Mini-Case: Quad "Tightness"

This case is coming from treating one of my co-workers yet again, although it is a different one from last week's post. A few weeks ago, one of my co-workers came to me with complaints of a "squeezing tightness" with CKC flexion of his R knee. I was pretty busy at the time treating my patients, but I have treated this co-worker a few times with repeated motions and, due to his excellent compliance, I knew he would likely respond well to repeated motions.

My co-worker told me he had a history of knee problems from several years ago when he was in the military and thinks those issues may have been contributing to his current symptoms. His asterisk sign was a lateral lunge. On his L side he had no issues and displayed good depth. On his R side, he had significant loss of depth and reports of intense "squeezing" the deeper he lunged. As always, I checked the lumbar spine first which displayed relatively good lumbar flexion and extension mobility but a slight loss of sideglide motion, loading the involved side. This was the same side I had previously given him sideglides to and he told me he has kept up with them, but hadn't noticed any changes in his quadriceps symptoms. I continued my assessment and noticed a loss of hip flexion mobility on the R side. I had hip then perform repeated hip flexion and reassess the lateral lunge, with reports of improved depth and less tightness. About a week later, my co-worker told me he didn't notice any significant symptoms remaining at all.

I thought this case was worth bringing up for a couple reasons. One, as always, compliance plays a significant role with treatment. My co-workers, knowing the benefits of being consistent, are more than compliant with the 10 reps/hour prescription and, thus, typically get better extremely quickly. Second, don't let "weird" symptoms confuse you. Neural symptoms can be reported in many different ways but remember to always stick with your system of looking at mobility in each joint and treat accordingly. Finally, while most cases like this will respond well to lumbar treatment, you will have instances where other joints are limited and their treatment are essential to improving your patient's primary complaint.

-Chris

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