The Fascial Manipulation Method is a cycle of articles dedicated to the understanding of themost common dysfunctions we meet during our clinical practice, specifically theirmanifestation and treatment with Fascial Manipulation. FM specialists report clinical cases,accurately describing their symptomatology, the chosen work plan and the resultsobtained, thanks to the treatment. For privacy reasons, the names of the patients have been changed.
Clinician: Trevisan Gianfranco
A 52-year-old woman, employed and passionate about swimming and trekking, presented to the clinic with complaints of knee pain, predominantly localized on the left side. This issue began three years ago and had progressively worsened over the past year, reaching a severity of 0 to 8 on the NRS scale. The pain was most pronounced during activities such as climbing or descending stairs, walking uphill or downhill, or resuming movement after a period of inactivity. However, while walking on flat ground, the patient reported only mild discomfort.
The patient’s history revealed two instances of knee sprains coinciding with the onset of pain and a previous left ankle sprain that occurred five years earlier. She also reported persistent pain in the right hip and the left lumbar region.
Motor Verification:
During the motor verification, knee pain was elicited when the patient attempted to squat, while the lumbar and right hip pain intensified with forward trunk flexion. Palpatory verification focused on the left lower limb, particularly on the foot and talus segments, to identify potential alterations in planes and diagonals. The horizontal plane was the most affected, as confirmed by longitudinal palpation.
First Session:
The initial treatment targeted ER PE, ER TA, and ER GE points on the left side, balanced with IR TA and IR GE. By the end of the session, the patient reported a 60% reduction in knee pain and an 80% improvement in lumbar and hip discomfort.
Second Session:
Ten days later, the patient reported sustained improvements. The treatment continued to focus on the horizontal plane, addressing the following points: ER LU, ER PV, ER CX, IR PV, and IR LU on the left; and ER CX, ER PV, and IR PV on the right. At the end of this session, knee pain had further decreased to 2/10 on the NRS, while hip and lumbar pain had completely resolved.
Third Session:
In the third session, knee pain was reduced to a mild lateral discomfort (NRS 2/10), experienced only during squatting and climbing stairs. Palpation identified densifications along the frontal plane, including latero pes, latero talo, latero genu, medio genu, medio talo e medio pes. After treatment of these points, the patient reported no pain during squatting.
Two-Week Follow-Up:
Two weeks later, the patient reported an increase in knee and left ankle pain (NRS 6/10) during stair ascent and descent, accompanied by a sensation of shortening in the left lower limb. However, during motor verification, she only reported mild discomfort (NRS 2/10) while squatting. Palpation revealed densifications along the ante latero diagonal, and AN LA GE, TA and CX were treated. Post-treatment, the pain further decreased, though a slight shortening sensation persisted.
Further evaluation identified densifications along the retro medio diagonal, which were addressed at GE, TA and PE segments. Following this session, the patient reported a sensation of lightness and normality in the lower limb, with complete pain relief even during squatting.
Long-Term Outcomes:
A telephone follow-up conducted 15 days and one month later confirmed that the patient remained free of pain and discomfort. She reported being completely symptom-free and had resumed her regular activities without any limitations.