What do you do with the patient who has seen five other providers, experienced 10-plus years of knee pain, and desperately wants to avoid getting a total-knee replacement (TKR) before turning 60 years old? Plus you only have two visits before they go back to their surgeon to decide on surgery. This was a real patient who I treated, but not that uncommon a situation. No two knee patients are the same, but I can share something that worked with this patient and has been a common finding if you know where to look.
The patient’s chief complaint was anterior knee pain that limited walking, stairs, and prolonged sitting. When I first looked at the patient’s knee, there was a low-grade effusion typical of a knee osteoarthritis patient, but I also noticed a good bit of swelling distal to the patella.
Infrapatellar Fat Pad vs. Patellar Tendon
When I started doing palpation (see Figure), the patient reported a return of her pain. What I palpated was actually the infrapatellar fat pad (IFP). An easy way to differentiate this fat pad from the patellar tendon is simply to have the patient contract the quads to see if the patellar tendon pops into your fingers.
I needed to show meaningful improvement quickly with this patient, so I thought it was worth a shot to explore the IFP more since it replicated her pain. The IFP is a highly vascularized structure that is hypothesized to become fibrotic and a source of pain.1
Before I conducted any intervention, I had her go up and down steps to determine her pain level (6/10). Next, I used the HawkGrips HG9 “Tongue Depressor” instrument (which I love for all types of injuries, especially tendon issues!) and was able to get her pain down to 1/10 within 5 minutes of treatment.
The patient was thrilled! She said that she had “not felt that great in months.” I was able to get immediate buy-in from the patient because I listened to her symptoms, conducted a patient-specific evaluation, and applied effective treatment. The HawkGrips instrument was a huge part in getting this result, but obviously only one (vital) piece of the puzzle. I saw her for 11 more visits and we worked on motor control, stability, mobility, flexibility, and more. The patient was discharged without needing a TKR, and was even able to get back to doing a recreational walking program with her friends.
My takeaways from this case were:
- Listen to the patient; they will tell you what is wrong.
- Know your anatomy, and don’t forget about the fat pads in the knee.
- Learn how to use the instruments (HawkGrips) that get you excellent results, fast!
1. Scapinelli R. Vascular anatomy of the human cruciate ligaments and surrounding structures. Clin Anat. 1997; 10(3): 151-62.
The human skin is the the largest organ of the integumentary system. It is enriched with dense neurological tissue that permeates the entire body and provides a uniquely accessible means of influencing tone and function of underlying structures. Fascia and muscle generate and transfer kinetic energy in an environment by which functional movement relies on a combination of elastic recoil and eccentric control around a focal, multi-planar axis.
“Tennis elbow,” a diagnosis that strikes fear into the hearts of clinicians the world over! (OK… that may be a slight overstatement). Why is this condition so dreaded? Because when treating tennis elbow, everything works and nothing works. Tennis elbow is one of the most commonly diagnosed and discussed musculoskeletal conditions known to humankind. An article by Arnett et al. on the evaluation and treatment of lateral epicondylitis reported a 2-percent incidence in the general population, with a significantly higher rate among manual laborers.
Although I’m a certified athletic trainer, it’s rare that I seek any type of physical treatment for myself. There are many reasons, but mostly I just feel bad about asking fellow clinicians to treat me when I know they’ve already been treating patients all day. Recently though, something wonderful happened. I asked Mark Shires, MS, ATC, PES, to treat my left shoulder and neck because of tension headaches I’ve been experiencing and he said yes!
BRIDGING THE GAP FROM REHAB TO PERFORMANCE By Sue Falsone Review by Phil Page, PhD, PT, ATC, CSCS, FACSM First, a disclaimer: I’ve known Sue Falsone for almost 20 years and she is a great friend and colleague, and one of the smartest and hardest working people I...
Is treatment with HawkGrips painful? The simple answer to this question is no. However, it may depend on your definition of the word “pain” versus “discomfort.” This treatment is certainly not based on the “no pain, no gain” adage. In fact, if a patient feels pain during treatment, they should inform the clinician that too much pressure is being applied. Then the clinician can modify treatment to ensure it is tolerable for the patient. Instrument assisted soft tissue mobilization (IASTM) employs smooth…
We often hear questions at HawkGrips about the emollient that’s a necessary adjunct to instrument assisted soft tissue mobilization (IASTM). In this blog post, I’ll provide the answers to these common queries.
What Is It? HawkGrips original oil-based emollient is specifically manufactured to contain the least amount of allergens to reduce the possibility of adverse reactions among your patients.