The Clinical Link Between CNS Tension and Acute Meniscus Tears
Clinicians often zoom in on the knee with an acute meniscus tear, but the body usually has other plans. In this episode, I walk through two client cases who arrived with classic meniscal presentations: pain, swelling, and loss of flexion. But the real driver of their pain at that assessment revealed itself only when I followed LTAP® findings back to the central nervous system.
I break down how CNS tension alters dynamic alignment, hip mechanics, and tibiofemoral arthrokinematics, and why this pattern shows up so often in clients with knee pain. You’ll hear exactly how I used the LTAP® to identify the true restriction and why the CNS initially mattered more than local knee work.
In this episode, you’ll learn:
• How CNS tension alters gait, hip rotation, and knee loading during daily movement
• Why addressing cranial containers can transform lower-extremity biomechanics
• How simple sensory-driven treatments can reduce symptoms in structurally injured knees
• When to treat locally, when to treat globally, and how to make that call with confidence
This episode Is a practical reminder that system-level clarity leads to better outcomes, whethers it’s in acute or chronic client cases.
Resources & Links Mentioned In This Episode:
Episode 86: Decoding The Nervous System For Health Pros
Episode 94: Understanding The Piriformis Puzzle
Learn the LTAP® In-Person in one of my upcoming courses
Considering the viscera as a source of musculoskeletal pain and dysfunction is a great way to ensure a more true whole body approach to care, however it can be a bit overwhelming on where to start, which is exactly why I created the Visceral Referral Cheat Sheet. This FREE download will help you to learn the most common visceral referral patterns affecting the musculoskeletal system. Download it at www.unrealresultspod.com
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Anna Hartman: Hey there and welcome. I'm Anna Hartman and this is Unreal Results, a podcast where I help you get better outcomes and gain the confidence that you can help anyone, even the most complex cases. Join me as I teach about the influence of the visceral organs in the nervous system on movement, pain and injuries, all while shifting the paradigm of what whole body assessment and treatment really looks like.
I'm glad you're here. Let's dive in.
Hey, hey, welcome back to another episode of the Unreal Results Podcast. I am coming in to finish talking about the cases. I want to talk about the last episode. I know I only got to talk one case because, um, I gave you a big update on how I was feeling with my illness and, um, went on a little bit of a rant, uh, from, uh, the comment on Instagram.
Also, as I was filming it, I was having a trouble breathing still, and I was like, okay, I'm done talking. I'm still a little bit like that. Like overall I feel better. I have like a little congestion and um. A cough that is lingering, which I hate. And um, I really wanna go get another nebulizer treatment 'cause it helped so much.
However, I've been pretty busy with work and, um, needing to get things done slash avoiding the drive to Encinitas. Um, I. Like always am like, feel kind of lame for me. Like I don't wanna drive to North County, but, and it's not even bad when I think about like, how traffic could be in Southern California.
Driving from San Diego to North County is actually not that bad. It's just annoying and I don't, it just like makes for such a long day, especially this time of year when the um. The days are so short just from a lighting standpoint, like I already feel like there's not enough time in the day because I don't know about you, but it gets dark and I am like, oh, time to do nothing.
It's time for bed. And so I just like, ugh. To drive to Encinitas is like 40 minutes from here. With no traffic, and then the treatment was like 45 minutes and then another 45 minutes back. But it's one of those things, it's like driving to la. If you drive to LA and you look out and it's an hour and 45 minutes to two hours.
That means on the way home, it's gonna be terrible. It's gonna be three hours or more. Kind of the same thing. Like if you luck out and get to North County in 30 to 45 minutes, then on the way home it's probably gonna be like an hour and or more. And I just, I hate that. So you can time it, if you can time it like midday, sometimes you can get 45 minutes on both sides.
It's just. That's right in the middle of the day and I'm doing stuff. So I don't know. I need to find somewhere closer to San Diego proper that has the nebulizer treatment because like I said, I really felt it was helpful. So hopefully I'll be able to get up there this week because I need it. Clearly. You can still hear it in my voice.
Um,
so. Whew. Excuse me. Here we go. What I wanted to talk about, I've had two assessments and treatments, um, lately. Recently for two men with meniscus tears diagnosed via Doctor slash MRI and come in with pretty uncomfortable swollen knee, can't kneel on it, can't bend it very well, just overall uncomfortable.
And you know, it was one of those things, it was like, well I'll set see you and treat you. And, um, still gonna use the LTAP to guide me, the locator test assessment protocol and my general listening local listening skills because I know that. And the body's protecting something else. It can change our dynamic alignment so greatly that it really does impact acute injuries.
