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An Integrative Manual Therapy Viewpoint on Chronic Knee Pain

From a more whole-body, Integrative Manual Therapy approach, we can take this idea of balanced forces a step further and find ways to help even the more chronic problems at the knee.



We have seen patients with long standing problems, who have findings on an MRI of degenerative problems, patients who have been un-helped with standard good quality physical therapy, orthotics and anti-inflammatory medications.



We’ve been able to help these people by looking further into the cause of the problem, the “why” of the injury. Why would a person’s body keep a pain or problem for 10 or more years, despite resting it and despite good treatment?



What I’ve found is that, especially in difficult or chronic cases, the body is protecting something very important, and this is why the knee is not healing.



Let me give a brief explanation. In standard physical therapy treatments, we look at strength and flexibility around the affected area. However, there is so much more in the body. There are organs, lymph vessels, veins and arteries along with the toxins that affect the body.

The body will use “less important” structures like muscles, ligaments, tendons, and even joints to protect “more important” structures like organs or vessels. It will also do the same to protect itself from toxins.



There are common patterns when you look at the body from this more whole-body approach. If the body has toxins from a leaky gut syndrome, which is very common, the pelvic organs can be affected. The body will then lock down the joints of the pelvis and hip, which in turn affects the way the leg works.

If the body has infection and inflammation in arteries, also very common, the body can lock down the spine, pelvis and legs. If the body has infection and inflammation in the urogenital areas (uterus for women, prostate for men or bladder for both), the pelvis can lock down, causing more compression in the knee and leg.



In all of these cases, the knee will have a hard time healing because of all of these protective restrictions in the spine, pelvis, and legs. The body is more protected from infection and inflammation, but the spine, pelvis, and legs are tight and causing stress on the vulnerable knee.

Ralph Havens PT, OSC

Ralph Havens, PT, OCS



Ralph received his undergraduate degree from Texas A&M University in 1981 and his masters of science degree in physical therapy from Texas Woman's University - Houston in 1985.

He is a board certified clinical specialist in orthopaedic physical therapy. His post graduate training has included extensive study in Integrative Manual Therapy, joint and soft tissue mobilization, craniosacral therapy, visceral manipulation, mechanical link, and strain-counterstrain. He has worked as a teaching assistant for soft tissue mobilization and craniosacral therapy courses.

Ralph is also a marathon runner with a personal best time of 2:28:15 in 1990. He has been the owner of Mission Hills Physical Therapy since 1992.

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