Integrated Manual Therapy & Orthopedic Massage For Complicated Knee Conditions

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1 Integrated Manual Therapy & Orthopedic Massage For Complicated Knee Conditions Assessment Protocols Treatment Protocols Treatment Protocols Corrective Exercises Artwork and slides taken from the book Clinical Massage Therapy: A Structural Approach to Pain Management Published by Pearson Education By Author & International Lecturer LMT, CPT

2 Integrated Manual Therapy & Orthopedic Massage For Complicated Knee Conditions Today s manual therapist needs to have multiple skills in order to address a wide variety of complicated musculoskeletal pain conditions. Specialization in just one modality is becoming a thing of the past because of limited patient outcomes. This unique total system consists of orthopedic assessment, clinical reasoning, multidisciplinary and multimodality therapies, and precise corrective stretching and strengthening exercises. Participants will learn to integrate the skills of leading practitioners from the fields of massage therapy, physical therapy, athletic training, personal training, osteopathic and chiropractic to restore balance, posture, function and pain free living. Recent clinical studies will forever change the way manual therapists look at musculoskeletal pain, muscle-tendon strain pain, and adhesive capsular pain. This seminar will teach manual therapists to address ACL & PCL sprains, medial collateral ligament (MCL) sprains, lateral collateral ligament (LCL) sprains, medial and lateral meniscus injuries, patellar tendinosis, chondromalacia, bursitis, IT band friction syndrome, hamstring strains, posterior fixated fibular head pain, and posterior knee pain.corrective stretching and strengthening techniques will be also taught to keep the muscles balanced, and joints aligned for pain free living. Twelve Steps: 1. Client History 2. Assess Active Range of Motion 3. Assess Passive Range of Motion 4. Assess Resisted Range of Motion 5. Area Preparation 6. Myofascial Release/ Compression Broadening 7. Cross Fiber Gliding/Trigger Point Therapy 8. Multidirectional Friction 9. Pain Free Movement 10. Eccentric Scar Tissue Alignment 11. Stretching 12. Strengthening is an Author & International Lecturer who teaches approximately 40 seminars per year around the globe. He s served as AMTA Sports massage Chair and FSMTA Professional Relations Chair. He s developed 8 Orthopedic Massage and Sports Injury DVDs, and authored manuals on Advanced Orthopedic Massage and Client Self Care. His new book, Clinical Massage Therapy: A Structural Approach to Pain Management was published by Pearson Education in James presents at state, national and international massage, chiropractic, and osteopathic conventions including keynote addresses at the FSMTA, World of Wellness, New England Regional Conference, the World Massage Festival, and Australian National Massage Conventions. His audience includes massage and physical therapists as well as athletic trainers, chiropractors, osteopaths, nurses and physicians. He is a certified personal trainer with NASM. James received the 1999 FSMTA International Achievement Award and was inducted into the 2008 Massage Therapy Hall of Fame.

3 CLINICAL MASSAGE THERAPY A Structural Approach to Pain Management CHAPTER 3 Knee and Thigh Conditions Chapter Outline Twelve-Step Approach to Knee and Thigh Conditions Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL) Instability Patellar Tendinosis and Chondromalacia Quadriceps Protocol Plantaris Strain Chapter Outline Popliteus Strain Medial Meniscus Injury and Medial Collateral Ligament (MCL) Sprain Iliotibial Band Friction Syndrome Lateral Meniscus Injury and Lateral Collateral Ligament (LCL) Sprain Learning Objectives Choose the appropriate massage modality or treatment protocol for each specific clinical knee condition Release all the forces surrounding the knee, and eliminate the underlying cause of the knee conditions before addressing the clinical symptoms Learning Objectives Determine if there is an imbalance among the muscle groups that surround the knee Restore pain-free knee joint normal range of motion Learning Objectives Differentiate between soft-tissue problems caused by: instability or hypermobility of the knee myofascial restrictions Muscle tendon tension muscle imbalance 1

