In this article, Nuno Henriques, our Specialist MSK Physiotherapist, explains his process when helping his client, Kirsty, to recover from persistent knee pain.
Introducing Kirsty, the South London professional who loves touch rugby
Kirsty, one of my clients, is touch rugby obsessed! And she plays it competitively most weeks for her local team in South London.
Being a busy but sedentary city professional by day, not only does it give her the chance to let off steam, its a great way to socialise and it has very much become her social hub.
To prep for the game, Kirsty trains several times a week.
As a winger, her training plan centres heavily on sprinting (which she does twice a week) which she combines with gym sessions.
The problem: a continuous knee pain
Kirsty found that after sprint training sessions, she started to feel pain in back of her knee.
At first, this pain arose after her sprint session, but would disappear the next day. Over time, however, it would appear consistently during and immediately after sprinting.
The pain started as a small niggle but eventually became pretty severe and on testing she rated it a 4/10.
She noted that she sometimes felt a “twinge” when she was pushing herself to achieve personal bests.
In light of this, over time Kirsty became concerned.
Of course, to play competitive touch rugby, you need to be fit. And very sensibly, Kirsty recognised that this pain implied that she was susceptible to injury.
However, she also rationalised that as she is very active, maybe this small pain was normal?
The diagnosis: left/right leg discrepancy
Worried but unsure about this persistent pain, Kirsty contacted Technique and came to see me
Upon describing her problem, my first goal was to identify exactly what was causing her the pain; specifically whether it was her hamstring, calf, or both.
To do this, I performed two simple but powerful tests: a muscle bulk analysis and a hamstring and calf endurance test.
First off, the muscle bulk analysis brought no luck. It showed that her lower leg muscles were fairly even in size with only around a centimetre discrepancy. This wasn’t enough to say that the issue lay here.
However, the hamstring and calf endurance test brought valuable insight. Being able to do around 6/7/8 more reps with her left leg than her right, it revealed that Kirsty’s left side was much stronger, and therefore more dominant, than her right.
From this, I decided to enquire more about Kirsty’s fitness history, which reinforced this.
A couple of years ago, she’d experienced a partial tear on her right leg’s posterior cruciate ligament, as well as prolonged groin pain. (Note, she had visited a physio, who’d programmed single leg strengthening to resolve the issue).
Therefore, I diagnosed that Kirsty had a left to right leg endurance discrepancy causing her to overload the left leg during her sprints resulting in pain
The solution: unilateral training
In light of this, I devised a physio programme to reduce Kirsty’s left/right leg discrepancy and in turn fix her movement imbalance, predicting this to remove her pain.
To do this, I created a programme of unilateral training to correct her left leg’s overuse and imbalanced strength.
Specifically, this meant setting her a series of exercises: single leg Romanians; Nordic curls, and extenders
The result: realigned strength and reduced pain
I’m very proud to say that after months of training, this physio programme successfully reduced Kirsty’s left/right strength discrepancy and removed her pain.
We measured this using the hamstring and calf endurance test. From initially seeing a 6/7/8 reps difference in Kirsty’s left and right leg endurance, this has now been reduced to 3/4 reps.
Consequently, Kirsty’s pain has not only reduced, but has gone.
Kirsty has now returned to her original training plan, with sprint sessions twice a week.
Moreover, she is able to sprint at the same, and even more, intensity as before. (We started off conservatively but slowly increased to her pre-injury speed).
But most importantly, Kirsty has regained the confidence to play touch rugby again without the fear of injury.
It’s great to see Kirsty happy that she can play again to the same, if not better, level than last session.
The future: continuing strength alignment
Going forward, Kirsty and I are continuing to work together to reduce this strength discrepancy, including doing skill drills and false reactive training.
To learn more about Nuno Henriques, our Specialist MSK Physiotherapist, click here.
