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

5/15/2017

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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.
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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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  • Home
  • About Us
  • Insider Access
    • About Insider Access
  • Online Courses
    • Hooper's Knee
    • Physical Therapist Entrepreneur Course
    • Physical Therapist Consultant Course
    • Orthopedic Management of the Cervical Spine
    • Return to Sport Essentials Course
  • Resources
    • Newsletter
    • Business Minded Sports Physio Podcast
    • Day in the Life of a Sports PT
    • Residency Corner
    • Special Tests >
      • Cervical Spine >
        • Alar Ligament Test
        • Bakody's Sign
        • Cervical Distraction Test
        • Cervical Rotation Lateral Flexion Test
        • Craniocervical Flexion Test (CCFT)
        • Deep Neck Flexor Endurance Test
        • Posterior-Anterior Segmental Mobility
        • Segmental Mobility
        • Sharp-Purser Test
        • Spurling's Maneuver
        • Transverse Ligament Test
        • ULNT - Median
        • ULNT - Radial
        • ULNT - Ulnar
        • Vertebral Artery Test
      • Thoracic Spine >
        • Adam's Forward Bend Test
        • Passive Neck Flexion Test
        • Thoracic Compression Test
        • Thoracic Distraction Test
        • Thoracic Foraminal Closure Test
      • Lumbar Spine/Sacroiliac Joint >
        • Active Sit-Up Test
        • Alternate Gillet Test
        • Crossed Straight Leg Raise Test
        • Extensor Endurance Test
        • FABER Test
        • Fortin's Sign
        • Gaenslen Test
        • Gillet Test
        • Gower's Sign
        • Lumbar Quadrant Test
        • POSH Test
        • Posteroanterior Mobility
        • Prone Knee Bend Test
        • Prone Instability Test
        • Resisted Abduction Test
        • Sacral Clearing Test
        • Seated Forward Flexion Test
        • SIJ Compression/Distraction Test
        • Slump Test
        • Sphinx Test
        • Spine Rotators & Multifidus Test
        • Squish Test
        • Standing Forward Flexion Test
        • Straight Leg Raise Test
        • Supine to Long Sit Test
      • Shoulder >
        • Active Compression Test
        • Anterior Apprehension
        • Biceps Load Test II
        • Drop Arm Sign
        • External Rotation Lag Sign
        • Hawkins-Kennedy Impingement Sign
        • Horizontal Adduction Test
        • Internal Rotation Lag Sign
        • Jobe Test
        • Ludington's Test
        • Neer Test
        • Painful Arc Sign
        • Pronated Load Test
        • Resisted Supination External Rotation Test
        • Speed's Test
        • Posterior Apprehension
        • Sulcus Sign
        • Thoracic Outlet Tests >
          • Adson's Test
          • Costoclavicular Brace
          • Hyperabduction Test
          • Roos (EAST)
        • Yergason's Test
      • Elbow >
        • Biceps Squeeze Test
        • Chair Sign
        • Cozen's Test
        • Elbow Extension Test
        • Medial Epicondylalgia Test
        • Mill's Test
        • Moving Valgus Stress Test
        • Push-up Sign
        • Ulnar Nerve Compression Test
        • Valgus Stress Test
        • Varus Stress Test
      • Wrist/Hand >
        • Allen's Test
        • Carpal Compression Test
        • Finkelstein Test
        • Phalen's Test
        • Reverse Phalen's Test
      • Hip >
        • Craig's Test
        • Dial Test
        • FABER Test
        • FAIR Test
        • Fitzgerald's Test
        • Hip Quadrant Test
        • Hop Test
        • Labral Anterior Impingement Test
        • Labral Posterior Impingement Test
        • Long-Axis Femoral Distraction Test
        • Noble Compression Test
        • Percussion Test
        • Sign of the Buttock
        • Trendelenburg Test
      • Knee >
        • Anterior Drawer Test
        • Dial Test (Tibial Rotation Test)
        • Joint Line Tenderness
        • Lachman Test
        • McMurray Test
        • Noble Compression Test
        • Pivot-Shift Test
        • Posterior Drawer Test
        • Posterior Sag Sign
        • Quad Active Test
        • Thessaly Test
        • Valgus Stress Test
        • Varus Stress Test
      • Foot/Ankle >
        • Anterior Drawer
        • Calf Squeeze Test
        • External Rotation Test
        • Fracture Screening Tests
        • Impingement Sign
        • Navicular Drop Test
        • Squeeze Test
        • Talar Tilt
        • Tarsal Tunnel Syndrome Test
        • Test for Interdigital Neuroma
        • Windlass Test