Her knees always get painful first and then the hips will start to hurt. This typically happens after 45 to 60 min. of playing tennis. She feels that it is a bit less painful and that it takes longer time to trigger the symptoms when playing on softer ground.
Examination indicated a compensatory pattern from the toes to the spine. Reproduced knee pain by testing and palpating the knee capsule, lateral meniscus and the insertion of the iliotibial band. Both feet were pronating. Stretching the external rotators of the hip showed restrictions and increase in pain. Adductors were sensitive and shortened. Decreased dorsal flexion of the ankle both side and decreased inversion of ankle joint. Squatting was difficult to perform. Poor activation of peroneus longus and brevis.
We started ART treatment on her posterior talofibular ligament to increase the ankle dorsal flexion (dorsal glide of talus) and her lateral ligaments/retinaculum for inversion. When retesting squatting 5 min. later = no problems. Pushed her meniscus posteriorly on the tibia plateau, treated the iliotibial band and insertion, adductors and her hip external rotators.
Treatment was repeated 3 times and relevant exercises introduced. After 2 weeks the tennis player had no more limitations, thus no more pain. Preventive exercises introduced.
The ankle joint is of high importance when it comes to performance and endurance. If the ankle is limited/restricted in ROM, like this case, the problems will soon find their way up our kinetic lines. Although her pains, restrictions and weakness were in the knees and hips, the ankle was to blame.
Know you biomechanical stuff and your athletes will love you!