Case Study: Overcoming Post-Surgical Knee Stiffness and Restoring Function
Client Background & Presentation
History: The client is a 55-year-old female with a complex, lifelong history of knee dysfunction, including chronic patellar dislocations starting at age 8 and multiple corrective surgeries in her 20s and 30s. At age 53, she underwent a Total Knee Arthroplasty (TKA).
Current Challenge: The client presented to my clinic two years post-TKA. Despite the time passed since surgery, she was experiencing severe stiffness (consistent with arthrofibrosis) and pain during both flexion and extension of the knee. Her functional mobility was significantly impacted: she was limited to only short walks and experienced severe aching after prolonged sitting.
Clinical Assessment (The Discovery) When a client presents with chronic post-surgical pain, it is essential to assess the entire lower limb, as long-standing biomechanical compensations often become the primary source of discomfort.
Initial Findings: Palpation revealed severe tenderness and hypertonicity on the medial aspect of the knee. Abrupt passive movement provoked pain, but ligament tests were clear, indicating the restriction was primarily in the myofascial tissues rather than the joint structure itself.
Uncovering Compensations: As the medial tissues began to release in early sessions, the assessment revealed underlying compensatory patterns. The lateral structures (IT band, TFL) showed significant restriction, and tension was identified higher up in the kinetic chain, involving the hip flexors and the lower back.
Treatment Strategy (The Intervention) The treatment plan evolved over several months, shifting from acute symptom management to restoring dynamic tissue glide and proprioceptive control.
Phase 1: Regulating Tissue Distress: Initial treatments focused on myofascial release (MFR) and soft tissue mobilization (STM) around the medial knee, TFL, and lumbopelvic region to reduce immediate pain, guarding, and postural strain.
Phase 2: Restoring Patellar Mechanics: As the client's tolerance improved, we introduced active engagement lengthening. We applied targeted friction and stripping techniques to the extensor retinaculum and proximal patellar tendon while the client actively flexed her knee. This specific combination is highly effective for stretching fascial connective tissues and improving pliability around the kneecap.
Phase 3: Proprioception and Posterior Support: Treatment expanded to the posterior knee, targeting the hamstrings, gastrocnemius, and the popliteus. Addressing the popliteus is vital, as it acts as a “kinesthetic guidance system” for the knee, helping to restore balance and postural equilibrium.
Outcomes (The Results) The client's response to a comprehensive, whole-limb approach was highly successful.
Early Functional Gains: Within just three weeks, the client was able to descend stairs with limited visible compensation and without the need for a handrail. The severe medial knee sensitivity was resolved.
Transition to Maintenance: By the fourth month of treatment, the client was progressing nicely and officially moved into a maintenance phase. During this period the client began to incorporate an exercise regime, was taking longer walks and we began working other parts of the body. This was a good transition to noticing the whole body and its function with transition away from the problem knee, which had been dominating her felt sense.
Long-Term Success: Ongoing maintenance sessions now focus on sustaining the health of the entire kinetic chain—addressing the lower back, glutes, hamstrings, and calves bilaterally. Targeted deep tissue work and MFR on the rectus femoris and extensor retinaculum ensure the knee maintains its newly restored glide and function, allowing the client to enjoy her daily life with significantly reduced pain and stiffness.