Tight low back and inner knee pain: a real case

You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. Hello, everyone. Welcome to the Restoring Human Movement podcast. Thanks for joining the Movement Movement. This is Dawne Costantino, your co-host. And in today's episode, it's going to be really short and sweet. I'm just going to share a case of somebody who is dealing with a tight low back and some pain on the inside of their right knee. So we'll just get into some details about that. Just a couple of things that I think would be important to share with anybody who might be dealing with something similar.

If this is your first time, welcome. Don't forget that we have an entire, I keep calling it a vault. I need to find a better word. But just a lot of episodes recorded that you guys can go back and listen to. Not just about the back and the knee, but the hip and the groin, the neck and the shoulder, all the stuff that we're good at, we talk about and we record it and we put it on YouTube too. So check out those things. They're there for you for a reason. Take advantage of those free resources. So let's hop into a little update on me. I mean, there's not really big updates, but it's spring. And spring is spring in here in California as much as it possibly can.

But I have some really cool spring veggies coming up. This morning I walked outside to go water and there are a couple of peas finally growing. I saw the flowers come in a couple days ago and I was absolutely shocked by how fast that flower turned into a pea pod. Super, super cool. I've been like nerding out over the garden lately. Some things in life have given me the opportunity to start to build that kind of homesteading life. So we're growing veggies. We're, you know, succeeding in some and failing in others. Something dug up my garlic the other day and I'm pretty pissed about it because they've been in the ground for a while now.

So pretty irritating when things like that happen, but that's just a part of it. So we're learning to be okay with some failures here on the homestead. So yeah, I can talk your heads off about what's going on on the property here, but I won't. I'll get back to talking about low back and knee pain. So this is somebody that I saw in the past. They were coming in for some groin discomfort, which we found through our discovery sessions, which we offer in our office. It's typically what we do first before we do the initial appointment, just to make sure we can help you. During the discovery session, we found that this person actually was dealing with an inguinal hernia.

So just a quick peek at that and a couple of tests, and I referred him to go see somebody that I know. He got his surgery and he rested and followed directions and just had a great success with that. So he came back because we did find some things that we had discussed we could work on after he heals from his surgery. So he's coming back now with this, I have episodic low back pain. Normally on a day-to-day basis, just feels tight and stiff, but sometimes it'll feel like he throws it out. Very active person, plays pickleball and volleyball multiple times a week. And so they're just kind of coming back to get on top of how to prevent more of these episodes, how to move better, how to feel better.

And then during our time in the first couple sessions, the discussion of his inner knee had come up because we were doing some side planks together. And his knee said hello to him. And he said, oh yeah, I've been dealing with this too. So throughout the first few sessions together, we really noticed that he was pretty sensitive to some of these exercises. You know, things that I could see that his body needed and we coached through, he was pretty sensitive to. It was actually a little tricky in the beginning to find exercises he could tolerate pretty well. And I was shocked by that because his exam looks really, really good.

He is a very active person, very athletic. And some of the simplest exercises were just, you know, they were flaring him up a bit. So we had a little trial and error period together. But again, the reason, let me try to stay organized here. The reason why I wanted to talk about this specific person is because I wanted to bring awareness to some of you out there who may feel like you have two different things going on. That's what this person felt. My low back hurts and my knee hurts. Nothing in between hurts. It doesn't feel like it's radiating to my knee. So I have two separate things going on here that I need help with.

And number one thing that, you know, I had to do was to see if they were related in any sort of way. Typically, they are. Whether it's just related through movement and biomechanics or related through a nerve path. That's what we found on this person. So let me take a look at my notes here and make sure I'm staying organized. So back pain is generally tight. Flares up every month or so. Knee pain comes and goes. Has a hard time reproducing it. Has never noticed swelling. Has never really injured it. No trauma to the knee. No bruising. No popping. No clicking. No feeling of instability. Just kind of this general weakness.

Feeling a little timid to push it too much at times. Does not notice there's a correlation between when the back is worse, the knee is worse. Said that. Couldn't really recall if that was a thing. And so during one of his flare-ups comes into the office and we redo his examination and I show him a couple of things that we found that really prove. I think it's important sometimes if you could just prove to the person, not to prove them wrong, but to really show them like, I really understand what's going on here and here's how we know. This person's neurological exam showed me that the reflex on the knee was diminished compared to the rest of the reflexes in his body.

There was a slight bit of weakness in some of his muscle tests that correlated with the reflex. And there was also a positive nerve tension test. So typically what we can do when you think about like the knee, you might think quad or inner thigh muscle that attaches there. You can put those muscles on a stretch and then you can move a joint somewhere far away from that area, like the head, for example. There's nothing attached from your head to your knee, no muscle attached from your head to your knee. So if we move the head and it changes your discomfort in your knee, your pain, then we know we have a positive nerve tension test, okay?

