Many of you have experienced the problems associated with instability of the femoro-tibial joint (knee) and its relationship to the development of OA of the knee. Many of you have also witnessed or experienced the interesting phenomenon of treating a pelvic primary fixation (e.g. ilium), and finding that a previously sloppy, unstable knee becomes immediately stable!
In the past, I have offered the speculative opinion that there may be some sort of ligamentous relationship, which allows this to occur. However, this explanation was by no means satisfactory or perhaps, even logical. I would still contend that there is a mechanism which allows for the uncoupling of stabilization elements in the knee, in order to prevent lower quadrant restrictions, or mechanical disturbances from transmitting excessive load or stress, upward into the axial skeleton. This would prevent mechanical strain from potentially damaging the vital structures of the spine and spinal cord, which could lead to debilitating and life-threatening consequences.
Recently, I was treating a podiatrist, who was experiencing chronic knee pain. He had undergone an ACL repair, involving grafting of a portion of the patellar tendon. The results were rather unsatisfactory, inasmuch as he was subsequently unable to continue running (a previously favorite pastime), and was also experiencing chronic swelling and pain in the knee.
As I proceeded to find, and then treat, a pelvic injury pattern, I demonstrated the immediate stabilization of his knee. In attempting to rationalize this feature with my standard “ligamentous relationship” explanation, I found myself questioning my own theories. I suspect this was in part due to the fact that he was a health professional, who happened to be a specialist in disorders of the lower extremity.
As I began discussing possible explanations, I found myself reviewing the anatomy of the knee. I suddenly recalled a rather interesting muscle, the popliteus, which had always intrigued me, due its size and location. It is not involved with the obvious, physiological action of the knee, but with the more subtle aspects of rotational alignment of the knee during gait. Most interesting, is its attachment into the joint capsule of the knee! This key piece of information dawned on me as I sought an explanation for the sudden stabilization of the podiatrist’s knee. All of a sudden, it became clear – this was a sudden change in tension – which could only be explained by a neuromuscular process. The popliteus could be the reason for this alteration in joint biomechanics.
By correcting the shape of the ilium, we are likely normalizing the tensional relationships of the quadriceps (specifically the rectus femoris) and hamstrings, which are biarticular muscles (crossing the hip and knee). Receptors in these muscles may have a reciprocal feedback relationship with spinal reflex centers associated with the popliteus. With pelvic injury, increased stretch on the rectus femoris and the hamstrings, may result in golgi and muscle spindle activity. This may create an afferent signal at the spinal level, with cross reactive, inhibitory influence on the nerve supply to the popliteus, thus turning down the gamma efferent signaling to its intrinsic muscle spindles, resulting in reduced tone. The net result could be a reduced pretensioning of the articular capsule of the knee, thus apparent instability. Corrective treatment would tend to reverse this compensatory pattern.
Although this is still a theory, I would venture to guess it is a strong possibility for explaining this consistent finding in our experience in the utilization of Matrix Repatterning in the treatment of pelvic dysfunction.
The popliteus muscle in the leg is used to unlock the knee by laterally rotating the femur on the tibia during a closed chain movement (such as one with the foot in contact with the ground). It originates from the middle facet of the lateral surface of the lateral femoral condyle and inserts onto the posterior tibia under the tibial condyles, with its tendon running into the knee capsule to the posterior lateral meniscus. The Popliteus assists in flexing the leg upon the thigh; when the leg is flexed, it will rotate the tibia inward. It is especially called into action at the beginning of the act of bending the knee, inasmuch as it produces the slight inward rotation of the tibia which is essential in the early stage of this movement.
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