Medial Kneepain - What/Why/How treat?

[Feelgood.MD]

Good morning from Germany to everybody.

I have a patient, female, 32, Sports: Dancing Latin, gym; Officejob, pretty slender. About a year ago she went mountainhiking, about 6 hrs, downwards jumping with backpack over the meadow, downhill. Day after Kneeswelling left leg - Pain!Long journey of Diagnosis started until finally MRI stated:heavy Bonebruise medial Femurcondylus, no "infraktion" intacte peripheral cortical structures.
Further Femuro-Tibial Chondromalacie Grade 3
Patella structure Wiberg 2 with Chondromalcia patellae Grade 3
no visual degeneration of menisci
small edema
Baker csyt 5*2,5 cm - Patient is about 155cm
Lig. all intact
was treated with physio no change - Arthroscopy, shaving, lavage, microfracturing - thereafter immobilistaion, crutches 0-load für 6 weeks, no physio. On Christmas 09 15° of extension deficite, constant medial kneepain.
Physio with Physical training legpress etc. no change!
Since the mid of Jan, the patient is with me,
P/E the patient has no control or possibility of Muscular stabilisation of the Joint, she has been training in a legpress without even having conrol over the joint, both of her Quads are totally atropied, she feels constant Pain at the Muscle/tendinous inbterface of the M.Vast. med., EOR in Ext. she feels "her" Pain left leg.
I'having her do Isometric exercises with moderate extension -
Easy PNF patterns without resistance
as well as I#m trying to build up some strength in her popliteus and Hamstrings - Musculuare endurance for the beginning.

Could anybody help here?
I'd like to get more to the core oft the problem

Thank you everybody

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[Yarok]

Hi

Have U checked
- hamstrings/adductors trigger points
- pelvic and lumbar spine
- balance between glut medius and ITB
- ilipsoas and tensor facie late
?

all the best
Yaro

[Feelgood.MD]

Yes, pelvic and lumbar spine are a mess rec. Blocks from L2-5, that her doc. seems to be manipulating over and over.Better knee after mobilisation of SIJ in Nutation
Triggerpoints - no change
Tensor and Iliopsoas was interesting, seems that she get's a draft into counternutation everytime she stretches.
Thanks for the Ideas I'll keep you posted!

[Yarok]

Hi
its great, U have found the active points. keep working with them. any trigger pointS on ASIS. or trochnter?
check pelvic ligaments as well

keep working invastigating remember its dynamic body, recheck before avery session.

all the best
Yaro