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      Working with a pt with a complete tear of the medial patellar retinaculum. She can no longer hyperextend (as in the contralateral side) and has developed lateral quad tightness and overcompensation in the hip (internal rotation on quad set) with general quad atrophy. Wondering if IDN can improve tone in the VMO. She does NOT want surgery but I feel the structural change will continue to compromise the whole LE in time. She is a very fit, athletic 50 year old who teaches gymnastics.


        Hey Susan,

        Absolutely I would include IDN in my rehab planning. How long since the injury? What other conservative care have you done?

        It sounds like you have the pattern figured out so just use needling to accomplish the clinical goals you are describing. Needling in the femoral and obturator nerve distributions makes perfect sense. I would suspect some guarding in the adductor magnus and short adductors. I would try do some needling and facilitation in and around the glutes (HA’s superior cluneal, inferior gluteal) and would expect to find some guarding/tone in the area of the TFL to help with hip IR compensation. Don’t forget the posterior leg. HA lateral popliteal, popiliteus, proximal gastroc heads, sural are a few areas I would think to assess.

        I also would not hesitate to do ENS in the femoral n. distribution with a focus on the VMO. Follow that with your re-reduction drills. Try to re-enforce a less compensated pattern in the pelvis to get the activation you want.

        Dosing considerations include QA score, acuteness of injury (1/2 inch or more superficial needling around the knee and areas of swelling if acute), current pain level, and of course patents comfort with dry needling process.

        Let me know follow up questions or specifics from there. Keep us posted on how she does!

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