Knee pain that will not heal

An acute injury that is self-limiting (will heal itself) in a few days or weeks can, for a variety of reasons, become a chronic (on-going) pain that can even worsen over time, perhaps developing into a disability.  That person ends up with a complex issue of continuous inflammation, restricted movement favouring limbs and the impact of emotions.

Often, emotions can develop around the non-healing of the injury, or the injury is unable to heal due to pre-existing emotional blocks which the person is unaware of and does not connect with their injury.  Without this emotional component being acknowledged and treated, endless therapy from health professionals such as physiotherapists, chiropractors or exercise physiologists will make some improvement but not provide full resolution unless emotional aspects of the case are considered and resolved.

Case Presentation

The client, a 46 year old woman, presented with an injured knee in March.  She had slipped on a wet floor in December and twisted her knee.  Medical examination in hospital had shown only soft tissue injury and she was told to RICE the injury.  After returning to the doctor, when there was no improvement, she was given the same advice.  She then had ENAR (nerve electro-stimulation) for several weeks with no change.

By the time she came to me she was limping badly and her knee was swollen and very painful.  Unable to walk any distance and only able to drive with difficulty, she found it especially difficult to get into and out of her car.  She was also unable to lie down in bed, and so slept intermittently on the sofa therefore getting little sleep.  She was unable to go out and do the planned activities during her long service leave.

Treatment Goals

Given this presentation, the treatment goals were:

Goal 1

To become more mobile

This involved increasing her ability to move in a more balanced way and to reduce the swelling around her knee

Goal 2

To be able to lie comfortably in bed

If she was able to go to bed at night, her amount of sleep would improve and it would help the injury heal and give her more energy, improving general well being

Goal 3

To exercise and have more energy

As a result of feeling better and sleeping in bed at night, she wanted to get back to enjoying her long service leave, meeting friends and going out

Goal 4

To have a fast recovery and to increase her self-belief

Now that there was no pain and the swelling had gone we addressed the issues around the fact that she had been injured for a great deal of her long service leave and that she did not want to return to her previous job – in fact she wanted to find a new career.  In this way we addressed to emotional trauma involved in the injury that occurred in December.

Treatment Plan

Initial treatment involved hourly consultations twice a week for two weeks.  When the swelling had reduced and movement was restored, consultations occurred once a week for three weeks, reducing to fortnightly until she was happy with her plans for the future.  Thus the frequency of consultations, were reduced as her condition improved.

Naturopathic supplements to reduce the inflammation and treat emotional wellness were included in the treatment plan.  Home exercises were done throughout the treatment.  I also sought the advice of a physiotherapist to provide exercises to regain her fitness when we began working on Goal 3.  

Case Discussion

There may be many reasons that the soft tissue injury didn’t follow its normal healing course but the rapid improvement of the case illustrates the value of whole of body treatment and consideration of the emotional nature of injuries and trauma.  

Once the ongoing inflammation and swelling made movement difficult, simply treating the knee was not sufficient.  The physical treatment involved getting the whole body to function in a balanced manner and restore correct neurological messaging.  

Also, a reduction of stress and consideration of emotions was important, as the person had been in an unhappy work situation for some time before the accident.

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