I recently saw a young high level female gymnast with history of recurrent left knee pain. Her symptoms began at a growth spurt 4 years ago. Her symptoms were felt around her patella and left fibular head with landing, running, and most closed chain activities.
They normally resolve with self treatment which consisted of hamstring stretching and rolling out her quads and hamstrings with a massage stick.
Like most gymnasts hamstring mobility was not an issue. In fact, on her painful side she had about 140 PSLR compared to 120 on the right. She laughed about that one. Initially, my first thought was to Stop Thought Viruses and educate her that her left leg wasn't longer or older than her right - so it wasn't just growth. I did so and she understood, taking some mental threat away from her leg.
However....
After starting the physical exam, I noticed
- her left tibia had a bit more torsion than her right
- reflected in some single leg squat (and double leg) testing
- significant loss of tibial IR on the left compared to right
- loss of ankle df on the left compared to right
Check out the video below
Management consisted of
- functional tibial IR mobilization with EDGE Mobility Band
- started in double leg squat progressed to single leg
- functional (WB) ankle mobilizations in half kneel
- instruction on self tibial IR mobilization in half knee - 5-6 times daily and as part of her warm up
- instruction on single leg squat with correct knee tracking in a mirror
After 2 days, she texted me stating her knee pain was nearly gone and she was able to perform all of her events without limitation. On day 2, we focused on side planks and super clams for trunk stability and I plan on progressing her stability exercises and adding farmer's carries as well.
So in this case, structure may have mattered because it caused faulty patterns that added up after years of running/landing with some increased stress on her left knee. However, restoring mobility where possible and motor control of landing, plus ability to accept load threat free restored function pretty quickly (quicker than I thought it would).
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