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A 41-year-old male patient presented in my office complaining of gradual-onset bilateral knee pain. The pain in the left knee was concentrated in the medial and anterior area, while the right knee had pain in the lateral area. The patient also complained of low back stiffness and mild to moderate intermittent low back pain. |
History
With no apparent traumas or previous history of knee pain (except a two-month episode of bilateral knee pain as a high school football player), the patient stated a gradual onset of bilateral knee pain beginning one year before my initial examination. Approximately six months before this patient's visit to my office, he was examined by an orthopedic surgeon, prescribed pain medication and muscle relaxers, and referred to a physical therapist for six weeks of treatment. After six weeks of physical therapy, there was no apparent change in the patient's symptom complex. He also stated that he did not want to continue taking medications.
Initial Exam Findings
Significant exam findings include pelvic tilting (Fig. 1), mild restriction of lumbar ranges of motion, along with significant medial narrowing of the left knee and significant narrowing of the right knee laterally, as seen on A-P X-ray. (Fig 2) All orthopedic tests on the knees were essentially negative. A digital foot scan showed bilateral, asymmetrical foot pronation with greater pronation on the left foot. (Fig 3)
FABER (Patrick's) Test showed significant restriction of both hips.
Clinical Impressions
The patient was diagnosed with bilateral asymmetrical foot pronation, rotational bilateral knee and hip subluxations, along with lumbosacral fixation.
Treatment Plan
The patient was treated with conservative chiropractic spinal adjustments and adjustments to both feet, using bilateral adjustments for inferior/medial navicular, superior/lateral cuboid, inferior cuneiforms, anterior/lateral talus, plantar flexed/everted calcareous, and dropped metatarsal heads. The knees were found to have bilateral posterior tibia listings and internal rotation of both femur heads, so they were adjusted bilaterally for a posterior tibia, along with hip adjustments that addressed bilateral interior femur head rotation.
The patient was prescribed full-length InMotion+® custom orthotics from Foot Levelers. Both feet were initially taped until the orthotics arrived several days later.
Ice packs and cold laser therapy were utilized on both knees and the low back. The patient was supplied with ice packs for home therapy of the knees and lower back. Low back stretches were demonstrated for the patient to perform at home.
Response to Care
The patient was treated twice weekly for six weeks and then re-evaluated. This patient was consistent with treatment and home care.
The initial response saw a 50% reduction in symptomatology in the first two visits. Then, gradually, over the next five weeks, all symptoms subsided. This patient was very satisfied with his care and elected to continue a wellness care program.
References:
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- Guyton A. Basic Neuroscience. 2nd edition. Philadelphia: W.B. Saunders, 1991
- Zhang J. Chiropractic adjustments and orthotics reduced symptoms for standing workers. J Chiropr Med 2005; 4(4): 177–181.
- Fulton M. Lower back pain: new protocols for diagnosis and treatment. Rehab Management 1988; Nov/Dec:39-42
- Magee DJ. Orthopedic physical assessment. 2nd ed. Philadelphia: WB Saunders, 1992:459.
- Cambron, J. A., Dexheimer, J. M., Duarte, M, & Freels, Shoe Orthotics for the Treatment of Chronic Low Back Pain: A Randomized Controlled Trial. The Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 9, September 2017, Pages 1752-1762