A Tale of Two Knees
Same pain experience. Totally different cause. Totally different treatment.
Both patients were extremely happy with their results!
Written by Nick Rinard, PT, MPT, Cert. MDT
Two patients today. Both complaining of the same type of knee pain and similar weakness. Both were limited deep squat/crouching functions and both had difficulty getting up from the floor. Despite the patients’ similar knee experience, the mechanical evaluations and subsequent diagnoses were totally different!
It is important that your physical therapist understand how to rule in and rule out various known causes of knee pain and treat the different causes of knee pain differently. There are way too many generic knee programs out there that do not match the correct diagnosis and are therefore either ineffective, or cause additional damage.
Same Symptoms, Different Causes
Patient 1 had loss of knee motion, weak hamstrings, and no loss of spine motion.
Patient 2 had no loss of knee motion, weak quadriceps, and loss of spine motion.
When testing patient 1, repeated spinal motions had no effect on knee findings, but repeated knee extension cleared up a majority of knee findings when re-tested. Specifically, deep squat was better and they were no longer weak when testing resisted hamstrings, nor had any loss of knee ROM! It was important to rule out the spine first, then move on to knee.
In contrast, patient 2 responded immediately to repeated spinal extension, which centralized knee pain to then spine, and resulted in much improved deep squat and stronger quads afterwards! In this case, the knee pain was coming from the spine, so it was good to not miss that!
Why the Right Diagnosis Matters
PLEASE make sure your physical therapist is aware that all potential causes of your pain must be ruled in or out in order to give you the matching treatment. If you are not seeing results within 3-4 visits, it is highly likely the P.T. has missed the correct mechanical diagnosis and is not treating the cause.