One of my regulars presented a few weeks back with pain in her right hip. She pointed to the pain in the right hip and pointed out the pain as I worked on that hip. I only spent a few minute on the hip before I moved to her left knee, lower leg, & foot. This is when she mentioned that her left knee was hurting as well. I could see when she arrived for her appointment that her left lower leg was swollen.
I also know that she broke her tibial plateau about three years ago and now has nine screws and a metal plate attached to her left tibia. Because of the inflammation, direct palpation was painful for her. I used SMRT to work the connective tissue along the anterior border of the tibia. The swelling began to lessen immediately and was mostly gone within five minutes.
This meant that I could palpate her lower leg. I felt distinct tension between the fibula and tibia on the anterior lateral aspect of the lower leg. Knowing that this means the tibia is shifted lateral, and that this tibial pattern is most likely due to increased inversion of the ankle (think supination of the foot), I reaching down and tested the ROM in the ankle. It was limited. With the calcaneus in my hand, I duplicated the pattern of the calcaneus and the talus, while moving the distal end of the tibia lateral.
I held this SMRT position for 60 seconds. When I released the position, her ankle had substantially more ROM, her tibia had shifted to a more neutral position, and the tension in the anterior lateral aspect of the lower leg had significantly decreased. This made it very easy to release the muscles in this area.
After balancing the muscular in the left lower leg, I rechecked her right hip and she reported no pain.
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