• The limited mobility and persistent pain in her knee were a result of scar formation, tissue adhesion and persistent swelling rather than due to muscle tightness or weakness in the leg.
• The persistent swelling in her leg was due to a lymphatic drainage problem.
• The difference in leg lengths along with trigger points along the leg and spine indicated a biomechanical dysfunction that most likely was the original cause of knee degeneration  and also was contributing to the lack of progress after correction.

Treatment consisted of :

• Manual flexion/extension traction with heat to lengthen shortened spinal muscles.
• Intersegmental traction to improve joint mobility in the spine.
• Manual manipulation to the spine and lower leg to remove fixations and increase circulation, proprioception and comfort.Aggressive vibratory massage to the scar and restrictions surrounding the left knee.
• Application of Kinesio Tape to the left knee with varying techniques to either encourage lymphatic drainage or to aid in muscle function.
• Patient was seen three times a week for four weeks.. then two times a week for six weeks and as of this writing prefers to be seen two times a week.

Result:

• A dramatic reduction in joint restriction was observed following the first treatment and continued throughout the duration of treatment.
• Lower leg swelling is persistent and contingent upon the patients activity prior to treatment. Swelling is confined to her ankle and medial knee but is greatly reduced in both areas.
• Patients pain has decreased to occasional from constant.
• Patellar restriction and scar formation have both been greatly reduced. During the initial stages of treatment improvements were observed at the top area of the scar in regard to flexibility and coloring. As treatment progressed, the scar started to widen and become absorbed by the surrounding area.
• After the 5th week it was observed that while the tissue towards the top and bottom of the scar were improving in mobility, the central area was slower to respond and on several visits has reverted back to its tendency to adhere to the patella. Alterations were made in the application of the Kinesio tape which resulted in a slow yet constant improvement in this area.
• By week 11 the whole scar has become mobile. althoug in different degrees. and lifted from the patella.
• Patient began squatting exercises and reported increased mobility, decreased pain and was very happy with her progress and the treatment.

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