I just began working with a man scheduled for right knee replacement surgery. He wanted to know what pre-surgical strengthening he might do to help him recover from his surgery. When I examined his right knee, he was unable to extend it fully–lacking approximately 10 degrees. It was swollen and painful. During the course of my examinating I found several things wrong with his left hip, namely poor gluteal function and hamstring dominance. My initial thoughts were he was compensating for deficient strength of his left leg.

Then I decided to try and alleviate his right knee pain through a few alignment tests I like to perform. None of these had any effect. That is until I distracted the knee. Immediately he felt pain relief so we stayed with it for a few minutes. I asked him to stand up and he could almost fully extend the knee! I educated him about activating the gluteals while walking and we practiced that. Within 15 minutes his knee began to flex again so  we tried the distraction again, this time lying on his stomach so I could anchor a small weight on his ankle to assist the knee into extension while I provided the traction. The result was dramatic. He could fully extend the knee and walk correctly without pain.

We’ve since had two treatments (1x/wk) and he is now calling off the surgery and contemplating skiing this season. Again, my thoughts return to the fact that by improving his biomechanics by both fully extending the knee and correcting his gait dynamics we are able to improve pain free function. I do not doubt that his cartilage is still missing but it begs the question once more that just because we see an alteration in the structure of a joint or soft tissue, it doesn’t mean that is where the pain is coming from. To me it is an indication that something is wrong biomechanically. If we correct the mechanics, pain eases and function returns.