And we talked about that last week on that, um, episode. But, um, it was just interesting because both of these men had, um, a similar listening and, um. So I was like, you know what, let's unpack that and talk about sort of the anatomical relationship to what might be going on. So one of them was my friend, um, a friend of mine.
He is, you know, they're both. Middle aged guys. But so my friend, he had, um, he's pretty active. He, he coaches his kids in their soccer games and, um, he runs when he can. He used to run more than he does currently, but like, you know, he's an active guy. Um, not a big like strength training kind of guy. He'll do exercises that I've showed him over the years to help some aches and pains here and there.
But for the most part, like he's a. I want to go and run and then be active in the yard and be active with the kids. And, and, um, when I was visiting them, he was like, oh, Anna, my knee hurts. And I was like, oh, I'll take a look at you. And what happened? He was actually just sitting on the couch one day and stood up and then his knee hurt and classic middle aged, um, insidious onset, and he got an MRI and um, it turns out he has a meniscus tear and not just a tear of the meniscus.
Um. Actually specifically he has a tear of the capsule, so like the attachment of the meniscus to the capsule. And so he has an unstable meniscus. And um, the doctor was like, you could have a tear, um, could be a root tear, could be a regular tear. He is like, we really won't know until we get in there. But what we do know is it's your meniscus and you probably need surgery and, um.
Which I would agree with that doctor, based on that diagnostic and based on like all the active things that he wants to do. I'm like, yeah, probably meniscus surgery is in your future. And, um. So anyways, I did the locator test assessment protocol on him, and, um, it directed me to his central nervous system, um, meaning that he had central nervous system tension.
And I'm gonna go ahead and have Joe link it in the show notes, but I think I've done at least one, if not multiple episodes on the difference between central nervous system tension and increased stress in autonomic nervous system tension. Um, okay, so let's not confuse the two. They do have a relationship, but when we talk about central nervous system tension, we're talking about a situation in which the, there is some sort of adverse pressure tension in the area of the central nervous system.
So the central nervous system is the brain. The spinal cord and its containers, right? So the brain and spinal cord are the contents of the central nervous system, and the container is the The head, right? The face and cranium, the spinal column all the way down to the tailbone. Okay? So when, especially when we have pressure or tension in the cranial part of the central nervous system. The body really doesn't like that, and so what it does is it takes the rest of the central nervous system, the spinal cord, and it side bends. To the same side as the tension to try to alleviate it, to try to decrease the amount of tension in the area.
And so what we, what happens in our body is we have this sort of big old C curve that happens. Our tail is trying to come closer to our ear hole, so we get this, this. Physical stuckness in side bending. And of course we can't walk around the world during the day as a C shape. So what does the rest of our body do?
It, it tries to orient itself to the horizon and create some twists and turns and, um, different mobility changes to maintain our upright position because we are on our legs. Our feet are fixed on the ground oftentimes too. What I see with this lateral flexion pattern is it's driven by the opposite sides piriformis, because I've done a whole episode on this too, and I'll have Joe link it in the show notes, but one of the main functions of the piriformis in gait is hip abduction, right hip abduction, which.
When we look at hip ABduction, when the foot is fixed on the ground, that's contralateral lateral flexion of the spine because what does the piriformis do? It helps lift the pelvis up and rotate it during our gait pattern. So this is what we see clinically when often not always. But it, I see it as very strong pattern that when someone has central nervous system tension, they're stuck in side bending to that side.
And on the opposite side, their piriformis will be holding the body in that contralateral lateral flexion as well as rotation to that side. So a forward sacral torsion. So piriformis tightness creates a forward sacral torsion towards the opposite direction as the tight piriformis also called the contralateral.
So you get contralateral side bent position, lateral flexion, contralateral rotation at the pelvis with that tight piriformis. This can be a pattern in central nervous system tension. So why am I even talking about it? Because when going back to this issue of the meniscus tear, this means when, when the body is being held in that pattern, our piriformis being tight, we are limited in hip ADduction, limited in hip internal rotation long axis.
Limited in hip external rotation, short axis, right hip mobility because of the piriformis and we, we know that piriformis changes function as a rotator throughout the range of hip flexion range of motion. I talk about that in that piriformis episode too, that I'll have Joe link the show notes.
So. What does that do to the mechanics on our knee when we are sort of physically stuck in a externally rotated position? Especially during like our, our stance? Um, it really F's up the arthrokinematics at the tibio tibio femoral joint, AKA, the knee joint, and. That is why it can put a lot of stress on the meniscus 'cause, especially the meniscus is involved in that rotational arthrokinematic control as the knee goes through flexion and extension.
