Chronic knee pain in young adults is frequently managed through conservative modalities, yet persistent dysfunction often leads to early orthopedic referral and eventual surgical intervention. This case describes a 26-year-old female medical student with nearly a decade of debilitating right lateral knee pain that persisted despite bracing, physical therapy, and corticosteroid injections. In the setting of valgus alignment and chronic symptoms, surgical options were discussed during orthopedic evaluation, but the patient pursued osteopathic manipulative treatment prior to reconsidering operative management. This patient also presented with multiple chronic comorbidities, including Hashimoto's thyroiditis, type 2 diabetes mellitus, and a history of obesity, all of which are known to increase mechanical stress and systemic inflammation contributing to musculoskeletal pain. Despite medical management for these metabolic and autoimmune disorders, her knee symptoms persisted and progressively worsened over several years. Osteopathic structural examination identified a right anterior fibular head somatic dysfunction. High-velocity, low-amplitude manipulation was performed, resulting in immediate and substantial pain reduction from 9/10 to 4/10, with near-complete relief over the following 24 hours. Continued myofascial and muscle-energy treatments were administered to maintain pain reduction and function for weeks thereafter. This case highlights the potential of targeted osteopathic manipulative treatment as a non-surgical, low-risk alternative for chronic knee pain in young adults and supports broader consideration of fibular head biomechanics in musculoskeletal diagnosis and management.
Libman et al. (2026) studied this question.