So I thought a case study now and then would make good blogs. Check out this one…
The client is a 63 year-old male in good health. He sustained 2 knee injuries (same knee – the right) playing college football which required surgery. Back then the repair work was much more invasive than it is now, and the damage was extensive. In terms of current corrective surgery, it is now irreparable. The client has been experiencing a downward spiral in terms of what that knee can sustain during normal activity and the subsequent pain when it is over-taxed. Lately it’s been getting easier to over-tax his knee, and all his joints are stiffening from the hypertonicity of compensation. The restricted movement patterns have the client’s structures heading towards what allopathic would call osteoarthritis.
Visually, there is a very noticeable difference between his left & right knee. The right has more bulk: it is larger in all dimensions. Palpably, it has many irregularities to its shape as opposed to smoother surfaces of his left knee.
The bulk is collagen fibers, built up after surgery and sustained by years of his body coping with hyper-tonicities and the change in the path(s) his knee was now moving. This of course played through his SI joints and occiput/C1/C2, and then into the rest of his structural organization.
The goal here is to reform the knee into more functional collagen fiber organization and balance out his movement the best we can.
As you would expect, every session begins with loosening up the SI joints, working the tib/fibs (both joints & the inter-osseous space), occiput/C1/C2 along with assessing rotator cuffs. Any progress we make with his knee has to have someplace to go, or it won’t! Improving the overall resilience of his entire structure/posture must be part of every session.
An LMD ScarTissue massage technique to the knee is squeezing pressure into the ‘joint cleft’ of the knee and feeding flexion/extension into it. Interestingly, the joint cleft of his right knee is not in the same place as it is on the left knee. The joint has reformed, and it will never be like it was. However, it can be reformed to be more structurally and therefore functionally similar to the left knee. How close we can get it is to be determined; here’s how we’re getting it.
Video of case study: http://www.youtube.com/watch?v=TYYojSKxgiE
Another technique I added post-video is applied to his posterior knee in the prone position. I place the side of my upper table hand in the joint. I use my lower table hand to flex and extend his lower leg while I ‘saw’ side to side with the side of my hand. I can introduce a bit of traction as well, and it works movement and pressure into the joint very well, it’s been quite effective.
To sum up: To remodel connective tissue structures of all types, begin with a total grasp of the dynamics involved. Pressure from muscle tone over periods of time results in more collagen production. Movement in connective tissue structures results in the release of synovial fluid to lubricate the movement. Movement attracts/activates collagen-ase, a protein that dissolves collagen fibers. Lack of movement in connective tissue thickens the interstitial fluid, slowing circulation, while movement thins it, increasing circulation.
Those are the dynamics. I’ll have technique ideas I’ll share, and of course any technique that is in accord with those dynamics and fits with the goals of your work with a particular client is indicated.
Also, a way to look at your goals is:
First, where is the client currently at? What are their structural issues that cause pain and/or compromised function? You would like as clear an understanding of this as possible. Issues may be obvious or they may be something that becomes apparent in bits and pieces.
Second, how are you going to work towards the most functional connective tissue structures possible? In here is where you make your technique and timeline choices. Those choices are always evolving as myo-fascial/neuro-muscular/arthro-skeletal relationships change. Remember, any technique is used to serve the concepts you are working from. Technique is only an end in itself for beginners. Which we all are/were/andwillbe. Peace and good stuff.