Mr. Miyagi & the Misaligned Fibular Head

Sometimes I feel like Mr. Miyagi in the clinic. Today, I had a patient come in who I hadn’t seen for a few years. He starts the treatment by praising me for fixing his Achilles tendinopathy when I saw him last time after he had seen “dozens” of other practitioners who couldn’t help him (Achilles Tendinopathy is something I seem to have gotten really good at treating).

Then, he describes his new injury, which no one else has been able to properly diagnose. He’s no longer running, but he’s been cycling for about 20 hours per week with groups and competitively and whenever he stands up to pedal, specifically on the upstroke on his left leg, he feels pain. I ask him to show me where and he points right to his fibular head. He says it’s not the knee, it’s not below the joint, but it’s right “here” and points to the fibular head again.

Right away this sounds very much like a misaligned fibular head (the head of his fibula bone is not seated correctly in the joint). It makes perfect sense because the tendon of the biceps femoris muscle in the hamstring (what he’s using when he’s pulling “up” on the pedal and standing) attaches right to the fibular head and with that many hours of riding every week I have no doubt that it’s become tight and is yanking on the fibular head enough to displace it slightly.

So, I have him lie on the table, I bend his knee with one hand, get my forearm under the fibular head with the other arm, and then with one quick motion I set his fibular head. “CRACK!!!” And the pain is suddenly gone. I explain to him what I just explained above and flip him over to work on his hamstrings, give him an exercise to help lengthen his hamstring muscles and tendons (Nordic Hamstring Curls) and send him on his way. He was both giddy and in total disbelief that, once again, I fixed his issue when no one else even knew what it was.

I owe a big thanks to my mentor, Matt Callison, and his apprentice, as well as my other mentor, Vasa Mik, who taught me how to identify and set the misaligned fibular head when it becomes subluxated.

For anyone in the field, these techniques are taught in the Sports Medicine Acupuncture/AcuSport Education seminar series.