Ellie D

"I had my first pain free run of 13 miles, which I hadn’t been able to do for years!"
"I’m delighted to say this after 2 sessions (1 on zoom and 1 face to face) I totally recommend consulting with Paula"

WHO?

Ellie 35, an accomplished triathlete and fell runner based in Cumbria. Ellie works hard as an Intensive Care Doctor and found me in Cornwall via recommendation from a fellow physio and athlete.

THE PROBLEM

Hampered for many years by debilitating pain in her left knee crease as she approached 10 miles running or if on a long descent.

She’d had many forms of treatment, been diligent with rehab, strength & conditioning programmes and graded return to running after periods of rest, but still left knee pain reoccurred. 
 
To say she was frustrated and nearly out of hope would be an understatement.


TARGET THE CAUSE

Using a rigorous and robust assessment process within a unique Physiotherapy whole body approach, ConnectTherapy™ I was able to determine that the driving cause of her recurrent LEFT knee symptoms was in fact, her symptom free RIGHT knee.
How she’d habitually braced her shoulders and ribcage musculature was also a secondary driving cause.

This sheds light on why numerous interventions and thorough treatment plans designed to directly affect her left knee have not delivered lasting results. The symptomatic left knee was just the painful ‘victim’ of silent dysfunctional movement habits elsewhere in the body.


TRAIN THE CHANGE

Having found the ‘Drivers’ of Ellie’s symptoms, we targeted hands on treatment to these areas (her right knee & mid thorax musculature*) and trained her nervous system to get familiar with the new more optimal habits of control through specific cueing and repetition.

For Ellie, she was able to go out and run further without pain straight away because she already had a great strength base and was applying the new principles and checks straight away post session. Important to note- she’ll need further training however to help her consistently control her Drivers throughout day-to-day tasks and work through specific movement, strength and endurance exercises so that the new habits and greater movement variability becomes part of her normal way of living.

*See Thoracic Ring Approach™


TECHNICAL BIT
The ‘biologically plausible’ mechanism

Habits she unconsciously adopted to protect and move her right knee over the course of her life and in response to old injury, didn’t quite afford all of the movement options that it needed. Her incredible nervous system compensated, and in this case, she slightly shifted her weight off the right side and over to the left. The brain soon regards this slight off centre position as the true middle. A new reference of midline is established, and the rest of the body adjusts accordingly.

The left knee was a ‘victim’ in this instance and the pain was due to it living in an excess rotation. Local musculature working against this force and the popliteus muscle in particular was chronically tense and symptomatic in reaction to running mileage and on descents.

Our amazing nervous system adapts like this throughout our life to the various stresses and events we incur, it’s how we keep learning, adapting and continuing.

However, when we compensate for numerous events over time and if we don’t regain or maintain enough movement variability for our entire body, we can effectively funnel our habits down to the extent that we use fewer movement options for multiple life tasks.

This is when an area may take more than its fair share, as in an excess rotation, compression or lengthening loading force. Overtime this can cause pain and, via numerous mechanisms and in this case protective muscle spasm to self-limit micro trauma over time.