Knee Trigger Points – The Case of Mysterious Falls

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There is one trigger point that behaves differently from all the others in the body. And this story shows how it works.

There was an elderly lady, in her mid eighties who had a number of falls. She was really a grand old dame, and very independent, but because
of the falls, she had become increasingly frightened and was staying home and walking either with a frame or with two walking sticks.

There was no obvious reason why she should be falling – her health was fantastic. All her previous doctors couldn’t find any cause for the falls.

When I saw her, she told me that as she stood on her right leg it felt unstable. So she couldn’t trust it and every now and then would completely
give way so that she fell.

When I examined her, it became more puzzling. She had no nerve problems that would account for this weakness and had only very mild wear and tear in the knee.

Then I made the most striking finding: she had a very active trigger point in her lower thigh.

Vastus Medialis - Knee Collapsing Trigger Point

Vastus Medialis - Knee Collapsing Trigger Point

This particular trigger point is most unusual. Unlike all the other triggers, when you stress it,  this trigger makes the muscle just give way.

I treated the trigger with acupressure, and when I was finished she got to up to test out her leg. She stood on it, hopped a little bit and a huge smile broke over her face.

‘Young man,’ she said ‘that feels completely different.’ She immediately dropped the one walking stick to the ground and strode around my consulting room. Then she waved the second stick around, and dropped it as well.

I picked up her walking sticks, handed them to her and she walked out the into the waiting room with both sticks tucked under her arm!

This was the real ‘throw away your crutches’ experience. It was wonderful, and I owe it to my knowledge of trigger points.

This lady returned for one more treatment, and after that the mysterious falls never returned.

Now, this was one very dramatic case. But over the years I have treated several other elderly people with the same problem.

But I can’t help thinking that there must be many other people round the world who have the same problem with the same simple solution.

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Comments

  1. Pedro Sepúlveda says

    Dear Jonathan: may be, and you´ll probably think that this is a silly question. Anyway and althougt I´ve been studying for years the anatomy and physiology of voluntary striated muscle I’m still very confused about trigger points. I read somewhere that trigger points might have three explanations: the theory of energy crisis; the motor end synapses; and radiculopathies. Why do they never include the role of muscle spindles disfunction? It’s quite clear when you apply pressure followed by a stretching manoeuvre the intrafusal fibers will return to normal originating this way an action potential to extrafusal muscle fibers. Probably what I’m saying is not more that a big nonsense. I´ll be waiting for your opinion. Cheers Pedro

    • Jonathan says

      hello Pedro

      It is absolutely not a silly question! Muscle spindle malfunction or dysfunction has to be one of the primary problems of trigger points. They are an essential part of the protection and basic posture mechanism of the motor system of the body. It may also be that an “energy crisis” is part of the formation and the prolongation of myofascial dysfunction. the motor nerve ends in the motor endplate which is like a foot at the base of the nerve. this then transmits information to the muscle via the synapse. the vast majority of trigger points occur at this point, presumably because there is increased excitability in this area.

      So, all the suggestions be incorporated into a larger picture of the cause and perpetuation of trigger points.

      Kind regards
      Jonathan

  2. says

    I am so glad you wrote this article “The case of the mysterious falls”. I recently worked on a friend of mine who works on my car and, in exchange, I give him much needed massage for his back. He was in a car accident January 2010. He also does a lot of heavy lifting for his work. His major concern is low back pain. Sometimes it’s been so bad that he’s stayed in bed with a heating pad. He’s a young man in his early thirties. I focus on Trigger Point therapy and use Deep Tissue work to help relax the muscles. His back is tight and I did some DT and TP work to his shoulders and worked on his QL’s, which were a little tight. I then worked on his glutes, giving attention to his gluteus medius. From there I worked on his hamstrings and did some passive stretching as well as some Swedish and DT. Afterwards, I did do just a little myofascial release. I only know just a couple of techniques or I would have done more. The next day he told me, that when he got up in the morning, his right leg just collapsed under him. I couldn’t think of any work that I had done that could have caused this reaction. I did advise him to see his chiropractor the next day to have an exray to see if there was any compression on his nerve(s) from his vertebra/vertebrae. While I still think this was good advice that he should follow up on, I now do believe that there could be more that I can do. Since he does heavy lifting it’s likely that thevastus medialis is becoming overstressed with lifting heavy hotwater heaters, etc. If he is lifting correctly, he would need to be using these muscles to assist in lifting. My next session with him will include work to the vastis medialis. I will keep you informed on how that works out

    • Jonathan says

      Hi Pixie

      I agree that it is quite likely that they trigger point in his vastus medialis may well be the cause of the collapsing knee. you can sort this out quite quickly with a careful examination and then if you find a trigger – to treat it.

      Other causes may be damage to the meniscus of the knee or an anterior cruciate ligament tear. You’re quite right that the third cause may be weakness arising from compression of the nerve coming from his spinal cord.

      Let me know how it went.

