Mini-Case Revisited: Visceral Manipulation for Knee Pain During Squats

A couple months ago, I did a mini-case study on one of my co-workers. As you may recall, he had pain with squatting in his left knee. Apparently, the knee had been bothering him for years, but with his recent running, the symptoms had increased. At the time, I had been able to reduce his symptoms with repeated motions to the lumbar spine and knee. While that worked for awhile, his pain significantly increased after doing a 5K a couple weeks ago. At that point, he came to me regarding to his knee pain not improving with the previously successful repeated motions, hoping for further advice.

Having no longer responded to the quick treatments based off my initial brief evaluation, I recommended my colleague go through a more structured treatment plan. He had gone to a dry needling course with no change in knee pain. I told him to focus on glute strengthening and high repetition/low load training on the shuttle press for thousands of repetitions. While he did have success with reducing his knee swelling and general pain with the shuttle press, he continued to have pain and a contralateral shift with his squat.

Last week, I had some extra time in the clinic, so I though I would mess around with some different equipment. For those of you regular followers, you may recall that about a month ago I took a visceral manipulation course. While I am still practicing the techniques each week, I thought I might try one for my colleague due to the theoretically and potentially odd effects. Being that my colleague's knee pain was on the left side, I thought I would try a stomach manipulation. I first performed a squat assessment of my colleague and he had pain and a contralateral shift. I then performed a couple stomach manipulation techniques and reassessed. During the squat immediately following the techniques, he actually fell posteriorly onto his glutes at the bottom of the squat. It sounds weird, but he actually did and he described his “orientation” being off. We then quickly reassessed and his squat was marginally improved. Having remembered that the primary effects of visceral treatment occur within 48 hours of the treatment, I again checked first thing the next day. It was completely normal and pain-free.

Now I am not saying that the stomach treatment was the needed fix for sure, as it is difficult to identify correlation with such a long time between treatment and results; however, there was definitely an interesting change after so many less successful treatments. If anything, this case makes me more intrigued to practice and begin applying the visceral manipulation techniques, so that I may better learn patterns for which to apply them.

-Dr. Chris Fox, PT, DPT, OCS

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