Ÿ˜˜ Japanese girl Nina โค๏ธ Natural Big Boobs 38 DD ๐Ÿ˜˜Pink Mini Nipples Hot body slide, super enjoyable๐Ÿ˜˜๐Ÿ˜˜๐Ÿ˜˜๐Ÿ˜˜ very provocative service๐Ÿ˜˜๐Ÿ˜˜๐Ÿ˜˜, professional super Luna deep tissue massage, has therapeutic effect to loosen bones and relieve muscle pressure and will bring you unexpected service effects, she will bring you a little surprise๐Ÿ˜๐Ÿ˜๐Ÿ˜๐Ÿ˜โค๏ธYou are welcome to make an appoint
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