|
He had been to several
orthopedic surgeons, had MRI’s done, and dye
injected into the knee, but there was no
diagnosable orthopedic problem. The
orthopedic physician told him that he had
arthritis and normal wear and tear on his
knees for a man of his age, and that if his
symptoms worsened he could scope it to
remove the minor bits of calcium that were
evident. However, he did not see this as a
significant problem, and couldn’t understand
why the swelling and inflammation continued
to be a problem.
He had been to several
orthopedic surgeons, had MRI’s done, and
dye injected into the knee, but there
was no diagnosable orthopedic problem.
The orthopedic physician told him that
he had arthritis and normal wear and
tear on his knees for a man of his age,
and that if his symptoms worsened he
could scope it to remove the minor bits
of calcium that were evident. However,
he did not see this as a significant
problem, and couldn’t understand why the
swelling and inflammation continued to
be a problem.
Sandra, a 20 year old
marathon runner, started her heavy
training schedule six weeks prior to the
Boston Marathon, and developed sharp
pains in the medial side of her right
knee after running seven or eight miles.
An orthopedist evaluated her knee with
MRI’s and x-rays. He said there was no
structural damage, diagnosed her with
patellar tendonitis, and put her on an
anti-inflammatory. He told her to rest
her knee which would mean she would not
be ready for the Boston Marathon. She
scheduled a session hoping I could help
her.
Ralph, a 44 year old car
salesman, was 50 lbs overweight, and was
referred to me by his physical therapist
after he had his right knee scoped for a
torn cartilage. He finished a series of
physical therapy sessions but was still
unable to spend a full day on his feet
without severe pain in his knee.
Usually, his knee was okay in the
morning after resting all night, but the
pain returned when he was on his feet
for several hours.
These are three cases of
knee problems that I treated in the last
year. Each case was unique in age and
condition of the client, severity of the
problem, and treatment and diagnoses
that were given by healthcare
professionals. Obviously, each case
presented challenges. For my treatment
to be successful, I needed to identify
the core problems and treat from that
basis.
Each of the clients was
in a structural collapse of the core
distortion which had either caused the
knee injury, or was creating an
irritation within the knee due to the
imbalance. When there is a structural
collapse of the core distortion, the leg
on the side of the anteriorly rotated
ilium is longer, and the leg on the side
of the posteriorly rotated ilium is
shorter. This creates an imbalance in
the distribution of body weight down
through the legs, and a distortion
within the hinge of the knee due to the
relationship of the knee and lower leg
caused by the rotation of the iliums –
i.e. to compensate for the leg length
discrepancy the knee and lower leg tend
to be rotated in opposite directions.
Jim kept himself in good
shape throughout his life, and it had
taken 63 years for his body to fall into
a structural collapse of the core
distortion. Even though he was in good
shape, his constant vigorous dancing
routine pushed him beyond his ability to
maintain structural balance contributing
to his structural distortion. Aging had
caught up with him, and the initial
imbalance within the knees from the core
distortion was increasing with the years
of wear and tear on his knees causing
greater stress on his knee joints. As he
continued dancing and had more time to
take additional lessons, his knees were
getting worse to the point of developing
arthritis. When I viewed the x-rays, the
arthritis was minimal but there
definitely was evidence of wear on the
cartilage in each knee. On his left knee
the lateral cartilage was more worn
down, and on the right knee it was the
medial cartilage that showed the most
wear. This was synonymous with the
weaknesses found in the knees when the
imbalances of the core distortion are
left untreated.
Sandra, the 20 year old
marathon runner, was young, strong, and
in excellent shape. However, the
excessive training and pounding her body
had undergone during the miles of
running had worn her down. When she
trained into exhaustion, she was
reaching the point where her body was
collapsing further into the core
distortion due to the inability of the
core muscles to keep her balanced under
the heavy load. This was showing in her
body with an increase in her scoliosis
(structural collapse of the core
distortion of the spine) and the
resulting increase in the anterior /
posterior rotation of her iliums. As
with Jim, this was causing more of an
imbalance in her knees, specifically the
medial side of her right knee. Her
vigorous training regimen was pushing
her past the point of being able to
maintain appropriate knee structure
causing severe irritation and binding on
the medial side of her right knee. In
addition, the quadriceps muscles were
tightening up to counter the weakness in
her knee and were actually causing the
inside of the patella to be rubbing
against the bone and cartilage of the
knee joint.
Ralph, the 44 year old
car salesman, had been overweight most
of his adult life and had done little to
maintain the condition of his body. He
had a significant structural collapse of
the core distortion and indicated back
and neck problems in addition to his
right knee symptoms on his intake form.
