I thought I would post a clinical case of a recent patient (I have permission from the parents).
Two weeks ago, this nine year old boy presented with right knee pain that had been present for about one year. This is a long time for a child to have knee pain and initially set off my alarm bells of concern, however the family had visited their doctor and an x-ray of the knee had been done which was clear and blood tests were clear. I still had concerns regarding hip pathology (as this can refer pain to the knee) until I had a look at the child's back...
Now I am not sure if it is obvious to everyone, but if you look at the left hand photo, (which was taken on initial examination, before any treatment), you may be able to see some asymmetries. The left shoulder and shoulder blade are higher and the right hip is higher. You can see a reddish mark on the back due to a recent fall onto a tree branch.
Without getting complicated , this child has a scoliosis (which is an 'S' or 'C' shaped curve to their spine). The most common type is called idiopathic, which means the cause is unknown.
In my experience all the children I have treated over the years with idiopathic scoliosis have had a considerable cranial base strain (which can start in-utero, during birth, or from trauma to the head as a child). This cranial base strain can cause strain in the spine and shoulders and ribs due to the extensive muscle attachments between these structures.
The right knee pain was being caused by extreme tightness of the right thigh muscles, due to the pelvic unleveling and cranial base (head) unleveling. The parents had been massaging the right thigh muscles daily for months to try to help the knee but had not been able to make them relax. This is because these muscles were not the cause of the problem but were responding to the strains higher up.
A very gentle osteopathic treatment with the patient lying on their back, using cranial, balanced ligamentous and biodynamic osteopathic technique approaches was used to treat the head, neck, back and pelvis. There was immediate improvement as you can see from the middle photo. The right thigh muscles eased immediately which started to take the pressure off the right knee.
Two weeks ago, this nine year old boy presented with right knee pain that had been present for about one year. This is a long time for a child to have knee pain and initially set off my alarm bells of concern, however the family had visited their doctor and an x-ray of the knee had been done which was clear and blood tests were clear. I still had concerns regarding hip pathology (as this can refer pain to the knee) until I had a look at the child's back...
Now I am not sure if it is obvious to everyone, but if you look at the left hand photo, (which was taken on initial examination, before any treatment), you may be able to see some asymmetries. The left shoulder and shoulder blade are higher and the right hip is higher. You can see a reddish mark on the back due to a recent fall onto a tree branch.
Without getting complicated , this child has a scoliosis (which is an 'S' or 'C' shaped curve to their spine). The most common type is called idiopathic, which means the cause is unknown.
In my experience all the children I have treated over the years with idiopathic scoliosis have had a considerable cranial base strain (which can start in-utero, during birth, or from trauma to the head as a child). This cranial base strain can cause strain in the spine and shoulders and ribs due to the extensive muscle attachments between these structures.
The right knee pain was being caused by extreme tightness of the right thigh muscles, due to the pelvic unleveling and cranial base (head) unleveling. The parents had been massaging the right thigh muscles daily for months to try to help the knee but had not been able to make them relax. This is because these muscles were not the cause of the problem but were responding to the strains higher up.
A very gentle osteopathic treatment with the patient lying on their back, using cranial, balanced ligamentous and biodynamic osteopathic technique approaches was used to treat the head, neck, back and pelvis. There was immediate improvement as you can see from the middle photo. The right thigh muscles eased immediately which started to take the pressure off the right knee.
 Before first treatment |  Reassessing immediately after the first treatment |  Reassessing before the follow up treatment ten days later. |
Ten days later was the follow up appointment and I hope you can see in the right hand photo, that the spine is now much better aligned, the shoulders are level and the scapulae are now even. Also the pelvis is no longer higher on the right side. The knee pain has much improved and despite there being some pains at times in the back as the body was realigning itself, the child and parents are very happy with the changes.
What I think is interesting about this case is:
1) The scoliotic pattern ('s' curve) of the back and pelvis were causing the knee pain. It was not the knee itself. (Osteopaths really do look at the whole body!)
2) There was no structural (ie boney) leg length difference, so there was no need for a heel lift.
3) Only one very gentle osteopathic treatment was required to enable the body to realign itself. (This was helped because the child is still young and the soft tissues were able to change)
4) The body kept on improving for a time after the treatment. Which shows that given the right input, the body has the ability to heal itself
In an ideal world, all scoliosis would be caught at this age or earlier, the key being to find it and ideally sort it out before the child starts to grow into their adult body (from around age 11 to 18 years of age).
Please note that some types of scoliosis may need surgery and it is important to get diagnosed correctly early on. If a scoliosis like this one was found in an adult, it may need more treatment combined with specific exercises such as Rehab Pilates to achieve long lasting improvements in the alignment of the spine.
Note: Following up six months down the track and the scoliosis has not returned. Thanks for reading. I hope you found it helpful.
What I think is interesting about this case is:
1) The scoliotic pattern ('s' curve) of the back and pelvis were causing the knee pain. It was not the knee itself. (Osteopaths really do look at the whole body!)
2) There was no structural (ie boney) leg length difference, so there was no need for a heel lift.
3) Only one very gentle osteopathic treatment was required to enable the body to realign itself. (This was helped because the child is still young and the soft tissues were able to change)
4) The body kept on improving for a time after the treatment. Which shows that given the right input, the body has the ability to heal itself
In an ideal world, all scoliosis would be caught at this age or earlier, the key being to find it and ideally sort it out before the child starts to grow into their adult body (from around age 11 to 18 years of age).
Please note that some types of scoliosis may need surgery and it is important to get diagnosed correctly early on. If a scoliosis like this one was found in an adult, it may need more treatment combined with specific exercises such as Rehab Pilates to achieve long lasting improvements in the alignment of the spine.
Note: Following up six months down the track and the scoliosis has not returned. Thanks for reading. I hope you found it helpful.
Melanie Young
Reg Osteopath
B.A., B.App.Sc.(Clin. Sc.), B.Osteo.Sc. MONZ
Director City Osteopaths
www.cityosteopaths.co.nz
#osteopathyawarenessweek
Reg Osteopath
B.A., B.App.Sc.(Clin. Sc.), B.Osteo.Sc. MONZ
Director City Osteopaths
www.cityosteopaths.co.nz
#osteopathyawarenessweek
RSS Feed