And so especially in the lateral meniscus, but also it can, it's both lateral and medial meniscus, right? Because when we're lacking that ability internally rotate it, we have to make up for it somewhere else. And it's usually at the knee joint when, when our hip locks down or our ankle locks down, and it doesn't allow for either tibial or um, femoral arthrokinematic rotation.
The knee joint it tries to accommodate. And that is when things go south. So, um. So that was my one friend. Um, he was central nervous system tension. I'll talk to you about the treatment and stuff like that in a second. And then fast forward, actually literally the same week, I think, to be honest, it was the same week I go to Texas for the San Antonio LTAP level one course and the demo, the person I used for the demo, he also recently had torn his meniscus.
He had a diagnosed by doctor and MRI. Horizontal tear of his meniscus. His knee was swollen. He could not kneel on it. He did not have full flexion. He couldn't squat. Um, he, he couldn't lunge without pain. Um, significant pain and disability. And so I was like, he'll be a great demo because, well, one, I don't know if it's, I'm always like, I don't know if it'll change, but it's worth trying.
And then. If it'll change, like, wow, what a powerful example, which it ended up being so, and um, same thing. His locator test assessment. Directed me to central nervous system tension. So, um, both of them I treated differently. So for my friend, when it was directed me to the central nervous system, I went in there with my Barral Institute, neural manipulation skills.
I did an extra little assessment, um, and I utilized a technique, a manual therapy technique, addressing tension at the Tentorium. And, um. So then I did that treatment and then reassessed to see did I do enough? Did I take away the central nervous system tension pattern? Sure enough, I did. So then I went back to the knee and reassessed it, and now tibial internal rotation was better.
Um, and hip internal rotation was better, hip adduction was better. And then when I had. Then the next thing was like, okay, still a little bit, still a little bit left on the table with tibial internal rotation, even though it was better. So I decided to use cups and do dynamic cupping on the inside of the knee joint, kind of around adductor hiatus, infra patella, branch of the saphenous nerve, the ular nerves there.
Um, and um. Just did a little bit of cupping and then I had him recheck how he felt, and he's like, oh my gosh, I feel so much better. I can squat down, no pain. And he's like, my knee feels way better. He's like, how? He's like, how is that possible? And I was like, yeah, that's the crazy part, right? Like, trust me, you still have a meniscus tear.
He had a doctor appointment later that week, maybe even the next day, and I said, please still go to your doctor's appointment, still talk to the surgeon, still talk to him about how you're feeling. And he, he goes, well, if I feel really good, do you think the surgeon would be open for me to not do surgery?
And I'm like, well, that's a conversation for you and your surgeon to have. I was like, I wouldn't recommend it. I was like, if you needed surgery, you needed surgery. Um, but also, who knows? The body's cool. And I, I am like. Your body, your choice, and worst case scenario, it feels better for a while and then it doesn't and then you go back and get surgery.
But so he went to the doctor and sure enough, the next, it was like maybe two days later and two days later, he went to the doctor and the doctor's like, yeah, you know, looking at your MRI, you really need surgery, so let's get you on the calendar. And he was like, Hey, you know, I saw my friend, she is an athletic trainer and she treated me and I feel way better. Like my swelling's gone. I can squat. Like I feel really good. And he's like, so do you think I need surgery? And the doctor's like, oh, well that's interesting. But, um, he goes, you know, here's the thing. We'll put you on the surgery schedule. We're already scheduling out to January. Um, and he was like, if January comes and you have literally had no knee pain since this appointment, then go ahead and cancel.
He is like, but if you, you know. If we wait, then ski season happens. 'cause they live up in the Pacific Northwest. He's like, ski season happens, everybody hurts their knees and then it's gonna be even harder to get in to have surgery. So, um, and I just, I appreciated that approach for the doctor because I'm like, yeah, I'm with the doctor.
It's probably by the time January rolls around when his surgery is scheduled, chances are he will have felt it a little bit because again, I didn't change the fact that his meniscus is literally not attached to his joint capsule. So, um, chances are things might flare up again. Um, but it was cool to see it change with central nervous system.
Now to the other guy in the class. Horizontal tear, swollen guy couldn't kneel, couldn't do lunge or squat without discomfort, and I treated him. Um, so again, LTAP led me to central nervous system, central nervous system. I decided to not use my neural manipulation skills so I could show the students in the class like how you could do it just with the skills that you already have.
And, um. Understanding that the trigeminal nerve and the cervical plexus nerves innervate the tentorium and the tentorium is usually what is driving the central nervous system pattern. Um, I decided to do a assessment, a skin assessment scalp, a skin assessment skin slide, a skin stretch assessment of his entire scalp.
