Case Reports

BTF CASE 1

27-Year Old Runner With Left Foot & Knee Pain

A 27-year old female financial advisor reported to BTF with left foot & knee pain with her daily morning runs. She would run up to 6 miles every morning for exercise before work on the treadmill. Unfortunately, the gym in her condo complex, where she was using the treadmill, was closed due to COVID-19 restrictions, so she moved her running outdoors on the streets around her building. This is when she first started having, first the left foot pain, and then the left lateral knee pain.

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During an initial posture examination at BTF by Dr. Chad Moreau, she demonstrated a moderately pronated left foot and a valgus left knee position. This left foot pronation (dropped arch) puts an increased tensile load on the plantar fascia (bottom of the foot). The left knee valgus (knock-kneed) position puts a compressive load on the outside of the knee and allows the ITB (iliotibial band) to get short/tight on the outside of the left thigh.

During the orthopedic examination & functional screen, she demonstrated:

1) a positive left adduction drop test (modified Ober’s Test)

2)decreased left hip internal rotation at 26 degrees (normal is 45 degrees)

3)decreased right hip external rotation at 27 degrees (normal is 45 degrees)

Inability to get into left hip adduction (see image 1 above) means that she is unable to get her body weight to shift over to the left side efficiently. Add to this lack of left hip adduction is her lack of left hip internal rotation (image 2) and compensatory lack of right hip external rotation (image 3) and we have a situation that creates stress at the left foot and knee.

These postural and functional issues above create tension in the body. Her left lateral plantar fascia, left lateral hip, ITB and thigh and right medial thigh were abnormally tight. She also had a sacral and ilium misalignment that we typically see in someone with low back pain or hip dysfunction.

Treatment over the 4 weeks at 2 visits per week initially focused on myofascial release therapy at BTF to reduce and eliminate the abnormal tension in her left lateral and right medial lower extremities. Chiropractic manipulation of her sacrum and ilium addressed her alignment issues. Shockwave therapy was used on her left foot and lateral thigh in order to break up stubborn fascial adhesions. She was instructed on postural restoration exercises at BTF and then asked to do them every day in order to create a change in her postural and functional asymmetries. For a more detailed look at how we manage knee pain related to postural asymmetries, please check out the article Knee Pain & Posture.

For the first 2 weeks of her recovery, she was asked to just walk for exercise, but she could still do bodyweight exercises like squats and lunges if she didn’t notice them increasing her left knee pain. At week 3, she was asked to do a 1.5-mile run and she had minimal left knee pain at about the 1-mile mark. She was then asked to just walk again for the rest of that week for her morning exercise and to really focus on her repositioning exercises for the rest of the week. At week 4, she tried the 1.5-mile run again and was pain free!

At the week 4 mark the previous functional tests that were problematic were now as follows:

1) a negative left adduction drop test which means that now she functionally has adequate left hip adduction

2)left hip internal rotation at 48 degrees (normal)

3)decreased right hip external rotation at 45 degrees (normal)

Now she will add .5-miles to each successive daily run until she is able to tolerate her longer runs without any left foot or knee pain.

Below is the social media post that she tagged @btfdoc in to thank us for the efficient treatment plan and rehabilitation.

At BTF we absolutely love getting people to FEEL – RECOVER – PERFORM BETTER! If you need help with an injury, please give us a call at 310-534-1900 or email info@backtofunction.com.