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
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.
After Jonathan Kuttner had a serious hangliding accident above the cliffs of his home coastline, he had 6 years of chronic back pain.
This lead him to specialise in treating....
{ 15 comments… read them below or add one }
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
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
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
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
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
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
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!
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
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
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.
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.
Hi Jonathan, my trigger point is like a noggle on the tibis below the knee and doesn’t pain continually, but reminds me that its still there. Thank you , Marlene
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
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.
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