A 70-year-old man came to see me last August for a pain in the back of the knee he had for almost 3 years. In fact, the patient had consulted me for the same pain two years earlier.
The pain had appeared before a shingles attack that affected the S1 dermatome, which covers a part of the back of the thigh, pretty much the same area where he felt his pain. During the shingles crisis, the pain completely prevented him from walking. So the patient associated his pain this episode of shingles.
At the time of the first consultation, in 2016, the patient has difficulty walking long distances. He has pain in the back of the knee and in the back of the leg. The pain is stronger when he gets up from the sitting position and he is unable to flex the knee completely. The patient has no pain at rest, but feels it when walking. He also feels like his leg is weak and cold. Aside from this pain, the patient has no other health problems. Despite his age, he is in good general health and has opted for a healthy lifestyle to replace the Statins prescribed by his doctor for high cholesterol. The only noticeable symptom is that he has been urinating more often at night since his shingles attack, 8 months earlier.
During the first treatment, I treated in acupuncture the meridian affected according to traditional Chinese medicine. The following week, the patient reported an improvement. He could get up more easily, but pain in the hip and the inability to fully bend the knee persisted. To the acupuncture treatment, tuina massage and cupping were added.
The following week, at his third treatment, the patient was still reporting pain when walking. The pain originated from the back of the knee and radiated upwards to the back of the thigh. Intrigued by the persistence of the symptoms, I did some additional tests to better understand why the improvement of his condition was not more important. The patient had a marked weakness of the gluteus medius muscle (Trendelenburg gait and weak resisted abduction of the hip). In addition, we identified a specific point in the popliteal fossa and a soft mass in this region. Sensitivity to a very specific point in the popliteal fossa and the palpable mass, combined with the characteristics of the pain, led me to suspect that there was a blockage in the bloodstream.
Behind the knee is an important blood vessel, the popliteal artery, which brings oxygenated blood to the leg and foot. This artery can sometimes be compressed by the muscles around it. When this is the case, the blood circulation is diminished and symptoms can be expected to appear or increase when the muscles are more contracted (walking) and diminish or disappear when they are relaxed. In Western medicine, this problem is called popliteal artery compression syndrome (PAES – Popliteal artery entrapment syndrome). In Chinese medicine, the problem is named according to the path of the vessel or meridian that is affected.
However, the patient did not continue his treatments at that time. He did not return until two years later, after trying other approaches without success. When he came to my clinic in August 2018, the symptoms were pretty much the same as they were when I first saw him. He was still suffering from pain when walking and weakness of the leg. The pulse in the right ankle became difficult to perceive when the foot was flexed (dorsiflexion), which leads us to suspect a compression of blood vessel.
The treatments then aimed to relieve chronic tension in the leg muscles using trigger points and motor points. The first treatment only brought a slight improvement, but after the second treatment the patient was much better. He felt, however, a weakness in his leg. We continued, adding a treatment to restore the function of the gluteus medius. At the fourth treatment, the patient was much better. He could walk and go up or down the stairs painlessly. He no longer felt tired and weak in his leg. The patient was very excited about the improvement and about being able to walk without discomfort. He did not require further treatments.