Barral Institute Case Studies

VM -Bilateral OA knees Sarah Labrecque, Physical therapist

Patient Age / Gender

Female 72 yr old

Patient Symptoms

History: 72 yr old female presents with B knee pain. Coming for preop therapy for Right TKR in early April. Pt had 3 yr Hx of L knee pain and had been through synvysc injections which helped at time.Xrays showed moderate to severe degenerative changes on L knee. Had planned to have L knee replaced but in last few months R knee had become very sore and more of a problem than Left knee since November 08, no Hx of injury, xray showed mild degenerative changes, but as R knee more problematic and painful than L had opted to have R knee done 1st then later would have L knee done . O/E L knee 108deg flex -5 deg ext Pain EOR. Decreased quad strength and some VMO wasting. Pain worse after prolonged weight bearing/walking, sitting in one position too long and stiff feeling. Going up and down stairs was difficult. R knee 125deg flex 0deg ext. Pain in R knee worse when sitting and standing for too long, but sore most of the time whatever she was doing.

Evaluation / Treatment

GL: forward with R side bend R Ki. LL: R Ki motility stuck in expiration and internal rotation // 3rd degree ptosis Treatment; R kidney pt treated supine worked Ki on psoas with patients R leg over therapist shoulder, contract relax of hip flexors then mobilize R Ki on relaxation of contraction, also used expiration. Following this balanced L and R kidneys and did some motility work. Rest of treatment was traditional exercise for B knees to finish session.

Outcome

After 1st treatment R knee about 50% less pain, the following week did one more treatment for R kidney in sitting position and worked cecum with long levers of legs, finished with motility of ki and cecum, Lv and stomach. In following week R knee pain pesolved and pt continued with preop therapy for L knee. Pt called her surgeon up North to cancel R knee TKR and have L knee replaced instead. Pt had L TKR done April 09.Had not had return of R knee pain when last spoke to her.


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