To find an area that wasn't moving, and I, sure enough I did. I found an area on the right side of his head, which happened to be the side that he was side bent to that was really not moving very well. And so I did a little, very gentle but specific treatment to that little tiny area of his scalp that did not move.
Literally what I mean by a treatment is like I literally took, that area, didn't move, and I like did a little stretch or induction stretch on it, an indirect stretch. I basically tested it, which directions, it was going easy and I followed it and maintained a stretch on it, and then it started changing.
And so, um, and I did this treatment in the side bending to the right. So he was in his protection pattern, which is nice 'cause that's meeting the body where it's at in its protection pattern. And it always loves that. And, um. Then I did a little hair pull in the area and I reassessed both the skin on his scalp, and then I reassessed the central nervous system tension test from the locator test assessment protocol.
Those were improved, so then I reassessed his knee and when we reassessed his knee, he could kneel on it with no pain. He could lunch with no pain and he could squat with no pain. And he, he and me and a lot of the class were like, what? So that was really cool to see. And again. More than likely he was having some of that like changing of the dynamic alignment, changing of the arthrokinematic of the knee joint because the body was trying to hold itself in essential nervous system tension pattern.
And um, again, I didn't take his, I didn't change the fact that he has a meniscus tear, but I did change the load on it. I did change the way the knee arthrokinematics and function was going and he feels better. And it's been, gosh, three weeks since that course. I think maybe let's look at the calendar.
Um, it has been one, two, yeah. Three weeks since that course. And I texted him a few days ago and checked in to see how he was doing. 'cause I was like, Hmm, I'm gonna talk about this. I wanna know how long it's been. And both. So he. I said, Hey, how's your knee feeling? And he is like, oh my gosh. He goes, I still feel so much better.
He's like, I can still kneel, I can still squat. Everything feels good. Um, so crazy. Three weeks, one treatment, one little simple treatment to his cranium and his knee still feels better despite him having a meniscus tear. And my friend, same thing. I treated him that same week. I asked him, I was back up in the Pacific Northwest.
Last week for work. So I asked him, I was like, Hey, how's your knee? And he is like, I mean since you treated me way better, he's like, everyone you know, he's like here and there. He's like, it doesn't necessarily feel a hundred percent. He's like, but it feels so much better after you treated it. And he is like, I'm gonna keep the surgery appointment for January, but we'll see how it goes.
And I was like, okay, well probably should do the surgery, but also So cool. Three weeks. And your knee still feels so much better with one treatment to the central nervous system. Now, both of these guys, if I were to see them again, would it come up central nervous system again? Maybe, maybe not. Might come up visceral, might come up. Uh, peripheral neurovascular might come up, nothing might, and nothing, meaning there's no protective pattern. And then I could just do whatever I would like at the knee joint or strengthening their quad if they had had swollen swelling or like working on ankle, mobile, whatever. I think maybe the driver to being what tore their meniscus in the first place, I could work on that.
Or maybe we're working on just general strength, you know, and getting things strong. So if they do end up having surgery, they're gonna be better off going into it. You know, the better people feel, the less swelling, the better the mobility, the better the strength going into surgery, the better the outcome from surgery.
So again, like it's just one of those things that it's like, I want people to understand that yes, even acute injuries that seemingly you wouldn't think have a visceral or a neural driver. Often do, often do meniscus, tears, knee, general knee pain. I see it driven by the central nervous system a lot, a lot, and so, so valuable to be able to have a tool like the locator test assessment protocol that can identify the central nervous system tension pattern, and then understand the neuroanatomy enough to know that I don't need any fancy treatment tools. Like I don't need to know cranio psychotherapy to understand that I know that trigeminal nerve and upper cervical nerves innervate that structure that is holding that tension in the cranium. I can, I, I can. Do drills, I can do things to facilitate, improve trigeminal nerve function, upper cervical nerve function.
Those are sensory nerves primarily. And so it's, it ends up being pretty simple treatments that make huge differences. So that's it. Those are the cases I wanted to share. Um, and you know, hopefully too, like I share these cases to like show you like. The LTAP in action. And then also, again, to get to your mind around the idea that like knee pain, meniscus tear, like shoulder pain, clavicle fractures, like things that are very musculoskeletal, very sometimes biomechanical, also often can be supported from a treatment standpoint with.
Or whole organism approach. And the really what a whole organism approach does is it gets us to appreciate understanding the visceral and the central nervous system and the peripheral nervous system influences and connections to the area by knowing the anatomy better. This is always what it comes down to, knowing the anatomy better, and then getting to choose better treatment options that are more precise and specific to exactly what you need.
Right. So that's it for this week. Hope you liked it. We'll see you next week.