Old knee injuries suck.  They often linger and years after you think the knee is “back to normal” old patterns persist and often reappear as a completely different symptom.  Allow me to elaborate with an example from a recent patient of mine.

 

A 40 year old female triathlete presented with right sided proximal hamstring discomfort (just below the ischial tuberosity).  Aggravating factors included sitting and occasional post run ache.  Patient also mentioned that she felt like she couldn’t extend the right hip as well as her left.  A classic complaint with proximal hamstring issues.  Patient had been through a variety of treatments and nothing seemed to last.  The question that begged to be asked..  “Why was the right hamstring so pissed?”

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It turns out 5-10 years ago she had her ACL replaced on her LEFT knee (luckily a donor tendon was used so they didn’t need to steal her hamstring or patellar tendon).  Every time I see a patient with an old knee injury like this I look for lingering compensation patterns the body is still hanging on to.  The most common?  Contralateral adductor hypertonicity messing with lumbopelvic mechanics.

 

When a knee destabilizing injury like an ACL tear occurs the body often tends to shift its center of gravity away from the affected side.  Makes sense, right?  The body seeks stability.  All one needs to do is stand up and lean away from one leg to feel the opposite adductor shorten and light up like a Christmas tree.  Now walk around like this for a few minutes and you’ll understand that after a few months things will start to feel pretty shitty.

 

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Now we must ask “Why the increase in adductor tension years after the knee injury has resolved?”.  My guess is that nobody paid any attention to the right adductors during her left knee rehabilitation.  Using NeuroKinetic Therapy​® protocol I found her right pectineus to be compensating for all other adductors and her right glute max.  This explained why she felt her right hip extension was subpar.  Glute max and hamstring are our primary hip extenders so if one is out to lunch there will be increased reliance placed upon the other.  This also explained why the main aggravating factor was sitting.  Pectineus is a hip flexor so when symptoms are aggravated by sitting look for this little guy to be a potential culprit.

 

Once we corrected this pattern our work was half done.  We had opened up her motor control center for new learning as the pelvis felt much different after the correction.  It was now time to teach her to trust her left knee and “let go” of her right adductors.  My favourite exercise to accomplish this is the suspension/propulsion phase of Gary Wards flow motion model (see Anatomy in Motion​).

 

Remove the compensation pattern and provide a safe environment for the body to relearn movements it has been avoiding for who knows how long. That is a recipe for long lasting success 🙂

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