I was sent to evaluate a woman recently. She was in a late 80s. Upon meeting her I found her in a hospital bed in a home she shared with her daughter. Her daughter had told me that she fell a few months before and upon seeing an orthopedist was told that the pain she was experiencing at the knee was from being bone on bone and that she would require a total knee replacement to resolve the knee pain. Because of the fragile state of the woman, it was clearly not advisable to consider getting such a dramatic and extensive surgery. This left this woman with only one option; to basically be confined to the hospital bed other than when going to the bathroom. I told the daugther that I understand that her belief about her mother’s condition was based on the information she was given from an orthopedist and his understanding of the knee joint. Unfortunately this understanding does not include any possible causes of knee pain that might be muscularly generated. I told her I wanted to evaluate the knee to either confirm or refute the diagnosis given.
I asked the woman where her pain was and she noted it was around the knee cap. I tried to move her knee through range of motion and found it impossible to fully straighten the knee. I checked to see if the knee cap could be moved side to side and it was actually vacuumed seal in the knee joint so it couldn’t move. This presentation told me that the woman’s knee pain was not from her joint being bone on bone. In fact, she had pretty much full range of motion when bending the knee which clearly indicated that she wasn’t even bone on bone. My evaluation utilizing the Yass method presented a woman wtih a strained quad muscle (front thigh muscle). As a result, the hamstrings (posterior thigh muscle) and the gastrocnemius (portion of the calf muscle) had severely shortened. This prevented the woman from fully straightening the knee when standing on this leg with walking. The ability to lock out the knee is a key component to being able to walk normally. Since the knee was never fully straightened, there was always tension on the knee cap from the quad. This caused enough tension to occur to create a vacuum sealing of the knee cap in the knee joint. With weight bearing, this altered ability of the knee cap to move through the joint caused pain at the knee joint to where the patient was unable to support herself on this leg preventing her from getting around at all. Even with the assistance of an aide, this woman could not walk for any distance due to knee pain.
The resolution of her symptoms was clear. I massaged out the hamstrings and gastrocnemius and stretched them. I was able to almost fully straighten the knee at this point. I then mobilized the knee cap and almost instantly it was freed and could move in the knee joint at will. I then performed strengthening exercises for the quads and front shin muscle to try to create enough tone in these muscles to prevent the hamstring and gastroc from shortening any longer.
Then came the moment of truth. I taught the woman how to stand up from the bed properly and she started to walk with the walker. After two steps I asked if there was any knee pain and she said no. Then she was on her way. At first, I stayed close and guarded her. Within a few feet, I could see that the knee was actually fully extending as she stood on it. I knew it could hold her up. I stepped back and watch this woman walk for the first time in months by herself with nobody around her. I could the surprise in her daugther’s eyes as she walked by herself with no complaints of knee pain. The aide arrived to find this woman walking by herself unattended and asked how this happened. I explained the process and saw she understood. I asked the woman to sit down finally and continued to discuss my unique understanding that allowed me with one treatment to get the woman to walk without pain. Then the wildest thing happened. I looked across the room to see that this woman had gotten up by herself and starting walking again. Everybody in the room just stopped talking. The woman said she was so excited that she could walk without pain that she just wanted to keep doing it. She told me she hated that bed and didn’t want to be confined to it. I told her that if we performed the proper exercises, the knee joint would function properly and her pain would not return and she would be able to get up and walk whenever she wanted to.
It became time to leave and I walked out the door with this woman’s daugther and she looked at me with such sincerity and simply said “Thank you”. I could feel my heart melt. I was so happy to be able to give this woman the ability to get out of that bed that she had come to hate and make her daugther’s life just alittle easier.
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