Submitted by Dr. Daryl Bourke

History

A patient presented himself to our clinic with recurrent right medical knee pain. He state that he was a receiver for the university football team and had the problem reoccur on three occasions. The pain was located on the medial side of the right knee near the patella. When the leg was fully extended, the pain was dull and intermittent most of the time, but had become sharp and referred pain to the knee joint during football practice, preventing him from playing.

Examination & Treatment History

The patient had attended the Sports Medicine Clinic at the university on the three previous occasions. A medical specialist had examined his knee and found no joint abnormalities; muscular strength and flexibility were normal and x-rays and blood tests had proven inconclusive. The treatment was based on the diagnosis of muscular strain and the patient was prescribed physiotherapy, which included ultrasound, an exercise program including flexibility training, light weight training and a short course of anti-inflammatories. He felt that he had recovered after 10 days and returned to practice only to have the injury re-occur.

The patient was re-examined at our clinic, where we reviewed the previous diagnostic tests and performed auscultation of the knee joint in motion, which revealed crepitis (joint noise). Deep-tissue palpation revealed a trigger point in the vastus medial is approximately 2 cm in circumference, which reproduced the pain that the patient had complained about. This deep-tissue trigger point could have been caused by trauma, a blunt force injury or overuse, which would change the bio-mechanics of the knee by affecting the contraction and relaxation of the vastus medials. Typically, a trigger point will act like a small area of muscle tissue in a constant state of contraction. This results in reduced blood flow to the area and increases the buildup of lactic acid in the tissue. Left untreated, the tissue will become fibrotic and may never return to normal.

The patient was treated six times with localized Far Infrared Sauna Therapy (F.I.R.S.T.), which reduces pain and inflammation while restoring normal vascular supply and removing the lactic acid build up in the trigger point. Deep tissue massage of the trigger point and vastus medialis were incorporated, as well as and Bromelain (a natural anti-inflammatory) to speed the healing process. The patient was re-evaluated twice at four-week intervals and had no subsequent re-occurrence of the pain.