SharmaAmit92
3 posts
Mar 05, 2010
11:07 PM
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Hello!
I need help with a 36 yr old male client with total hip replacement on the left side. He had his replacemenmt done 3 years ago. He did not undergo his physiotherapy seriously then.
He has experienced left knee pain since the operation 3 years back, *but* feels that he could have had the knee pain before that also and that he might have become more aware of the pain since the operation.
He also has left shoulder pain (near the posterior deltoid) since approximately the last 20 years. He especially feels the pain while lifting his left arm laterally, as in the super 6 arm raise from the side. He can confortably lift his left arm only till his shoulder level, beyond which he feels acute pain. Raising from the front doesn not cause any issue.
When he came to me about 3 months back, his left thigh was 4 inches thinner than his right thigh. His ortho deduced that maybe the left knee pain is due to atrophy of his left upper leg. Since our training we have seen hypertrophy in his left thigh (now his left thigh is 1.5 inches thinner than his right thigh). However his knee pain is exactly as it was before we started training. The doctor is also at a loss as to why should he experience knee pain as there is no reason for him to have this.
Since a month, When I learnt the FAB 5, I started work on him accordingly. My observations are as follows:
1. Standing twists on the right side increased the pain in his left knee while he was in the twisted position. However, twisting on the left side did not cause any improvement.
2. I have done all the FAB 5 exercises and as many variations as possible, however there has been no improvement. I tested the good side vs. the bad side and exercised the good side, but there was no improvement.
3. In sit-2-stand, even with a height of 1 inch, he feels strain in the lower back.
4. Specific ankle mobility exercises (on both good and bad side) also do not give relief in knee pain.
5. I asked him to sit/stand/lie in a position which is most comfortable to him (and where his body wants to go). This was a position where he kept his left foot on the seat on which he was sitting, so that his left hip and left foot were next to each other at the same level and left knee was near his left shoulder, his right foot was on the floor and his right arm was sharing his weight. The right arm was placed behind the right hip. In this position, he felt no knee pain, however when he changed back to sitting with both feet on teh ground (the regular way) his pain just shot up for a few seconds.
6. I checked whether he has predominant right twisting throughout the day (i.e. towards his bad side). It turns out that he actually has to twist a lot to his left (the good side) throughout the day, much more than towards his bad side. When he asked whether twisting to the right side on a day to day basis for some time would help, we decided that there can be only 3 outcomes of this: if the right side is indeed his bad side, then his pain will increase; if his left side is actually the bad side then his pain will reduce; or he will experience no change. We tried it out, and his pain increased. The inference is that right side is indeed the bad side, but left side twisting even for the whole day with complete elimination of right twisting yields no results.
7. Finally, when we both got frustrated, we exercises both sides to make sure that we get the actual good side, in case the client is unablew to give me the right data, and the pain increases while exercising the bad side, but the issue doen not improve at all while exercising the good side.
Currently he is taking paracetamol 650 SR, 3 tabs in every 24 hours, but still experiences pain.
I am at a complete loss. Please help me!
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