Inner Knee Pain: A Case Study
David presented to my clinic with pain in the inner side of his right knee. Since he did not recall having any injuries, he was unsure about what caused his pain. In this post, we will explain the thought process in the assessment of musculoskeletal pain from unknown origin in order to formulate a successful treatment plan.
David is a 38 year old teacher, and spends around five hours a day standing. He runs 5 km twice a week and plays tennis once a week. He has been complaining of pain in the inner side of his right knee for the past two months, especially after prolonged standing and running. He did not have any accident, and the pain developed gradually.
On examination, there was no swelling or redness in the knee. He had full knee range of motion and strength. The medial collateral ligament of the knee was tender to the touch. However, ligament tests did not show any laxity.
Given that I did not find any abnormalities in the knee joint, I then assessed the proximal areas. I observed that his feet arches were quite low, possibly causing his knees to cave in and putting more stress in the inner side of the knees. When I tested his hip strength, I noticed weakness in the glute muscles.
I decided to apply rigid tape to his feet in order to support the arches and offload the pressure from the inner knee. I also taught David some exercises to strengthen the glute and quadriceps, which are the main muscles that support the knee joint in standing position. The following session, David reported improvement in pain level. We decided to get a permanent solution for his feet arches so I referred him to a podiatrist to get customized insoles. I instructed him to continue doing the strength training exercises twice a week in order to build up resilience in his leg muscles. At the following visit, he reported that he was able to run and stand for prolonged periods of time without pain.
When assessing pain from unknown origin, it is vital to consider the patient's lifestyle, activity level, and assess the whole body biomechanics in order to find out the root cause of the problem. In this case study, we saw how knee pain can be treated by addressing deficits in other areas of the body.