What do knee pain, back pain and a previously frozen shoulder have in common?
She called our office saying that one of her tennis partners recommended her and her right-sided knee pain was preventing her from playing tennis on a regular basis. While she had back problems in the past, a fall about a year and a half ago began a long journey into knee pain, back pain, sciatic pain on her left side and she reported that years ago, she had a frozen shoulder on the right side that improved with three months of physical therapy, but she reports that it is still tight at times and she has difficulty reaching for things.
During our interview, she had described many problems that in the past and now seemed to be primarily right-sided. As with all our patients, we look at everything during our evaluation because symptoms are just a guideline and need to be placed in their proper context; as just a part of the story. She also revealed that she wears custom orthotic insoles which were for plantar fasciitis which was a problem a while ago as well, and she wore a night splint which just relieved the pain a little.
She had seen many specialists over the past two years for her pain including an orthopedic who treated her with Synvisc for her bad knee and she saw the podiatrist for the plantar fasciitis, as well as a physical therapist for her sciatic pain, none of whom had been able to relieve her problems long term. For many of our patients, this seems to be a common phenomenon; many specialists and office visits with some relief but without resolving the patient’s problems.
Our exam had shown that she had bilateral foot overpronation, where the foot falls in and turns out on her right side, and the left side tracks straight without the arch falling in as much. Her pelvis was distorted, with the right hip lower (this is typical on the side of overpronation, as discussed in the book Cheating Mother Nature, what you need to know to beat chronic pain), with a secondary distortion compensatory in the mid-back and shoulders. She was unable to do a deep knee bend without falling over to the left and having to grab on to something for stability.
I explained to her that with this type of compensation, the core muscles will distort due to tightened myofascia (myofascia is like an exoskeleton which forms according to the forces we place upon it), making her feel kinked up every morning in both the lower back and the upper body and neck, something she was able to relate to. We then checked out her foot orthotics which were her old pair, and were under corrective. I had also explained to her that it is quite likely that her tennis backhand was better than her forehand because of the way her pelvis was unable to move. She was amazed at how the evaluation was able to figure this out but also began to understand how these symptoms of leg pain, shoulder, and foot pain were related and why her tennis game was suffering and how the knees were sore because of the pelvic distortion (if the pelvis is distorted, the core no longer works properly, the legs tighten, calves and hips tighten and the knees are exposed to a potentially damaging amount of force that can cause injuries).
I had taped her feet in neutral (the position the foot will work most efficiently in) and when she stood up, she felt marked relief in her lower back, leg and noticed that her shoulder that was frozen a while ago was much looser and her neck moved better and was a little less painful. When rechecking her pelvis with the tape on, her hips had leveled out and she was able to do a deep knee bend with greater stability. I had suggested that since her new orthotics did not make her feel as good as the tape did, that an off the shelf set of powerstep pro-control orthotics may be more effective. She tried them on and could not believe the difference between her custom set and the off the shelf set (Sometimes, you are better off with an off the shelf orthotic because it eliminated human error on the casting process).
I had performed myofascial release on her core muscles and legs and she was able to get up and down with much less pain. I had also worked on the muscles and adhesion in the back of her right knee which allowed her knee to fully extend, something that was impossible for over a year and she stated the when the physical therapist attempted to stretch it, it hurt a lot in contrast to what the myofascial release was able to do. She also noticed that after working on her calves, her feet were much more comfortable.
In summation, this patient demonstrated why it is often more appropriate to see a musculoskeletal primary care person first such as a sports chiropractor, before seeing different specialists who look at where you hurt, rather than why. In our practice, we see many people who have visited multiple specialists who look at pain through their training, rather than taking the holistic approach and looking at the person with the pain. Often, the pain is just the symptom, and the problem may be in another part of the body, which is why treating symptoms rather than understanding the mechanism behind the pain is often ineffective in resolving problems which in her case, required multiple specialists. She found out that the shoulder pain, the plantar fasciitis the lower back and sciatic like symptoms were one problem; a gait issue that had been handled piecemeal through different approaches, which did not resolve her problems.
Do you have a series of problems that can all be related? Many of us have been trained to visit medical people first since joint pain is a medical problem, or is it? It is a mechanical problem that requires a mechanical solution. Basically, you will be most satisfied with a body mechanic of sorts. Chiropractic sports physicians are likely to be the closest thing to a body mechanic.
What do you think? As always, we would love to hear your feedback.
Cheating Mother Nature, what you need to know to beat chronic pain is available through Amazon.com