      Kind regards
      Jonathan

  3. Linda King says

    I want to say a huge thank you for this information on the knee trigger points. I personally suffer with this and I will be able to use this in my sports massage treatments that I do. I have really enjoy all the emails you have sent me on trigger points and would like again to thank you for all your hard work.
    Regards
    Linda

    • Jonathan says

      hi Linda

      I am delighted that you have found the information on need trigger points helpful both for yourself and for treating clients. Keep up the good work.

      Kind regards
      Jonathan

  4. Rose Robertson says

    Jonathan
    Have never heard about this condition before.
    I had ‘collapsing knee’ for a spell at 21 years old, when waitressing after months of intensive study for my final exams at Uni. I fell off a pavement when the knee collapsed once. I think I was the only waitress to drop two trays in a week, much to my dismay. I never did follow it up – thought I was unfit and just became more active.

    Now I wonder if it’s a weakness that is feeding into a present condition I have now (40 years on, ho ho) with the hip on the same side. Osteoarthritis of both hips only produces pain symptoms in that hip (not collapsing knee exactly but acute, sharp intake of breath pain when pushing trolley round corner in supermarket etc. )

    Recently, the only exercise given me by hospital physios that has touched the problem has been a particular stretch to the quads (lie face down, knee bent up, lift thigh, straighten leg slowly and slowly lower leg).

    I identify the vastus medialis TP in question. It is very tender. I relieve it and wait to see how things are. Thank you so much for this piece of info. Long time, and forgotten, mystery under investigation!

    • Jonathan says

      hello Rose

      The trigger point in vastus medialis occurs much more commonly then is usually recognised. treatment after that often will make your knee feel more stable and stop the knee collapsing unpredictably. Trigger points in the vastus lateralis (the major muscle of the quadriceps) also refer pain to the knee and treating those may make quite a difference to your pain.

      You can slow the process of osteoarthritis in your knee by:
      losing weight
      increasing the strength of your muscles (quadriceps and hamstrings) — these act as shock absorbers for the knee.
      take glucosamine 1500 mg and chondroitin 750 mg per day.

      I will be interested to hear what treatment of the vastus mediators trigger does for your symptoms.

      kind regards
      Jonathan

  5. Kristine says

    Dear Jonathan! I am an 10K runner and changed my “high-sole” shoes for the “low-sole” shoes (usually called by competition shoes) and having so many trigger points in my calves and mostly the pain manifests on my heel(s). So I must change sometimes the shoes to not having troubles on my heels. I really like to run with my low-sole tenis rathen than the normal-sole tenis, but are creating a lot of pains on my heels. Do you have any advice about how to treat my “heel pain” which I think are coming from my calves. Thank you. Kristine

    • Jonathan says

      hello Kristine

      Trigger points in your calf muscles (gastrocnemius and soleus) can be treated with a mixture of ischaemic pressure, acupuncture or focal injections of local anaesthetic followed by appropriate neuromuscular stretches. Using a heel raise or wedge can reduce the tension on your calf muscles but does change your biomechanics. Sometimes flat feet with hyperpronation can perpetuate these trigger points and the use of appropriate orthotics can be really helpful. Sometimes heel pain can come from plantar fasciitis- which requires specific therapy.

      Kind regards
      Jonathan

      PS As I am not able to take a full history, examine you or to view your investigations, my comments will be general suggestions which you may choose to pursue with your own medical practitioner.

  6. Lisa says

    I just wanted to comment on the runner with pain in her heels when running with low-soled running shoes. I can’t speak to her situation specifically, but it may have to do with her running stride (if she lands primarily on the heel). Barefoot runners (or runners using very thin-soled shoes) have a very different stride where they land more evenly across the foot rather than heel-to-toe as most runners with traditional running shoes. Some barefoot runners claim they have fewer injuries because the stride is more natural for the body. I’m not a runner myself, but have started walking in very thin-soled shoes and have had to change my walking stride to avoid injuring my heels. Just a thought.

  7. Lidiya Voros says

    Thank you very much for the article “The case of the mysterious falls”
    It was exactly what I needed. I personally suffered with this. When I walked my legs felt like they were different length and left leg felt loose (right leg was okay). I felt like I was limping. Rarely my left knee cup collapsed and I stumble.

    When I started a careful examination Vastus Medialis I couldn’t find a trigger point to treat it, but muscle was painful and tight. I started to do gentle massage with 20% camphor oil twice a day. After a week, or so, the muscle was soft and the problem disappeared.

    I want to say you many thanks for all information on the trigger points.

    Kind Regards
    Lidiya Voros

  8. Bill Minish says

    I am an eighty-five year old man of good health with no cronik pains. During the last several years I have experienced times when my left knee would collaps while I was walking but never while was still. It was as if my left leg did not exist when I planted it for the next step. The failure of the knee never lasted for more than a split second and I was always able to recover and avoid falling. There was never any warning of any occasion nor was there any pain associated with it.–until five days ago when I was walking alone through a shopping centre parking lot. I was walking quite rapidly when my left knee collapsed. This threw me into an unstable forward leaning stance from which I was unable to recover. I landed on my hands, my elbows, and my knees. I received abrasions to all of these parts plus sore right shoulder and bruised or cracked right ribs. Although shook up I was able to get up and do some minor business I walked home, (a fifteen minute walk). Then the pains began.
    Is it possible that these knee collapses are triggered by some malfunctioning protective mechanism of the body?
    Thank you very much for the Trigger Points Manual which I received this morning.

