Topics in sports medicine
Using the MyoKinesthetic System to Treat Bilateral Chronic Knee Pain: A Case Study

https://doi.org/10.1016/j.jcm.2016.07.002Get rights and content

Abstract

Objective

The purpose of this case study was to report the effects of the MyoKinesthetic (MYK) system on pain, functional ability, and psychosocial well-being of a 20-year-old female collegiate softball athlete diagnosed with chronic bilateral knee pain associated with osteoarthritis.

Clinical Features

The patient presented with bilateral chronic knee pain lasting more than 2 years. A clinical examination and radiographic imaging revealed chondromalacia and the beginning stages of osteoarthritis of the knee. No other comorbidities were noted.

Intervention and Outcome

The patient received 4 treatments with the MYK system over 2 weeks. Treatments 1 through 3 were directed at the S1 nerve root; the fourth treatment was directed at the L4 nerve root. Outcome measures included the Numeric Pain Scale, the Patient-Specific Functional Scale, and the Disability in the Physically Active Scale. Pain, function, and quality of life were measured collectively using the Knee Injury and Osteoarthritis Outcome Score. The patient experienced clinical improvements (minimal clinical important differences, minimal detectable changes) for all outcome measures, with the exception of the quality-of-life subscale within the Knee Injury and Osteoarthritis Outcome Score.

Conclusions

The patient in this case study reported a decrease in pain and an increase in function during the course of 4 treatments, which were administered over 14 days and in accordance to the MYK guidelines. Traditional treatment guidelines typically recommend 8 weeks for positive effects to manifest. Manual therapy techniques, such the MYK system, may be a viable treatment option for patients with osteoarthritis of the knee.

Introduction

Osteoarthritis (OA) is widely prevalent across all demographics and is observed in both active and sedentary populations.1 Moreover, OA of the knee is one of the largest causes of disability on a global scale.2 Chronic joint pain is the most common symptom of OA and contributes to a wide array of physical and psychosocial disabilities.3 Distress, dependency, anxiety, depression, and a reduced quality of life are possible side effects of coping with chronic pain.4, 5

Treatment for OA varies, depending on the severity and progression of the disease. Vague diagnoses and a lack of knowledge of the disease’s causes and progression often lead to ineffective rehabilitation and pharmacologic treatments. Although mobilization with movement techniques and a combination of joint mobilization and exercise have both been shown to decrease pain in patients with OA of the knee,6, 7 the time commitment for more conservative therapeutic exercise could be extensive and result in poorer patient compliance and higher associated medical costs.

Traditional conservative therapy may be lacking in effectiveness because pharmacologic interventions treat the symptoms without addressing the underlying cause of pain, and physical therapy mostly involves addressing deficits in range of motion and muscle strength.8, 9, 10 In contrast, the efficacy of mobilization with movement techniques and the combination of other joint mobilizations and exercise may lie in the correction of misalignment, structural imbalances, or positional fault6, 11, 12 of joint surfaces, which are thought to contribute to the development and progression of OA of the knee.13

The MyoKinesthetic (MYK) system, a novel intervention strategy that was designed to treat postural imbalances and compensations, may be useful for treating OA of the knee. The MYK system is based on a manual therapy technique that theoretically decreases and clears nerve nociceptor firing that occurs as a result of joint or tissue movement restrictions.14 The targeted outcome of MYK treatments is to create bilateral postural balance by treating the neuromuscular system along a specific nerve root, leading to more functional and pain-free movements.15 Treating specific muscles along the nerve root and balancing posture are theorized to decrease muscle spasms and increase range of motion; this treatment quiets nociceptive signals and decreases pain.14

Implementation of this system begins by selecting from a list of patient evaluation options.15 On the basis of the results of the evaluation, a specific nerve root level is identified as the cause of the postural compensation related to the nervous system. The clinician treats the patient by massaging the muscles along the identified nerve root, bilaterally. During the treatment, the clinician moves the joint passively while massaging the involved muscles and then instructs the patient to move the joint actively while continuing to massage the same muscles.15

The evidence that postural and biomechanical dysfunctions can lead to OA of the knee,3, 10, 12, 16 combined with the theoretical design of the MYK system, suggests that use of this system as an evaluation and intervention paradigm may correct postural dysfunctions,15, 17 reduce pain, and improve function and psychosocial well-being in patients with OA of the knee. However, there is currently a paucity of evidence regarding the use of the MYK system. Therefore, the purpose of this case study was to report the effects of the MYK system on a patient diagnosed with chronic bilateral knee pain associated with OA.

Section snippets

Case Description

A 20-year-old collegiate softball pitcher presented with chronic bilateral knee pain, although her primary complaint was pain and dysfunction in the right knee. No specific mechanism of injury was reported. The pain was described as constant and gradually worsening over the past 2 years. An initial clinical orthopedic examination was performed to rule out other injuries; positive results of tests for a possible torn meniscus required referral to an orthopedic surgeon.

Magnetic resonance imaging

Intervention

Patient-reported outcome measures (the Numeric Pain Scale [NPS] score, the Patient-Specific Functional Scale [PSFS] score, the Knee Injury and Osteoarthritis Outcome Score [KOOS], and the Disablement in the Physically Active Scale score) were collected prior to the postural assessment with the MYK system (Table 2). The MYK postural assessment was completed, and S1 nerve root treatment was indicated for the first treatment. Each subsequent visit required an additional postural assessment to

Outcomes

The patient experienced clinical improvement (ie, minimal clinically important difference18) in pain after the first treatment. At her second visit, the patient reported further improvement in pain (1 of 10) and clinically significant improvement (ie, minimal detectable change19) in function (8 of 10). The second treatment resulted in no immediate changes in pain or function, and the patient did not report any further improvement between the second and third visits. After the end of the third

Discussion

The patient in this case received 8 weeks of therapeutic exercise with minimal relief. However, with 2 weeks of treatment (4 treatments) using the MYK system, she reported an 83% decrease in pain and an 80% increase in function. Moreover, the patient reported clinically meaningful improvements, as indicated by achieving a minimal clinically important difference on the NPS and a minimal detectable change on the PSFS because of MYK treatments. The clinically meaningful results provided support

Limitations

The case study described in this article was the first to examine the effect of the MYK system on OA of the knee. However, it is a report of outcomes in a single patient. Other individual factors may influence the positive effects of this technique on patients with a similar presentation. The patient in this case was a young, physically active athlete; the effects of the MYK system may not be as beneficial on an older, more sedentary population. Moreover, because OA is a life-long condition and

Conclusions

The patient in this case study experienced clinical improvements in pain, function, and psychological well-being by undergoing an MYK system treatment protocol. The course of treatment was 4 treatments over 2 weeks; this was compared with the 8-week traditional rehabilitation protocol, as prescribed by her orthopedic doctor, which did not produce significant improvements. Although the MYK system may not be the solution for all patients with OA of the knee, it may be a viable treatment option

Funding Sources and Conflicts of Interest

No funding sources or conflicts of interest were reported for this study.

Contributorship Information

Concept development (provided idea for the research): V.F.S.

Design (planned the methods to generate the results): V.F.S., R.T.B.

Supervision (provided oversight, responsible for organization and implementation, writing of the manuscript): V.F.S., R.T.B., J.M., A.N.

Data collection/processing (responsible for experiments, patient management, organization, or reporting data): V.F.S.

Analysis/interpretation (responsible for statistical analysis, evaluation, and presentation of the results): V.F.S.,

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