CASE STUDY TROUBLESOME KNEE

A CASE STUDY:

BY STUART HINDS, SOFT TISSUE THERAPIST

THE PATIENT A 36-year-old male adventure racer was in the beginning of his training phase for an upcoming competition. The competition was the prestigious one-day coast-to-coast race in New Zealand – a multidisciplinary event that includes running, cycling and canoeing (Box 1). His training regimen consisted of six days training with one

day of rest per week. A typical training day would be a mixture of 2–3 hours of kayaking, 2.5–3.5 hours of cycling, 1–2 hours of running, and two hours in the gym. All sessions were fitted around a full-time self-employed job and a young family.

SYMPTOMS The patient presented with left anterolateral knee pain. His BOX 1: THE NEW ZEALAND COAST-TO-COAST RACE

A World multisport championship one-day race from the Tasman Sea to the Pacific Ocean, covering a distance of 243 km across the Southern Alpine of New Zealand.

Stage 1 n Run 3 km n Cycle 55 km (takes 1.5–2.5 hours depending on ability)

Stage 2 n Mountain run 33 km carrying a day-pack containing compulsory mountain safety equipment (takes 3–8 hours)

Stage 3 n Cycle 15 km n Kayak 67 km (takes 4–8 hours)

Stage 4 n Cycle 70 km

The average age of participants is 36 years, but the oldest participant was 75 and the youngest was 15. Top competitors take nearly 11 hours to cover the distance, and the slowest recorded time was over 24 hours.

For more information see http://www.coasttocoast.co.nz www.sportEX.net

This is the first in a series of case studies by leading practitioners. Here we follow the treatment of an extreme sport athlete from first presentation through to the successful completion of a grueling sporting event.

SYMPTOMS WERE OF A SLOW INSIDIOUS ONSET … POORLY LOCALISED KNEE PAIN WITH A DEEP SENSATION

symptoms were of slow insidious onset. He reported poorly localised pain with a deep sensation. There was no obvious mechanism of injury.

The majority of the pain was felt at the end of his training run and he complained of significant post-run aching lasting 1–2 hours. He also experienced mild awareness of the pain when he was on the bike. His symptoms had begun four weeks before and had increased over the last 2–3 weeks. His pain levels, on a scale of 1 to 10, ranged from a best of 3+ to a worst of 6–7.

ASSESSMENT Physical assessment began by assessing the lumbar spine and hip movements for any restriction or dysfunction. The movement of his lumbar spine was restricted on right lateral flexion, highlighting a restriction in his left quadratus lumborum. He had a left anteriorly titled ilium and a right posteriorly rotated sacrum. His left prone knee bend was restricted, indicating shortening of the rectus femoris. This was confirmed on a modified Thomas test (Box 2). A left

7

THE TROUBLESOME KNEE