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Dynamic Chiropractic – October 10, 1990, Vol. 08, Issue 21

A Case of Knee Pain

By Michael Haneline, DC, MPH

Not long ago, one of the attorneys that I work with in the area of personal injury made an appointment to have me look at a problem that he had been having with his knee. When the receptionist told me that he was coming in, I became somewhat apprehensive; I really wanted to impress him and show him what a good doctor I was.

At the appointment, he told me that he had been experiencing pain on the medial aspect of his knee whenever he ran for more than a mile or two. The pain was of such intensity that it would force him to stop in the middle of his run. He had taken up jogging one year previously and was quite adamant about continuing the sport, so the simplest solution for his problem was out of the question.

Examination revealed tenderness to palpation over the right superomedial tibia and mild hyperpronation of the right foot. Period! That was it! All orthopedic tests were normal and motion palpation was normal throughout the entire spine, pelvis, and lower extremities. In addition, his musculature was supple and free from apparent myofascial involvement (trigger points).

Treatment consisted of fitting him with custom foot orthotics which he was to wear at all times that he was on his feet. I received a phone call within two weeks wherein the patient stated that his knee pain had completely resolved as soon as he began to run with the orthotics and had not returned.

I was delighted that everything worked out so well with his treatment since he was responsible for a number of referrals to my practice. I was also delighted that I knew exactly what was wrong and what to do to correct it.

There was a time, however, that I would not have known how to conduct an appropriate motion palpation examination of the spine or of the lower extremities. At that time I would have treated the condition quite a bit differently -- lumbar rolls, physiotherapy, and my good old standby, medial meniscus knee adjustment three times a week, until either the patient got better or quit coming in.

The point in relaying this story to you is this: With the motion palpation and diagnostic skills that I have learned from MPI, I was able to approach this case confidently. If you have not yet taken the motion palpation courses, I urge you to register. If you have only taken the spine courses, I urge you to register for the extremity courses. I you have taken motion palpation courses but haven't quite gotten around to using it, I urge you to take a refresher course. With a little effort, the art of motion palpation can be mastered and, I promise, will be one of your most important diagnostic tools.

Dr. Michael Haneline is dean of undergraduate and graduate studies at the University of Western States and chair of the CHC section of the APHA. Previously, he was the head of the chiropractic program at the International Medical University and before that, a professor in the department of research at Palmer West, where he also taught courses in evidence-based practice.

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