Isolated knee pain: a case report highlighting regional interdependence.

Abstract

Case report. A number of pain referral patterns for sacroiliac dysfunction have been reported in the literature. However, very little has been written about pain localized to the knee joint for cases involving sacroiliac dysfunction. A 25-year-old female runner was self-referred to physical therapy for medial knee pain of 4(1/2) weeks' duration without a significant onset event. The pain completely curtailed her training for the Boston Marathon. Examination of the patient's knee and hip did not reveal any abnormal findings and there was no reproduction of pain with any test procedures except for medial knee joint tenderness to palpation. Additional, more proximal examination suggested significant asymmetry of sacral bony landmarks of the pelvic girdle without significant findings on the provocation tests of the sacroiliac joint. A single session of manual therapy procedures directed to the pubic symphysis and sacroiliac joint ipsilateral to the side of knee pain was provided. The patient was able to return to running without further incident of knee pain after a single therapy session. This case suggests the importance of regional interdependence in the examination of patients with an apparently common clinical problem. Furthermore, the case describes a previously unreported presentation of local knee pain possibly attributable to sacroiliac joint dysfunction.