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Case Study on Knee Pain ~By Shay Biggar, Registered Massage Therapist~

Knee pain is an extremely common complaint among patients seeking massage. This past month, I’ve worked with a few patients who have expressed discomfort with their knees, in fact they were all dealing with the same symptoms. This has inspired me to share a case study I performed during school that dealt with treating one of the most common forms of knee pain: patellofemoral pain syndrome (lateral patella tracking). I will share just the highlights of the paper, not the whole scientific and wordy 27 pages I wrote during bleary-eyed and caffeinated nights during the last semester of my school career.

First off, what is it? Patellofemoral pain syndrome (PFPS) is one of the most common pathologies affecting the lower limb that is prevalent both in the general and sporting populations. Patients with PFPS have characteristic symptoms, which clinically present as diffuse anterior knee pain that is aggravated with activities such as stair climbing, kneeling, squatting, prolonged sitting, and other activities which increase pressure between the patella and femur. The cause of anterior knee pain relating to PFPS may be caused by direct trauma, overuse, faulty patellar tracking from malalignment, degeneration, or a combination of these factors.

What this means is that the muscle on the outside portion of the thigh is too strong in

comparison to its counterpart muscle on the inside part of the thigh, just above the knee. Since the inside muscle is too weak, it is not able to counter the pulling force of the outer muscle, which causes the patella to be pulled towards the stronger muscle, resulting in the diffuse knee pain felt with PFPS.

The participant involved in the study, who will be referred to at PC, is a 26 year old male office worker who has been experiencing symptoms of PFPS affecting his left leg for about 7 to 8 years.The major symptoms of PFPS that PC experiences include sore, achy pain behind the patella and up into the quadriceps tendon, with occasional shooting pain when sitting for too long, performing a squat, or getting out of a chair. PC describes the symptoms as being episodic, ranging from experiencing an acute flare up of symptoms, and periods of time where the symptoms are rated much lower of the VAS. PC reports that when his symptoms are at its worst it is hard for him to sit down for long because it feels like his patella’s are on fire and the pain shoots up towards the quadriceps tendon. In order to attempt to relieve the pain, PC finds he needs to stand up and move his knee through range of motion.

The aim of this study was to investigate the effects of massage therapy and therapeutic

strengthening exercises on symptoms associated with PFPS. It was hypothesized that through the combined use of Swedish Massage and remedial strengthening exercises, it would decrease the associated signs and symptoms of a patient with long term chronic PFPS. The primary goals of this study were to decrease muscle hypertonicity of the quadriceps, specifically vastus lateralis (VL) and rectus femoris, in order to decrease the lateral pull on the patella; to increase the strength of vastus medialis to affectively stabilize the patella throughout knee movement; and to decrease subjective pain felt during the functional test ‘squat and rise’ to 90° of knee flexion.

Therapeutic exercises have been widely recommended to help prevent the development of pathologies, to decrease pain, and to increase function. The benefits of exercise extend beyond the improvement in muscle performance, it actually may have a positive effect on the strength, integrity and organization of collagen that is found in all types of connective tissue. The exercise techniques selected for this case study provided substantial care for activating the VM through specific movements to target the contraction of the muscle as much as possible.

A total of 5 therapeutic massage sessions were given over a 4 week period. Sessions averaged 60 minutes, which included 40 minutes dedicated to Swedish massage for the anterior and posterior legs, 10 minutes of therapeutic strengthening exercises focusing on the VM, and 10 minutes of assessment split between pre and post treatment.

Over the course of the 5 weeks of massage and strengthening routine, PC had noted major

improvements in his symptoms of PFPS. The hypertonicity of the muscles had significantly

decreased, muscle strength of VM had increased, and most importantly PC’s perception of the pain he had been dealing with had considerably decreased, not only with the functional squat and rise, but with everyday actions, significantly increasing his quality of life.

So, now that you’ve read through the short version of the case study, what does this really mean for you? Well, if you are suffering from similar symptoms described by PC, try giving this strengthening routine a shot for a month and see if it helps decrease your symptoms too!

Photo Credit: Haley Phelps

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