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In this case of a 13 year old female called Nyah, there was a 4 year history of right knee pain following a skiing trip. The pain was in the medial thigh, around the bulk of the vastus medialis (tear drop muscle). Scans revealed nothing so physiotherapy was ordered via the GP. Several sessions were taken, based around exercises, but the pain persisted.

When I examined Nyah, neurological and orthopaedic tests were unremarkeable, however I did find that she couldn’t contract several muscles eccentrically if I applied only a small force.The muscles involved were the hip flexors, pectorals, gluteal medius and gluteus maximus, with hamstrings, calves and toe flexors all bilaterally.

This situation is not generalised weakness. It results from an inhibition caused by an irritation on the body. It can be a spinal joint, tooth, or sometimes something quite remote. In Nyah’s situation, the one thing that strengthened all the muscles was when I asked her to press an area on her face just below her right cheekbone.

The reason I did this was that no spinal joints corrected the situation, and there was seemingly nothing left to try. The only thing in her medical history, was that she was under investigation for a mass in her right maxillary sinus. It seems benign but the irritation there was enough to inhibit large muscles in her arms and legs, putting her into a flexor withdrawal reflex.

I’ve included an image of the mass here with Nyah’s family’s permission.

Treatment comprised of massage to the area identified for around 2-3 minutes. The muscles all strengthened as a result. It was advised that mum was to continue this at home on a daily basis until a follow-up treatment 2 weeks later. Nyah reported feeling much stronger generally, and the knee pain had gone (By the way I did very little to the knee).

A month on and she is absolutely fine, and begun trampolining with no symptoms.

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