Addressing Degenerative Joint Disease of the Right Knee through Integrative Therapeutic Massage while Treatment Planning Efficiently with a Deaf Patient; A Case Study
Frank Mazzella
 

Background Knee pain can result from injuries to the knee or hip. The knee joint is composed of three articulating bones – the femur (thigh bone), tibia (shin bone) and patella (knee cap). These bones are held together by ligaments and the quadriceps muscle helps with stability. The joint, like other joints in the body is lined with cartilage, but in addition, it also has menisci which help to mould the surfaces of the knee joint so they can articulate more favorably and help to provide some lubrication. Knee pain can result due to injury to any of the above structures.  The objective of this case report was to document the changes that were made to the case study participant who is deaf and suffers from knee pain especially around the medial aspect of the right knee. The case study was performed over a 5 week period and was supervised by the authors massage therapy school.  Each massage session lasted anywhere from 60 -150 minutes. Multiple modalities were combined in this soft tissue approach to resolving medial knee pain.

Case Presentation The client is a retired 70 year old divorced woman who is 5 feet 2 inches tall and weighs 150 pounds. The client is fully deaf in both ears and was diagnosed with prelingual hearing loss at the age of two.  She is affluent in sign language, she does not read lips very well and her main form of communication is through written communications to those that do not sign. It appears that the onset of this condition may have been a gradual one but 2 weeks prior to massage therapy superiorly to the gluteal region and inferiorly to the posterior leg compartment. The client’s Chiropractor gave a diagnosis of degenerative joint disease to both knees, with by bilateral lateral patella displacement.

Therapist Assessment - The client has multiple postural asymmetries that were documented in a postural charting assessment prior to the first treatment. The inferior aspect of the medial knee appears to have excess  tissue with fascial restrictions that were examined during pre-treatment palpations. Upon palpation of the medial aspect of the knee the client reported an intense burning sensation. It was observed that both patella’s were laterally displaced and this was confirmed with an anterior/posterior bilateral radiograph of the knees. The client’s gait cycle contains a limp when the client puts pressure on the right leg. Standing for a short duration during the initial postural charting assessment only exacerbated the knee pain.

Outcomes - The therapist is a massage therapy student and participated in this case study through the supervision of a clinical supervisor. he is in his 18th month of school and will graduate one week from the end of this report. The client’s overall level of pain decreased significantly and this was documented through three separate assessment measures that were later graphed. The client states that although she is not 100 percent pain free, the overall knee condition is greatly improved. Her ability to return to her regular routines and hobbies has been restored.

Keywords - Pre-lingual deafness, Osteoarthritis, Patella, Vastus Lateralis, Fascia, Table Tennis, Treatment Plan, Massage Therapy

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