Case study - 4 medical specialists cannot help dancer with severe knee pain

Listen to Allie tell her story: [Permission graciously granted without monetary benefit to Stretch to Win by the people in this story to post this blog entry & these videos about a personal medical condition]. A 12 year old female pre-professional ballet dancer by the name of Allie came in to see me last week. She was referred to me by the director Lisa of the Plum Performing Arts Center in Scottsdale because her student hasn't danced for 3 months due to severe left knee pain. Allie came in with complaints of pain on the front-inside (it's called 'antero-medial') part of her left knee but her diagnosis was a Baker's cyst which occurs in the back of the knee. In adults, Baker's cysts usually arise from almost any form of knee arthritis and cartilage (particularly the meniscus) tear. Baker's cysts in children do not point to underlying joint disease. Baker's cysts arise on the inside calf (between the tendons of the medial head of the gastrocnemius and the semimembranosus muscles & posterior to the medial femoral condyle). Allie told me that about 8 months ago she had lost her balance while in her pointe shoes & fell onto the front of her left knee. She kept dancing that day (typical dancer) but the knee got increasingly worse over time until 3 months ago she had to stop dancing. X-rays & MRI revealed only a small popliteal (Baker's) cyst. Allie's mom told me that they have been to 2 medical doctors & 2 physical therapists over the last 3 months & there was no change in her pain (7/10 at rest---8/10 walking---9/10 squatting---10/10 pain dancing). She had been on anti-inflammatories with no effect. They were both very frustrated & the mom felt that the medical system left them without any hope that her daughter would be able to return to dance anytime soon, if at all. After taking her history & physical exam, it became clear to me that she probably had a biomechanical dysfunction in the joint beneath her kneecap. When I asked the mom if any of the previous medical specialists or therapists mentioned the words "patellofemoral joint syndrome" she said no, which encouraged me to pursue this line of reasoning (& differential diagnosis) even further. When I tested the strength of her quads manually, she had 8/10 reproduced pain with quad weakness (tested at 3/5), so I shifted her kneecap with my hand & firmly held it in place while again testing her quad strength. This time it was pain-free & strong (tested at 5/5). Next I used the Kinesiotaping method to shift her kneecap into a better position & taped it into place. When she stood up & walked her pain was 1/10 & a squat tested at 1.5/10. I added another strip of tape on a specific angle - she then tested at zero pain in walking & .5/10 pain squatting. Allie had a big smile on her face & her mom said "Is that all it took? I can't believe it! Why couldn't the others figure this out??" I replied "I don't know but I consider this a basic & fundamental part of evaluating a knee". It annoys & angers me that this simple diagnosis & treatment was missed by 2 medical doctors & 2 physical therapists & caused so much wasted time & unnecessary pain on the part of the patient who is supposed to matter the most. I think a big part of the problem is that with "managed care" doctors & therapists are way overbooked & don't spend the necessary time to ask the right questions & take the time to look at the whole patient. Next week she starts a dance specific Pilates rehab program to progress her to dance class in another 2 weeks. * * * Here is her home program: - self myofascial release (self-massage) of trigger points on the outside hip & leg connective tissue (for anatomy geeks: glute min/med, IT band, lateral hamstring/quad). - stretch above mentioned muscles - inner quad (vastus medialis obliqus) strengthening - self tape kneecap * * * Listen to Mom tell the story:

STW Institute graduate helps client make the Olympics & big leagues!

Paul Turner is a kinesiologist & provider of Fascial Stretch Therapy in Vancouver, BC, Canada and graduated from our Institute as a Certified Flexibility Therapist - Level I. With his permission, I present to you his short story about how dreams come true for those that stay focused & no one stays more focused through the ups & downs of life than Olympic athletes. Enjoy:

Three Peaks kinesiology client Scott Richmond was named to Canada's Olympic team last week and his good luck has continued as he has been called up to the big leagues this week with the Toronto Blue Jays. check out the active roster at this link: Toronto Blue Jays.

During the off season Scott worked with me (Paul) 2-3 times a week helping him maintain and improve his flexibility in his throwing arm and throughout his back. We at Three Peaks Kinesiology are extremely excited and proud for him getting his well deserved recognition, and a chance to show that he can throw the heat in the big leagues and for Canada.

Good luck Scott with Toronto and in Beijing.

We are behind you all the way. See you in the off season.

--------------------------------------------------------

If you want Paul to help you achieve your goals, here is his contact information:

Paul K Turner BHkin, RK,CEP, CFT-1

Three Peaks Kinesiology INC.

