No system ever works alone

No system ever works alone

Case study 
A 30 year old male, with a chronic right knee pain, suffering from headaches, under performing at work and unhappy in his marriage.
The name used in this case study is not the real name of the patient.

Jay, a 30 year old software programmer, married for one year has been complaining of chronic knee pain for 18 months. At the age of 17, he suffered from a football injury. He had physiotherapy treatment around the knee with machines and manual therapy locally. He recovered from the initial injury; but the knee pain re-occurred a few times. Upon returning to football he re-injured himself, and stopped playing the game he loved. 
When Jay came to me, he felt helpless and confused about his future. He was not able to participate in social gatherings and activities due to the pain. It also contributed to his under-performance at work. The emotional stress and anxiety took a toll on his marriage.
Upon a thorough examination and an open chat, I discovered there were other factors that contributed to Jay’s chronic knee pain. The following are listed:

  • Right eye socket was slightly drawn back.
  • Non-alignment of the pelvis and mid ribcage.
  • Decreased range of motion of the neck.
  • Tenderness in jaw muscles
  • Swelling around the inside of the knee (knee cap region)
  • Tenderness in the breast bone.
  • Lunges and gait slightly deviated on the right leg.
  • Shallow breathing.
  • Stress at work
  • Disconnection from family and friends.


  • Treating the fascia connections of the systems. Fascia is our bodies connective tissue, providing the framework for our body. It runs continuously from our big toe to the top of our head, encapsulating our cells, each individual muscle fibre, each muscle, our bones, nerves, blood vessels and organs. It is EVERYWHERE!
  • Treating the visual system, visceral (organ) system, lymphatic system to help assist with the swelling, nervous system (especially the autonomic nervous system) to regulate the flight and fight response.
  • Prescribe specific exercises for the eyes, posture and spine region.

Lifestyle recommendations
After removing the barriers and impairments found in Jay’s physical body, the following lifestyle activities were implemented:

  • Minimising screen time after night, so that he gets adequate sleep.
  • Going for walks with the partner and exercising together for at least 2-3 times a week.

Positive changes overall. His headaches and knee pain significantly reduced after few sessions. Jay has lost weight. He has a better relationship with his partner. His energy levels have increased, and he feels that his body is functioning at an optimal level.
A message to take home
The body keeps a score. Old injuries leave a mark on the body, therefore it is important to check how the injured site integrates with the rest of the body.
Working on the systems of the body allows to bring back homeostasis; a balance point in the body where the body can heal itself.
No system in the body ever works alone. Never get injured alone. Never heals alone. Think bigger. Think systems.

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Camberwell Physiotherapist Nad Perera, founders, Alive Physio

Nad Perera

Chronic pain expert, Manual therapist and blogger

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