Case Study – Running and Knee Pain

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Patient is a 43 year old woman who, due to poor patella alignment and poor VMO strength with decreased ITB flexibility and decreased core strength and muscle imbalances at bilateral hips, is unable to run without sharp pain in her right knee.
On evaluation, patient presented with poor muscle definition of VMO right vs. left with painful knee extension @ 4+/5. She also demonstrated malalignment @ pelvis and sacrum affecting muscle length @ her hips. Bilateral hip abduction (glut med) was 4/5. She had min. decreased ITB flexibility and hamstring flexibility. Her core strength was poor due to lack of awareness of supporting muscles. Patient was unable to run greater than 3 miles without getting sharp knee pain that she needed to stop running.
Physical therapy was initiated for stretching, myofascial release techniques, soft tissue mobilization, joint mobilizations, proprioception activities, strengthening, kinesiotaping and patient education especially with regards to form for exercises and running. No formal protocol was provided. Patient was seen for a total of 7 visits and was very compliant with HEP.
With kinesiotaping, MET’s and a focused HEP, patient progressed to running a half-marathon – she did have some mild increased pain after 6 miles but with adaptations to form, she continued without pain other than general fatigue from a half marathon. Her glut medius strength increased to 4+ but should continue to progress with focused HEP. Her core strength increased to 5/5 and her awareness of focused strengthening for her core is good. At discharge, patient is able to do full squats, lunges and jump without pain and with good knee control.