Peak Recovery, Peak Performance, Peak Fitness

Reach Your Peak http://3pk.blogspot.com/ check out our blog for great health info.

Located @ Total Fitness Langley.

202 20165 91A st

o: 778-298-3pks F: 604-648-9552

------------------------------------
If you want to find a provider of Fascial Stretch Therapy who graduated from our Institute in your area, go to our Locator at this link: http://www.stretchtowin.com/therapist-locator.

Stretch to Win at Cardinal's Camp

Written yesterday:

I am writing this from Flagstaff, AZ where we came today to work with our clients from the Arizona Cardinal football team (Ann is downstairs working on Anquan "Q" Boldin right now). Ten players were waiting for us to help them with jacked up hips, backs, knees and ankles from turf that "was messed up". Hard, dry, cracked and uneven, the players said that it was an accident waiting to happen.

Fortunately we also had our naturopathic physician, Dr. Brian Popiel, with us to administer electrolytes & vitamins by IV to help them recover much quicker. Ann and I notice that their connective tissue feels much more responsive to the stretching as well. Tomorrow, Jimmy Yuan, chiropractor extraordinaire will be joining us to complete the "dream team" of rehabilitation for the sprains, strains and dehydration that is endemic to the football training camp experience.

The players told us that they couldn't live without the electrolyte water that we get for them and also reported that the Neuro1 product is really helping them focus while the Sleep1 is helping them sleep and recover.

We're here till Sunday, so I'll try to report back again on what's going on with the Cardinals... .

In the meantime, check out the video of Matt Leinert & teammates in practice below.

A question about assisted fascial stretching

Question excerpt from one of my Stretch to Win Institute students:

Dear Chris and Ann,

I have an unusual situation with a client arise, I thought you might have some advice....

When doing the "sack of potatoes" stretch with this gentleman last week there was a loud crack during the stretch phase of the work. It sounded just like scar tissue... at the time he had pain in the lateral aspect of the joint. It lasted for three days, getting progressively better each day (again, just like scar tissue). All special tests for the knee clear ligaments, tendons, and meniscii. There are no ROM limitations. In addition, he tolerates all weight bearing exercise, including change of direction and heavy squats without difficulty.

However, when I bind the fascia for the sack of potatoes stretch and also for the gluteus maximus position, he experiences pain in the medial/anterior aspect of the tibia (no where near any ligamentous or muscular attachments and beneath the meniscus). There are no other subjective complaints except in those two positions (he is even able to perform a glut stretch in sitting and supine without symptoms, full range). Again, there are no significant objective findings.

There are restrictions in the gluteus maximus and the hip, so ideally I would be able to work with this fascial train. I'm not sure how to proceed and also have no idea exactly what happened. Do you have any advice or have experienced a similar situation???

Answer:

I discussed your case with Ann and we both have not had this experience nor have we ever heard of any others experiencing what you describe.

While seeing a video of you performing the moves would also be helpful, we'll just work with your descriptions and offer you my thoughts:

Since you say that all tests and FWB functional movements screens are clear then all that remains is either a trigger point referral or a cruciate ligament trigger point vs scar tissue lesion.

a) there is possibility that your client is experiencing what Travell calls a "shortening activation" which basically means that the antagonist to the muscle being stretched reacts by contracting. In the case of the positions you mentioned, it's plausible that the adductors may by reacting this way to the glutes and other lateral structures under increasing tension. Solution: search & deactivate TPs in antagonists.

b) in the sack the anterior cruciate is under the most tension, since there also occurs some tibial IR therefore if there is any defect or scar tissue in the ACL, the stretch may stimulate this & cause pain in the antero-medial aspect. Solution: if you believe the cruciates to be hypomobile from a scar or whatever then it is probably safe to explain to the client what you are doing and get a verbal OK to proceed. If not, then use the upper hand wrapping around the outside of the thigh, fingers coming underneath to control & direct traction and even rotation, thus greatly reducing or even eliminating any traction with rotation to the knee joint. If no pain with this modified move then you will have no more pain in the knee using this technique (but it suggests that there is a lesion in the knee that needs separate treatment). This effect may also occur in the glute stretch because of the long lever force pushing the knee into a slight anterior draw position with a slightly internal rotated knee (no problem for a normal knee but stressful to other knees). Another solution: try varying the leverage angle & while simultaneously reducing the IR.

Let us know how it works out or if you need more direction.

Dear Chris,
Thanks again for taking the time to respond... I found a major trigger point at the Gracilis origin and after releasing it was able to perform both the sack and glut max stretch! I'm very excited 1) to have learned something new and 2) to be able to assist this gentleman with his martial arts work.