He had experienced knee symptoms for
some time and his knee had weakened to
the point that the medial cartilage on
the right side had torn during a
twisting motion while carrying a
suitcase. He had surgery to repair the
cartilage and physical therapy to
strengthen the leg and knee. However, he
was still in pain and not progressing
with his physical therapy. Even though
he had successful surgery and physical
therapy, his knee was still imbalanced
in the structural collapse of the core
distortion and unable to be fully
rehabilitated.
Obviously, my first goal
was to release the structural collapse
of the core distortion by moving the
iliums into balance to take the pressure
off the stressed areas of the knees. The
quickest and most direct way to
accomplish this was to apply
Cranial/Structural releases that release
the iliums into alignment and give
weight bearing support to the sacrum.
This also initiates an unwinding of the
myofascial holding patterns affecting
the entire leg and the structural
imbalances of the knees. Once these
changes were initiated it was time to
apply effective soft tissue treatment.
The challenge was to
apply a soft tissue protocol that would
maximize the release of structural
imbalance and allow the knee and leg to
support the body in balance. This
required knowing which leg was long due
to the anteriorly rotated ilium, and
which was short due to the posteriorly
rotated ilium. This was accomplished by
structural assessment while the person
was standing. Locating the ASIS of each
ilium showed me which was rotated
anteriorly as it was lower than the one
that was rotated posteriorly. Also,
viewing the client from behind it was
easy to see that the PSIS on the ilium
that was rotated posteriorly was lower.
The gluteus maximus was more defined on
the side of the posteriorly rotated
ilium, and there was a shortness between
the crest of the posteriorly rotated
ilium and the floating rib. This gave me
the information necessary to effectively
address and release the myofascial
holding patterns causing the distortions
affecting the knees.
Using the 3-step approach
- (1. release the ischemia,
inflammation, and swelling, 2. release
the myofascial holding pattern working
with deep, broad, slow strokes that only
move with the release of the tissue, 3.
release individual fibers, adhesions and
scar tissue with deep very specific
strokes also moving only with the
release of the tissue) - I was able to
work effectively and deeply from the
first session with each of the above
clients.
Jim’s initial treatments
focused on moving the structural
collapse of the core distortion into
balance by releasing the iliums out of
rotation into weight bearing support for
the sacrum. This required applying a
different protocol on the left side
(anterior rotation) than on the right
side (poster rotation). It was
interesting to note that the majority of
Jim’s knee problems disappeared in this
process. After two sessions to
accomplish the pelvic balancing, I then
concentrated more directly on the knees.
Jim’s left knee had more of an imbalance
and binding on the lateral side with his
lower leg and foot turned out. I focused
on the lateral side of the lower leg and
knee and Jim reported a total cessation
of symptoms. His right knee had more
tension on the medial aspect down
through the inside of his leg into his
arch. On this side I focused on those
areas, and after this session Jim
reported no symptoms in his right knee.
By paying attention to the differences
in the legs from the anterior /
posterior rotation of the iliums, I was
able to effectively restore support and
release the strains from Jim’s knees
which allowed him to resume his active
dancing social life.
Sandra, like Jim, was in
a structural collapse of the core
distortion, so that was where I started.
In the process of bringing the
anterior/posterior ilium rotation into
balance I also treated the quadriceps of
her right leg. After two sessions Sandra
reported about 1/3 of the intensity of
the symptoms in her right knee. I then
addressed the lower leg relationship to
the knee along with the quadriceps,
medial side of the knee, and the inside
of the leg, ankle and arch. After that
visit Sandra was able to resume
training. I focused more specifically on
the connective tissue around the knee in
her last session, and Sandra was able to
run her marathon.
Ralph had been in the
structural collapse of the core
distortion for some time and was
overweight. With these two factors, it
took longer to balance the anterior /
posterior rotation of the iliums. After
five sessions he reported less pain in
his knee. He also noted improvement in
both his back and neck. Now he was able
to increase strength and range of motion
in his knee during the physical therapy
sessions. I then focused on the right
knee, quadriceps, adductors, hamstrings,
and inside lower leg. When this all
released, Ralph reported no more pain
and full range of motion.
From these three cases it
is evident that we need to view the core
distortion when treating knee problems.
The influence of the structural collapse
of the core distortion on the knees
usually results in either injury or
pain. It is only by releasing this
distortion into balance and weight
bearing support that we can take the
stress off the knees and facilitate full
rehabilitation for our clients long
term.
Don
McCann, founder Structural Energetic
Therapy |
