Kinesiology for Manual Therapies Chapter 18 Dimensional Massage Techniques for the Muscles of the Thigh and Knee Joint McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Learning Outcomes 18-1 Define key terms. 18-2 Locate on a human skeleton bony structures of the hip and knee joints. 18-3 Palpate bony landmarks of the hip joint and knee joint on a partner. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Learning Outcomes (cont.) 18-4 Explore the origins and insertions of the muscles of the knee joint on a partner. 18-5 Review general pathologies and conditions of the muscles and soft-tissue structures of the knee joint. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Learning Outcomes (cont.) 18-6 Discuss a treatment protocol for working on muscles of the thigh for the hip and knee joints. 18-7 Demonstrate safe body mechanics. 18-8 Practice specific techniques on the knee joint muscles. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Learning Outcomes (cont.) 18-9 Incorporate dimensional massage therapy techniques in a regular routine or use them when needed. 18-10 Determine safe treatment protocols and refer the client to other health professionals when necessary. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Introduction Massage therapy for the muscles of the thigh and knee joint can help facilitate rehabilitation from injury or surgery, prevent atrophy, relieve back pain, provide relaxation, or be included as a part of a sports training or event program for athletes, dancers, and others. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Structural Perspectives of the Knee Joint Genu valgum or knock-knees, is a walking pattern marked by a lateral angulation of the leg in relation to the thigh. Genu varum, or bowlegs, is a walking pattern marked by a medial angulation of the leg in relation to the thigh. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Structural Perspectives of the Knee Joint (cont.) Patellar tracking is often the result of unusual gait problems that prevent the patella from riding normally over the knee in a superior and inferior direction during extension and flexion, respectively. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Structural Perspectives of the Knee Joint (cont.) The iliotibial tract becomes “contracted” when the tensor fasciae latae and the gluteus maximus become shortened and contribute to a contracted iliotibial tract. Ober’s test is an orthopedic test for a contracted iliotibial tract. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

The Muscles Balancing the muscles of the thigh requires appropriate stretching, strengthening, and training. Hamstring strains in eccentric contractions are common in track and field events. A large hematoma, or bruise, can be the result of a bad hamstring sprain.

Injuries and Overuse Syndromes Trauma can take its toll on the knee joint and its structures. Ligaments and menisci are at risk. Structural changes in the knee joint, abnormal gain patterns, or imbalanced muscular development in the thigh can cause a trigger point in the fibular collateral ligament. Osgood-Schlatter disease is a dysfunction with the growth plate of the tibial tuberosity. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Nerve Complaints Pain in the anterior thigh, or meralgia paresthetica, can be attributed to branches of the femoral nerve being entrapped in some location by soft tissue. The sciatic nerve can be entrapped between the adductor magnus and the biceps femoris in the posterior thigh. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Arthritis, Osteoarthritis, and Surgical Intervention Knee replacement is a common solution for a painful hinge joint that no longer functions properly. A substitute hinge is called a prosthesis. A healthy knee joint, without trauma or problematic gait issues, needs exercise, stretching, and massage for maintenance. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Unwinding the Muscles of the Thigh and Knee Joint: Where to Start? Use appropriate techniques for the density of the soft tissue – athletes need sports massage techniques. Treat the anterior thigh and hip flexors first. Treat the pes anserinus area and involved muscles appropriately. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Unwinding the Muscles of the Thigh and Knee Joint: Where to Start Unwinding the Muscles of the Thigh and Knee Joint: Where to Start? (cont.) Address the groups of muscles used by the individual. Use a dimensional approach with the posterior hip and thigh muscles. Work the attachments. Review the treatment protocol. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Unwinding the Muscles of the Thigh and Knee Joint: Where to Start Unwinding the Muscles of the Thigh and Knee Joint: Where to Start? (cont.) Treatment Protocol McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint Supine – Rock and Roll McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.) Supine – Elliptical Movement of the Quadriceps McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.) Supine – Jostling the Quadriceps McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.) Supine – Jostling the Quadriceps McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.) Supine – Compression Using Thigh Rotation McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.) Supine – Myofascial Techniques for the Quadriceps McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.) Supine – Wringing the Thigh Muscles McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.) Supine – Broadening the Quadriceps McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.) Supine – Compressive Effleurage McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.) Supine – Tensor Fasciae Latae Technique with Flexed Hip and Knee McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.) Supine – Parallel Thumbs to the Vastus Lateralis McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.) Supine – Bent Fingers to the Iliotibial Tract and Vastus Lateralis McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.) Supine – Vibrate the Iliotibial Tract and Vastus Lateralis McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Locate the origin of the rectus femoris. Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.) Supine – Deep Transverse Friction for Attachments of the Rectus Femoris Flex the hip and knee. Locate the origin of the rectus femoris. Apply deep transverse friction to the attachment. Apply deep transverse friction to the patellar tendon above the patella. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.) Supine – Stripping the Sartorius McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.) Supine – Forearm Stroking McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.) Supine – Broadening the Quadriceps with Active Shortening McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.) Supine – Lengthening the Rectus Femoris with Active Engagement McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.) Supine – Loose-fist Percussion McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.) Prone – Elliptical Movement of the Posterior Thigh Muscles McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Apply compression to the posterior thigh muscles. Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.) Prone – Compression of the Posterior Thigh Muscles Apply compression to the posterior thigh muscles. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.) Prone – Myofascial Hamstrings and Posterior Thigh Muscles McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.) Prone – Broaden the Hamstrings and Posterior Thigh Muscles McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.) Prone – Stripping with Collapsed Fingers and Flexed Knee McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.) Prone – Olympic Hamstring Tendon Stretch McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.) Prone – Petrissage the Medial Hamstrings and Adductors with Flexed Knee McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.) Prone – Vibrate the Hamstrings McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Apply compressive circles with your palms on the hamstring tendons. Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.) Prone – Palmar Circular Friction of the Hamstrings Apply compressive circles with your palms on the hamstring tendons. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.) Prone – Deep Transverse Friction for Hamstring Attachments McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.) Prone – Forearm Stroking McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Use compressive effleurage liberally throughout the routine. Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.) Prone – Finishing Up Use compressive effleurage liberally throughout the routine. Locate and treat trigger points in both the anterior and posterior positions. Apply loose-fist percussion to the posterior thigh muscles. Finish with stretches and nerve strokes. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Chapter Summary This chapter discussed the structural perspectives of the knee joint and discussed specific muscles that should be treated for soft-tissue problems. Injuries and overuse syndromes including trauma, trigger points, and Osgood-Schlatter disease was discussed. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Chapter Summary (cont.) Nerve complaints on meralgia paresthetica and sciatica were explored. Arthritis, osteoarthritis, and surgical intervention were reviewed. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Chapter Summary (cont.) Treatment protocol and sequence of the muscles of the knee joint areas were outlined for unwinding these muscles. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Chapter Summary (cont.) Dimensional Massage Therapy techniques for the muscles of the knee joint were depicted for the supine and prone positions. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Chapter Review The Chapter Review is divided into true and false, short answers, and multiple choice questions. The questions are designed for the students to test their knowledge. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Explore and Practice Activities in this section are for practice and demonstration. Every opportunity should be utilized to locate muscular attachments on as many different bodies as possible to support kinesthetic learning. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved

Explore and Practice Use the muscle cards and book in technique classes, for log hours, or for case studies for reference purposes. McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved