JW ComplicatedKnee

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 James Waslaski LMT, CPT
Integrated Manual Therapy & Orthopedic Massage For Complicated Knee Conditions
Todays 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 James Waslaski is an Author & International Lecturer who teaches approximately 40 seminars per year around the globe. Hes served as AMTA Sports massage Chair and FSMTA Professional Relations Chair. Hes 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 2011. 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. www.orthomassage.net
8/3/2013
CLINICAL MASSAGE THERAPY

A Structural Approach to Pain Management
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
Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski
CHAPTER
Knee and Thigh Conditions
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 Muscletendon tension muscle imbalance
8/3/2013
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
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 3-1
ACL Stability Test.
Figure 3-2
PCL Stability Test.
Figure 3-28
MCL/Medial Meniscus Eccentric Force.
8/3/2013
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.
8/3/2013
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.
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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.
8/3/2013
Precautionary Note
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 2-74
Hamstrings.
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.
8/3/2013
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.
8/3/2013
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.
8/3/2013
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
8/3/2013
Figure 3-27 Multidirectional Friction, MCL/Medial Meniscus.
Figure 3-29 Problems.
Poor Posture for Medial Meniscus
Figure 3-36
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
8/3/2013
Precautionary Note
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 3-39
Quadriceps Stretch.
Figure 3-42
Gluteus Maximus Lateral Fibers Stretch
Figure 3-43
TFL Stretch.
Figure 3-40A
Distal Hamstring StretchStart.
Figure 3-40B
Distal Hamstring StretchFinish.
11
8/3/2013
Figure 3-41
Gastrocnemius Stretch.
12

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Integrated Manual Therapy & Orthopedic Massage For Complicated Knee Conditions

By Author & International Lecturer James Waslaski LMT, CPT

CLINICAL MASSAGE THERAPY

Knee and Thigh Conditions

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

ACL Stability Test.

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

PCL Stability Test.

MCL/Medial Meniscus Eccentric Force.

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Valgus Stress/MCL Sprain Test.

Varus Stress Test (LCL Sprain Test).

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Patello Femoral Compression Test.

Patella Tendinosis Test.

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Patellar Tendinosis Knee Flexion Test.

Figure 3-10C Patellar Tendinosis One-Legged Knee Flexion Test.

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Knee Flexion, 135 degrees.

Abnormal External Tibial Rotation.

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Internal Knee Structures.

Apley Compression Test.

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Apley Distraction Test.

Myofascial Release Up Quadriceps.

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Myofascial Release Up Rectus Femoris.

Gluteus Maximus Compression.

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

TFL Myofascial Release.

Gluteus Maximus Lateral Fibers Stretch.

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Evaluate External Tibial Rotation.

Myofascial Release, Hamstrings.

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Myofascial Release, Gastrocnemius.

Lengthen Biceps Femoris.

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Clinical Massage Therapy: A Structural Approach to Pain Management James Waslaski

Correct Posterior Fixated Fibular Head Dysfunction

Myofascial Release, Hamstrings.