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Successful treatment for knee and patellar increase range of motion and degrees of freedom.

Updated: Apr 18

Client Case History as of 3/30/2023:

16 months since fall injury resulted in a ruptured kneecap in multiple pieces ➡️ surgical reconstruction ➡️ physical therapy ➡️ screws came out of place ➡️ a second surgery ➡️ additional physical therapy intervention ➡️ lack of range of motion improvements leading to nerve damage/impingement ➡️ specific injection treatment and 5 out of 6 consulted doctors advised patellar replacement surgery ➡️ an unfortunate car accident caused setbacks in progress ➡️ more physical therapy ➡️ months of constant pain, difficulty with basic daily tasks, walking with a cane, and inability to move the knee due to excruciating pain and discomfort, toe walking, and locked ankle in high heel plantar-flexion.

FRA (Functional Range Assessment) and palpation tissue evaluation on 3/30/2023 revealed:

▪️Difficulty assessing in the prone position due to pain when the knee's gravitational extension and skin contact with the table surface (indicating altered length-tension relationship),

▪️Knee flexion: 140* Passive ROM

▪️Knee extension: -40* Passive ROM

▪️Ankle dorsiflexion: difficult to assess (when walking, heel always positioned approx. 6-8cm above the ground, mimicking an imaginary high-heeled shoe 👠)

▪️Absence of any patellar gliding or degrees of freedom (completely restricted to one position),

▪️Abnormal fibrotic tissue deposition with visibly and palpable increase in volume of the infrapatellar fat pad, medial and lateral to the patellar tendon,

▪️Restricted scar tissue movement and extensibility (note: second surgery incision along the same scar tissue)

▪️Medial part of the patellar tendon with significant "ropiness" sensation of connective tissue (seems related to surgical incision, deep collagenous scar, and haphazard fibroblast cell deposition)

▪️Additional important anatomical structures restricted over time due to tissue retraction, loss of extensibility, and atrophy from 1.5 years of disuse, including quadriceps group, rectus femoris insertion site, patellar tendon, ACL, PCL, LCL, MCL, other knee joint ligaments, Achilles tendon, calf muscles, and distal tendons of the hamstring muscle bellies.

▪️Left leg bone density loss over 20%

▪️Adipose/fatty infiltrations surrounding quadriceps tendon, above the kneecap, popliteal fossa, Achilles tendo-calcaneus medial and lateral area.

From April until October 2023, we followed a treatment and training plan entirely based on Functional Range Systems rules and principles, encompassing 12 hands-on weekly sessions (45 min each) using @FunctionalRangeRelease manual therapy inputs combined with @FunctionalRangeConditioning homework, featuring multiple daily training inputs.

The client's successful progress allowed her doctor to schedule an arthroscopic knee surgery to investigate potential bone spur formation under the kneecap and extract adhesive formations accumulated post-surgery.

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