4 Learning Objectives Differentiate between soft-tissue problems caused by: myoskeletal alignment problems trigger point tension strained muscle or sprained ligament fibers scar tissue Learning Objectives Teach the client self-care stretching and strengthening exercises (if needed) to perform at home to maintain muscle balance, joint alignment, and pain-free movement following therapy Precautionary Note Figure 3-1 ACL Stability Test. Do not work on a client with a recent injury (acute condition) exhibiting inflammation, heat, redness, or swelling. RICE therapy (rest, ice, compression, elevation) may be the appropriate treatment in this situation. Clients with a hypermobile knee due to excess ligament laxity should consult with their physician. If in doubt, refer out! Figure 3-2 PCL Stability Test. Figure 3-28 MCL/Medial Meniscus Eccentric Force. 2

5 Figure 3-26 Valgus Stress/MCL Sprain Test. Figure 3-36 Varus Stress Test (LCL Sprain Test). Figure 3-9 Patello Femoral Compression Test. Figure 3-10A Patella Tendinosis Test. Figure 3-10B Patellar Tendinosis Knee Flexion Test. Figure 3-10C Patellar Tendinosis One-Legged Knee Flexion Test. 3

6 Figure 3-3 Knee Flexion, 135 degrees. Figure 3-5 Abnormal External Tibial Rotation. Figure 3-25 Internal Knee Structures. Figure 3-7 Apley Compression Test. Figure 3-8 Apley Distraction Test. Figure 3-11 Myofascial Release Up Quadriceps. 4

7 Figure 3-12 Myofascial Release Up Rectus Femoris. Figure 3-31 Gluteus Maximus Compression. Figure 3-32 TFL Myofascial Release. Figure 3-33 Gluteus Maximus Lateral Fibers Stretch. Figure 2-71 TFL Stretch. Figure 2-73 Quadriceps Stretch. 5

8 Precautionary Note Figure 2-74 Hamstrings. If it is a springy end feel, it could be a fixated posterior fibular head due to a short biceps femoris. This can be corrected by lengthening the biceps femoris and performing a simple myoskeletal alignment technique. Figure 2-80 Evaluate External Tibial Rotation. Figure 2-77 Myofascial Release, Hamstrings. Figure 2-78 Myofascial Release, Gastrocnemius. Figure 2-81 Lengthen Biceps Femoris. 6

9 Correct Posterior Fixated Fibular Head Dysfunction Figure 2-77 Myofascial Release, Hamstrings. Figure 2-75 Upper Hamstring Strain. Figure 2-76 Hamstring Muscle Belly Strain Test. Figure 3-19 Resistance Test, Plantaris Strain. Figure 3-20 Cross-Fiber Gliding Strokes and Trigger Point Work, Plantaris. 7

10 Figure 3-21 Multidirectional Friction, Plantaris. Figure 3-22 Plantaris Eccentric Muscle Contraction. Figure 3-24B Distal Lateral Hamstring Stretch Only to Correct External Tibial Rotation (Caution) Figure 2-57 Myofascial Release, Adductors. Figure 2-59 Use Muscles to Stretch the Intermuscular Septums and Deep Investing Fascia. Figure 2-61 Adductors Stretch. 8

11 Figure 3-14 Multidirectional Friction, Patellar Tendon. Figure 3-16 Eccentric Muscle Contraction, Patellar Ligament. Figure 3-26 Valgus Stress/MCL Sprain Test. Figure 3-27 Multidirectional Friction, MCL/Medial Meniscus. Figure 3-28 MCL/Medial Meniscus Eccentric Force. Figure 3-36 Varus Stress Test (LCL Sprain Test). 9

12 Figure 3-27 Multidirectional Friction, MCL/Medial Meniscus. Figure 3-29 Poor Posture for Medial Meniscus Problems. Figure 3-36 Varus Stress Test (LCL Sprain Test). Figure 3-37 LCL Multidirectional Friction. Figure 3-38 Eccentric Force LCL (Varus Stress Test). Stretching (Client Self-Care) Goal: for the client to perform stretches demonstrated by you to create normal range of motion in shortened or contracted muscle groups. 10

13 Precautionary Note Figure 3-39 Quadriceps Stretch. Stretching is not suggested for the muscle groups around a hypermobile joint. Strengthening would be more appropriate to stabilize any joint that has excessive movement due to ligamentous laxity. Figure 3-42 Gluteus Maximus Lateral Fibers Stretch Figure 3-43 TFL Stretch. Figure 3-40A Distal Hamstring Stretch Start. Figure 3-40B Distal Hamstring Stretch Finish. 11

14 Figure 3-41 Gastrocnemius Stretch. 12

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