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If a patient has knee complaints - and I rule out the spine as the source - I assess (and usually treat) the knee with repeated movements. Usually the movement is to address the joint position itself, though sometimes the movement addresses a tendon or muscle. Here McKenzie diplomat Joel Laing demonstrates the movement: knee extension with overpressure in partial weightbearing. I used this with a patient last week in fact! There are many ways to move a knee, but this is one of the most commonly used movements. Please remember, even in the presence of arthritis, meniscus, ligament, tendon, or cartilage damage, in most cases joint pain can be rapidly fixed with repeated movements. The typical exercise prescription for home for the knee is 10 repetitions every 3-4 hours. McKenzie clinicians are trained to examine whether your problem falls into the 80% of cases which will respond to repeated movements, and to find which movement is best for you. --Laura Patient complaint: right Achilles pain preventing him from training and competing (sprinting). By taking a thorough history and mechanical exam, it is clear his pain is originating in his low back. When taking his verbal history, what made me suspect his spine - and not his actual Achilles tendon - is the tendon pain variability, his report of intermittent low back and calf "tightness," and his history of other lower extremity issues.
If a tendon itself is the problem it is very unlikely that it “warms up” and pain during a workout subsides. The more you stress a problematic tendon, the worse it usually gets. However, it is likely that a joint moves from a place causing pain to a harmless position as you move (“warm up”). When we did the mechanical exam he had an obstruction to movement in his right low back and sciatic nerve tension on his right. When he initially did 10 right, single-leg calf raises, the Achilles burned starting with repetition #2. After repeatedly moving his spine into extension with pressure (about 30 repetitions), this test was much less painful. His homework was therefore spine extension in lying with belt overpressure. After a couple weeks of doing that (10 repetitions every 2 hours), we added spine bending to ensure the injury was fully healed. He was discharged at visit 4 with a prevention and maintenance program. -- Laura When people twist or roll an ankle, the common diagnosis is that the ligaments are sprained. However, the joint itself is also affected! Here, a patient who twisted her ankle is treated successfully with simple repeated movements of the ankle JOINT. Therefore, the ankle JOINT was injured, not the ligaments. She was discharged with full recovery at visit number 2. Clinicians MUST assess joints as joints are injured far more commonly than soft tissues such as muscles, tendons, and ligaments. (I learned how to assess joints like this through my post-doctoral studies with the McKenzie Institute, not in school.) -- Laura I approach fixing a patient's injury in three ways: 1. Find a specific movement to correct the injury. 2. Address and correct everyday habits (especially posture) which contribute to the injury. 3. Place the patient's activities which prevent the injury from healing on hold temporarily. This video (about 2 minutes) is a nice example of how to correct everyday habits, including posture. Making these simple adjustments can make a world of difference to our bodies. (I'd prefer better posture on the bicycle, however. Or forgoing the biking for walking or jogging.) -- Laura
See how wonderful a McKenzie evaluation can be! Often, a thorough clinical evaluation makes imaging tests (x-ray, MRI, CT scan, etc.) unnecessary for orthopedic conditions.
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