  9. April says

    I have had continuous pain just under my knees towards the side of the legs. No one appears to know the cause and I cant find a trigger point to release the pain

  10. Ralph says

    It hasn’t been explained why the VMO TP behaves differently from all others, nor has anyone asked.
    I fail to see what Kirstine’s heel pain has to do with this VMO.

  11. ROY RATCLIFFE says

    Hi Dr Kuttner finding your info on triggers very helpfull , i have had a trigger in my neck for 15 years it has been very differcult tocope with some day i have been applying presure on it but not been able to get rid of it, do you think acupuncture woul work on my neck. it would be grate if you could find the time to give me some feed back , keep up the grate work. yours sinserley roy.

  12. Martha Virden says

    Dear Dr. Kuttner, I have suffered with fibromyalgea for 33 years. I am now 76 years old. Pain was constant for 22 of those years in my neck, rib cage and arms. Now I have trigger points everywhere and I have been unable to apply the pressure on them without causing pain. The jump around and sometimes I’m successful in one area like my upper arm and they move to my thighs or somewhere else, I’ve tried Feldenchrist, Somatic, yoga, Alexandra methodaerobics, walking and other exercise methods. I’ve been to chiropractors, had accupuncture, acupressure, and isometrics. Now I’m taking Zumba dancing, which does not seem to be followed by any more pain. I had a hip transplant 2 years ago and a compressed verterbre last fall which causes a pain when I get up in the morning and when I’m sitting or lying down for a while: stretching helps some. I thank you for all the information you send me. I live in the Miss. Delta where there are a couple of massage practioners, and chiropractors, and physical therepists . and that is it. Massage does not last. The most effective treatment is light tickling over the hurting area, which more often than not is out of my reach. Any more suggestions? Thank you again. Martha

  13. Maureen says

    Hi Joanathan, I found this intersting reading,i have had one knee replacement in my right knee,and my left knee also needs doing ,but because of my back un stability i am puting it off as long as possible, plus my left sacorilic joint muscells arent stablised,i have reflexology,and have been told i have trigger points in my calfs ,which he massages for me and shown me how to do it,it helps,i also have a very tight left shoulder,which feels swollen ,and can you get trigger points on your head just wondererd as i have severe anziety symthoms ?Maureen

  14. Ann says

    Hi Jonathan,

    While I was training (Judo), I got a small tap against my left ankle (on the lateral side). Nothing happened, it looked like the time stood still for a second, and then my knee collapsed to the medial side. It hurt for a long time and the physiotherapist didn’t know actually what to do. The only treatment he applied was muscle strengthen exercises, but my knee kept hurting and felt unstable. It felt like I couldn’t trust my left knee anymore. After five/six months I went to another physiotherapist, which used trigger point therapy. After the treatment of my vastus medialis, I was able to stand only on my left knee while bending it (for the first time since the accident!!!).
    Unfortunately, the trigger points in my vastus medialis still come back. For example when I’m stressed for a match. How can I stop the trigger points from coming back?
    When they come back, I also can’t turn then off by myself, because the only way to turn that one off, is to use dry needling. Can you tell my how to stop that trigger points in my vastus medialis from coming back definitively?

  15. Shaktimanah says

    whatever the modality TP’s are esentul knowledge so thank you for your association & if your ever in the Hartford CT area look me up for a free (MT) or Reiki session, In grattatude (WC) a.k.a. Shaktimanah.

  16. says

    Finally! You have just explained my falls. It was such a frustration to my orthopod that he told me I would just have to learn to fall!! Then he dropped me as his patient. Knowing about the trigger point issue would have saved me years of pain and being thought “crazy or a faker!
    Thank-you.

  17. William E. Wheeler says

    Hello Jonathan, I have just come across your article and I was quite amazed.
    A year ago I went into hospital to have my gall bladder removed,when I returned home after a week I found that my legs felt quite weak. A week later I started falling without any reason, in 8weeks I fell down 16 times, the first was I fell down my stairs backwards, and then frontwards, and then I fell in all manner of places – I have had scans , x- rays, and have been treated with my doctor, nobody could tell me what was causing the problem! I then decided to go to a chiropractor , following a examination she told me that she thought that I had a muscle pressing on a nerve, over the next few months I stopped falling, and my legs felt stronger, I finished going to the clinic now, and I’m left with some pain in my knees and my thigh. I am going to try the trigger point you mentioned (if I can find it).

    William

  18. REMO says

    Hi Jonathan, thank you very much for your precious emails! I’d lik e to know if you can show us something about the Dry Needling Technique. Isn’t faster (and less painful) to needle a muscle rather than compress it? Have you got some stuff about? Ciao dall’Italia.

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