So there's just some sensitivity going on there. And so we, and then we also did a full knee examination, you know, just making sure there was nothing else going on inside and around that knee joint that could be playing a role. And it was a pretty impeccable knee exam besides some tenderness to just touching around where his pain was, some tenderness to the inner thigh muscle called the adductor. And I wanted to share this because I think sometimes this information can be really helpful. Sometimes it can be actually kind of scary. When you tell people, hey, your knee is related to an irritated nerve in your back.

We need to figure out what's going on there to get the knee better. I've had people that have told me that's really scary. What does that mean? Do I need to go see an ortho? Do I have to go get surgery? Like for some reason, our brains, there's certain people's brains that connect the spine, nerve compression, disc issues to automatic surgery. And that's not always true. For this particular person, actually showing him his knee exam and then showing him we could reproduce some of that discomfort and how we can change it with the way he moves his head, to him it was actually really reassuring, he had said.

He said, I feel really grateful that you could show me that there was nothing wrong with my knee. It makes me feel like I don't have to be as timid when I'm playing pickleball and volleyball. You know, I actually feel a little bit better knowing it's related to my back and that makes sense because I've had back pain for a really long time, episodic episodes. So if you're telling me it's the same thing, one less thing to worry about, really. So I thought that that was really cool. I like when educating people gives them a sense of reassurance and not a sense of like feeling scared. If you are feeling that way, I think that sometimes it's just the way that information is shared with people.

Maybe ask your provider if there is like some fear. Don't be afraid to open up. I tell people all the time, this room is a safe space to feel whatever you need to feel because the physical and emotional are very much connected. And if there's any fear inside of you, if there's any concerns, if there's any questions, if there's whatever it is that's coming up, I need you to bring it up so I can make sure that we can address it in the best way we possibly can. Because if you're hiding fear, then we are not going to be able to rehab you and move you to your full potential. A lot of that stuff, the emotional stuff kind of gets in the way of the ability to see some progress.

So keep that in mind. And I'm hoping that me sharing this story today actually gives you a sense of reassurance. Like I've been trying to get this knee issue dealt with for a really long time. My back has never really been a concern and maybe it doesn't hurt, but maybe it's related to some old back stuff that I've had in the past. Hopefully that's helpful for you. If nobody's brought that up, if nobody's brought your attention to it, yeah, just go ask about it. Go see if that's what's going on with you. We are happy to take a peek at it for you too if you'd like to. We do discovery sessions virtual or in person and across state lines in different ways.

So depending on where you are, if you want to reach out to us, we can always do that for you. So let me just share really quickly what the common denominator in this case was. So yes, back issue. Yes, radiating to the knee. Yes, they were the same thing. But the hips are the problem here. So just because we know where the diagnosis is, just because we know what tissue it is, this person's very active, but they do not move very well through the hips. Not a lot of mobility there. Not a lot of control there. Some simple movements like squatting. Knee can't tolerate it. Some simple things like hip hinging, like a deadlift type motion, maybe a single leg version of that.

Really, really difficult to teach. Really hard for the body and the brain to understand what we needed from those joints. So those to me are just areas of opportunity to improve. Not necessarily things to avoid, but things to improve upon. So currently we're working on ways to mobilize the hips without flaring up the knee, without flaring up the low back. We're working on ways to control just functional movements through the hip, like a hip hinge pattern. And to me, I think it's gone, you know, we're on the right path. We're starting to see some progress. We're starting to see some better movement, some better strength.

The knee's getting better, and the back hasn't really gotten aggravated in a while. So, you know, there's always a common denominator somewhere if this is what's going on. It's not like you have multiple things that need to be worked on. The back and the knee will feel much better if the hip joint is moving better. And this looks differently for everybody. So, again, reach out to us if you need some individualized care. Bring these concerns or questions up to anybody you're already working with. If it hasn't been brought to your attention, you know, feel free to challenge the people who are helping you.

Because if they're not thinking about certain things and you bring it to their attention, you know what? That is a good idea. I've had that happen to me. You know, my patient bringing something up that they found on the internet. And it actually was really highlighting for that person's case, that person's program, all of that. So just, you know, trust your providers, but remind them sometimes when you have fears and concerns that need to be addressed. Because you know you're in good hands if they're willing to listen and if they're willing to help and educate you properly. I'm out of breath because I'm doing circles in my room here trying to record this podcast.

Told you it was going to be short and sweet. Just little tidbits to leave for you guys to consider. And we'll see you next time.