You are making a difference! :-)

Laura

Stretch to Win client qualifies for Olympic Trials

Bryan Gilmore, former wide receiver of the S.F. 49ers (now a free agent) said to Ann Frederick 6 weeks ago "I'm bringing in a friend of mine that I'm training. He'd like to make the Olympic team and I believe he can do it."

After Bryan paid for Michael Lawrence's first visit, Ann said "It's on the house from now until he makes the team. I've always loved supporting at least one athlete each Olympics". The last Olympian Ann worked with extensively was Sanya Richards who won the gold in the 4 x 400 and later became the fastest individual runner in the world in the 4oo meter event.

Michael Lawrence is like Forrest Gump in the sense that he doesn't have much of a background training for the games but knew that he could run and should soon find a coach if he was to fine tune his technique. Bryan Gilmore ran track in high school and believed that his friend was a natural.

Well the short story is, Michael found a running coach in Phoenix and then he found Ann who has been his flexibility coach for the past 6 weeks. This past weekend , all the hard work paid off big when Michael ran the 200 meters in 20.4 seconds qualifying him for the Olympic trials and a chance to make team Beijing.

After he qualified, Michael said "Ann not only got my body right, she got my head right too!" We wish him the best in his quest to make the mens Olympic track team for 2008!!

FAQs from readers

Question:

I am an ACE-certified fitness instructor and on the mailing list for the Human Kinetics catalogue, which features Ann and Chris' book, Stretch to Win.

I have been on a quest to become more flexible for a number of years, and the book sounds good, but before spending the money on yet another book that may not make much difference to my flexibility level, I thought I would write and ask what this program can offer someone with my goals.

As an aspiring classical dancer who started dancing later than childhood, I did not develop the extreme flexibility that comes with beginning regular stretching at the age of 8 or 9. I need a split in at least the front and back directions, and very open hipflexors in front, which are quite tight. With my access to the fitness and dance professions, I have consulted at least 4 different practitioners over the past year for help with flexibility, and I have improved somewhat, but not to the level I need to become a fluid dancer.

I have seen accomplished athletes struggle for basic flexibility, and I'm wondering if your book addresses people like this. I am way beyond the basic level--yet still have not attained the flexibility level a dancer needs to be effective in classical technique. Can this program offer a quantum leap in flexibility (with dedicated practice, of course)?

Many thanks for your attention to my inquiry.

Answer:

My wife & I were professional dancers & like you, my focus was on classical ballet training. I started late (17) yet still managed to get accepted intoJoffrey Ballet when they were one of the top companies in the USA. The reason why I tell you this is for you to know that it is still possible to make quantum leaps but you need to have a certain amount of natural or genetic ability in strength, flexibility, balance and musicality to endure the rigors of classical dance.

What makes the flexibility training program in my book different is that I take you through a Personal Flexibility Assessment (PFA) & teach you how to do the same for yourself so that you may gauge your progress. Then you proceed to focus on the areas that are restricting your flexibility after you have identified them through yourPFA.

The first part of the program is based on self myofascial release (sMFR) which is much more than just rolling on a foam roll. Stretching, which is the second part, comes after sMFR but instead of the static stretches that many dancers do before class (which is wrong) I teach you about the Stretch Wave™ which are undulating movements that areperiodized.

The Stretch Wave™ is done a little faster before dance class (or sports) in order to increase blood circulation & body temperature, as well as to move in all possible directions, for a comprehensive warm-up. After class, rehearsals or performance (or after training or a sport participation) the Stretch Wave™ is done slower to take advantage of the high body core temperature & restore elasticity of the fascia before it tightens again when you cool down and go to bed.

After you try this program, I'd be happy to help you adjust the program even more to suit your particular needs. Happy stretching!!

Stretch for Sex

After using Fascial Stretch Therapy™ (also called FST™) on thousands of patients & clients to eliminate pain or to improve function & performance, several of them have commented that their sex lives have improved as well.

That makes sense because loss of mobility & flexibility from injury, surgery, accumulation of scar tissue or lack of having a good anti-aging strategy will lead to tighter muscles & stiffer joints. This scenario will not only affect daily functional activities but can also dampen or even eliminate one of the great joys and de-stressors of life, namely sex.

To see Ann & Chris Frederick on local major network TV check out the story & video at this link: Exercise for "love muscles". (Link should work for a few more weeks).

If you want to download the free video "Stretch for Sex" core flexibility program & also get the stretch program on a sheet then go to this link: download FREE program now.

Happy stretching!