During advanced trainings conducted at my office, people who have specific soft-tissue problems are invited to receive treatment from me with a small number of my students present. Mr. V. was one of those lucky few on our schedule. (I turn away nearly 10 people for every client we accept. Knowing this, I was a little surprised at Mr. V.’s distant attitude.) 

“Can you tell me again how you were referred to me?” I asked.

“Essentially, my wife encouraged me to come,” Mr. V. replied. “This isn’t something I would typically do, as I teach at the university.” 

I thought to myself, “What a strange comment,” but also believed that I may not have heard him correctly. 

“I have had knee pain for many years,” Mr. V. continued, “probably dating back to when I played football in college. My left knee is much worse than my right. I had arthroscopic surgery for arthritic changes in my left knee about two years ago, but it did not help. Lately, I have been diagnosed with patellofemoral syndrome, but the quadriceps strengthening exercises given to me by the physical therapist haven’t really helped either. My knee pain is seriously affecting my daily life.”

“Is there some action you can do that consistently initiates the pain?”
I inquired. 

“That’s easy,” Mr. V. answered. “It hurts every single time I bend it.” 

Sure enough, the pain on his face was obvious after bending his knee about 30 degrees. Mr. V. said his pain was only evident during weight bearing, and that passive motion of the knee was not typically painful. The pain was generally at the medial knee, but the distribution seemed fairly broad.

Having just reviewed several tests for patellofemoral syndrome with my students, we went right to work. It was at this point that the assessment train began to derail. None of the standard tests for patellar-tracking issues showed positive, in direct conflict with his diagnosis. That left me in an uncomfortable position, especially in front of my students. There were two possible explanations: either the tests did not pick up his condition (in which case, why should we use them?), or Mr. V. did not have patellofemoral syndrome. 

I decided to act quickly, choosing to treat Mr. V. as if he had patellofemoral syndrome anyway. Examining carefully his vastus lateralis, I was surprised to find nothing overtly remarkable in it or the iliotibial band. I then examined his vastus medialis, thinking that perhaps a trigger point had created motor inhibition, but found no trigger points. I asked him to stand again, and Mr. V. tried a small squat. 

“Still there,” he said. “No change.”

“Well, that was remarkably unsuccessful,” I said, stating the obvious. “Lie down again and let’s try a different approach.”

For the next 20 minutes, I kept adding muscles that might account for his pain, only to discover that none of them helped his ability to squat. Just as I was running out of options, I added treatment to the articularis genu muscle and asked Mr. V to stand up and squat one last time. Squatting, his face brightened, then a return to straight legs, then another squat.

“Oh my goodness,” Mr. V. exclaimed. “I can’t believe it! This is great. I can squat with no pain!” 

I couldn’t resist teasing him a bit. “I’d appreciate it if you didn’t act so surprised. We are supposed to get results. That’s the point!” 

“I can’t help it,” he said. “I’m really surprised. I didn’t think this therapy would help. I, um, teach at the university.” 

There was that comment again. This time I had to ask. 

“What does teaching at the university have to do with this?”
I asked.

“Well,” he said, “I teach a class on community health, and one of the modules is on quackery.” I continued to look confused as he was saying this. “Massage therapy is in that module.”

It took a moment for that last statement to sink in before
I asked, “Quackery? Seriously?”

Mr. V. looked a little sheepish, which was perfectly appropriate given the present pain-free state of his knee. 

“How old is the text you are teaching from? Actually, never mind,” I said. “I have a better idea. If you’d like, I’d be happy to come speak to your class about the science behind massage therapy.” 

Mr. V. happily agreed to have me speak to his class, and he left my office with a big grin on his face and a bounce in his step not present when he arrived an hour earlier. 

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