18-1

Kinesiology for Manual Therapies

Chapter 18

Dimensional Massage Techniques for the Muscles of the Thigh and Knee Joint

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-2

Learning Outcomes

o 18-1 Define key terms.o 18-2 Locate on a human skeleton bony structures of the hip and knee joints.o 18-3 Palpate bony landmarks of the hip joint and knee joint on a partner.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-3

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 McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights © 2011 by The McGraw-Hill Companies, Inc. All rights reservedreserved

18-4

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 McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights © 2011 by The McGraw-Hill Companies, Inc. All rights reservedreserved

18-5

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 McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights © 2011 by The McGraw-Hill Companies, Inc. All rights reservedreserved

18-6

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 McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-7

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 McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-8

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 McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-9

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 McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-10

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.

18-11

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 McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-12

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 McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-13

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 McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-14

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 McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-15

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 McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-16

Unwinding the Muscles of the Thigh and Knee Joint: Where to Start? (cont.)

Treatment Protocol

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-17

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint

Supine – Rock and Roll

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-18

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.)

Supine – Elliptical Movement of the Quadriceps

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-19

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.)

Supine – Jostling the Quadriceps

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-20

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.)

Supine – Jostling the Quadriceps

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-21

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.)Supine – Compression Using Thigh Rotation

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-22

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.)

Supine – Myofascial Techniques for the Quadriceps

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-23

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.)

Supine – Wringing the Thigh Muscles

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-24

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.)

Supine – Broadening the Quadriceps

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-25

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.)

Supine – Compressive Effleurage

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-26

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 McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-27

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.)

Supine – Parallel Thumbs to the Vastus Lateralis

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-28

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 McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-29

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.)

Supine – Vibrate the Iliotibial Tract and Vastus Lateralis

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-30

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 McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-31

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.)

Supine – Stripping the Sartorius

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-32

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.)

Supine – Forearm Stroking

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-33

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.)Supine – Broadening the Quadriceps with

Active Shortening

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-34

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.)Supine – Lengthening the Rectus Femoris

with Active Engagement

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-35

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.)

Supine – Loose-fist Percussion

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-36

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.)Prone – Elliptical Movement of the Posterior

Thigh Muscles

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-37

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 McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-38

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.)

Prone – Myofascial Hamstrings and Posterior Thigh Muscles

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-39

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.)

Prone – Broaden the Hamstrings and Posterior Thigh Muscles

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-40

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.)

Prone – Stripping with Collapsed Fingers and Flexed Knee

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-41

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.)Prone – Olympic Hamstring Tendon Stretch

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-42

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 McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-43

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.)

Prone – Vibrate the Hamstrings

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-44

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 McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-45

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.)

Prone – Deep Transverse Friction for Hamstring Attachments

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-46

Dimensional Massage Therapy on the Muscles of the Thigh and Knee Joint (cont.)

Prone – Forearm Stroking

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-47

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 McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-48

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 McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-49

Chapter Summary (cont.)

Nerve complaints on meralgia paresthetica and sciatica were explored. Arthritis, osteoarthritis, and surgical intervention were reviewed.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-50

Chapter Summary (cont.)

Treatment protocol and sequence of the muscles of the knee joint areas were outlined for unwinding these muscles.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-51

Chapter Summary (cont.)

Dimensional Massage Therapy techniques for the muscles of the knee joint were depicted for the supine and prone positions.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-52

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 McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-53

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 McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved

18-54

Explore and Practice

Use the muscle cards and book in technique classes, for log hours, or for case studies for reference purposes.

McGraw-Hill McGraw-Hill © 2011 by The McGraw-Hill Companies, Inc. All rights reserved© 2011 by The McGraw-Hill Companies, Inc. All rights reserved