In the case of Joelle G., Neuromuscular Therapy treatment at our clinic near Boston proceeded as follows:
The quadriceps muscles that straighten the knee were the first to be treated to release tension in these overworked muscles and to work on Trigger Points referring pain to her knee. Walking on bent knees, the quads were always working, trying to straighten the knee against a force that was keeping the knee bent.
Because the hamstring muscles bend the knee, they were the second group of muscles to be treated. Since Joelle’s knee remained bent even in a resting position, indicates that they were too tight (hypertonic) and therefor of particular interest in her recovery. Releasing the hamstrings to straighten the knee was crucial to restoring balance at the joint and allowing the quads to get some rest.
The gastrocnemius muscle in the calf was treated because Trigger Points that refer to the posterior knee can cause irritation in the calf and lead to secondary Trigger Points in the gastroc. Acting as a stabilizer of the knee, this muscle was overworked because, in a bent position, the joint is relatively unsupported by the bones of the limb and the muscles have to do the support work.
The popliteus and plantaris muscles located behind her knee were treated because Joelle’s pain was mostly right there. The popliteus has a strong Trigger Point that refers to the posterior knee. Additionally, local dysfunction of the muscles could cause pain. The popliteus unlocks the knee when you first put weight on it so it was working constantly in this bent-knee position. Tension in these muscles seriously hamper walking and going down stairs.
Other considerations: When the knee is bent, the hip flexes, so Joelle’s hip flexors were treated (tensor fascia lata, the tendons of the muscles that cross the hip joint and the short muscles in the groin). The ITB (iliotibial band) that attaches to the outside of the knee and the LCL (lateral colateral ligament) were addressed as were the muscles of the tendons that form the pes anserinus attachment at the inside of the knee.
Results: It took a long time to get Joelle out of trouble because the problem had been going on for so long and had progressed so far. All of the above muscles needed work and eventually responded to treatment, giving her pain relief, a relatively normal walking gait, and the ability to climb stairs more comfortably. She lost weight which took the added pressure off the joint. She no longer needed surgery. Good news!