A seasoned 49-year-old male runner presented with a non-painful limp that began after completing the Boston Marathon. He felt quadriceps stiffness, which developed into a limping gait. A bone scan revealed possible osteoarthritis, while an MRI revealed moderate chondromalacia (asymptomatic for pain). Physical therapy, yoga and acupuncture were not successful in resolving the limp.
Evaluation, clinical reasoning & treatment strategizing
Range of motion tests were normal; palpation and observation revealed an atrophied right thigh. The treatment plan was made to investigate the vastii quadriceps muscles because of their association with ‘trick knee’, and to assess the pathway of the lateral femoral cutaneous nerve in relationship to the sartorius muscle. Questions about daily activities revealed a diet high in processed foods/low in fresh foods, and a severe diet coke habit.
NMT sessions emphasized treatment of latent (non-painful) trigger points that could be interfering with muscle firing patterns. These included the quadriceps, adductors, abductors, hamstrings, gluteals and iliopsoas muscles, with emphasis on the vastus medialis and sartorius. Seven sessions that included NMT, gait re-training, fascial taping and hip flexor strengthening were mostly ineffective.
Outcome and follow-up
Having ruled out structural and biomechanical sources of the limp, a more biochemical (nutrition and digestion) component was suspected. Muscle health and nerve transmission can be adversely affected by poor nutrition. The client was referred to a nutritional consultant and then to a physiatrist for case management to look at whole-body biochemical, neurological and nutritional perspective before returning for further manual treatment.