JW ComplicatedKnee

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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 M anagement Published by Pearson Education

ByAuthor & International Lecturer

James Waslaski LMT, CPT


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Integrated Manual Therapy & Orthopedic Massage

For Complicated Knee ConditionsTodays 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 multi-modality 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 andchiropractic 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 jointsaligned for pain free living.

Twelve Steps:1. Client History2. Assess Active Range of Motion3. Assess Passive Range of Motion4. Assess Resisted Range of Motion5. Area Preparation6. Myofascial Release/ Compression Broadening7. Cross Fiber Gliding/Trigger Point Therapy8. Multidirectional Friction

9. Pain Free Movement10. Eccentric Scar Tissue Alignment11. Stretching12. Strengthening

ames Waslaskiis an Author & International Lecturer who teaches approximately40 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 osteopathicconventions 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 orthom ss ge net
http://www.orthomassage.net/http://www.orthomassage.net/http://www.orthomassage.net/http://www.orthomassage.net/


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CLINICAL MASSAGE THERAPYA Structural Approach to Pain Management

CHAPTER

Clinical Massage Therapy: A Structural Approach to Pain Management

James Waslaski

Knee and ThighConditions

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Clinical Massage Therapy: A Structural Approach to P ain Management

James Waslaski

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 ManagementJames Waslaski

Chapter Outline

Popliteus Strain

Medial Meniscus Injury and MedialCollateral Ligament (MCL) Sprain

Iliotibial Band Friction Syndrome

Lateral Meniscus Injury and LateralCollateral Ligament (LCL) Sprain

Clinical Massage Therapy: A Structural Approach to P ain ManagementJames Waslaski

Learning Objectives

Choose the appropriate massagemodality or treatment protocol for eachspecific clinical knee condition

Release all the forces surrounding theknee, and eliminate the underlyingcause of the knee conditions beforeaddressing the clinical symptoms


Learning Objectives

Determine if there is an imbalanceamong the muscle groups thatsurround the knee

Restore pain-free knee joint normalrange of motion


Learning Objectives

Differentiate between soft-tissueproblems caused by:

instability or hypermobility of the knee

myofascial restrictionsMuscletendon tension

muscle imbalance


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Learning Objectives

Differentiate between soft-tissue

problems caused by: myoskeletal alignment problems

trigger point tension

strained muscle or sprained ligamentfibers

scar tissue


James Waslaski

Learning Objectives

Teach the client self-care stretching

and strengthening exercises (if needed)to perform at home to maintain musclebalance, joint alignment, and pain-freemovement following therapy


Precautionary Note

Do not work on a client with a recentinjury (acute condition) exhibitinginflammation, heat, redness, orswelling. RICE therapy (rest, ice,compression, elevation) may be theappropriate treatment in this situation.Clients with a hypermobile knee due toexcess ligament laxity should consultwith their physician. If in doubt, refer

out!Clinical Massage Therapy: A Structural Approach to P ain ManagementJames Waslaski

Figure 3-1 ACL Stability Test.


Figure 3-2 PCL Stability Test.


Figure 3-28 MCL/Medial Meniscus Eccentric Force.


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Figure 3-26 Valgus Stress/MCL Sprain Test.


James Waslaski

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 TendinosisOne-Legged Knee Flexion Test.


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Figure 3-12 Myofascial Release Up Rectus Femoris.


James Waslaski

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.


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Precautionary Note

If it is a springy end feel, it could be a

fixated posterior fibular head due to ashort biceps femoris. This can becorrected by lengthening the bicepsfemoris and performing a simplemyoskeletal alignment technique.


James Waslaski

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.


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Correct Posterior Fixated Fibular Head Dysfunction


James Waslaski

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 Strokesand Trigger Point Work, Plantaris.


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Figure 3-21 Multidirectional Friction, Plantaris.


James Waslaski

Figure 3-22 Plantaris Eccentric Muscle Contraction.


Figure 3-24B Distal Lateral Hamstring StretchOnly to Correct External Tibial Rotation (Caution)


Figure 2-57 Myofascial Release, Adductors.


Figure 2-59 Use Muscles to Stretch theIntermuscular Septums and Deep Investing Fascia.


Figure 2-61 Adductors Stretch.


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Figure 3-14 Multidirectional Friction, Patellar Tendon.


James Waslaski

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.




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Figure 3-27 Multidirectional Friction,MCL/Medial Meniscus.


James Waslaski

Figure 3-29 Poor Posture for Medial MeniscusProblems.




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 stretchesdemonstrated by you to create normalrange of motion in shortened or

contracted muscle groups.


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Precautionary Note

Stretching is not suggested for the

muscle groups around a hypermobilejoint. Strengthening would be moreappropriate to stabilize any joint thathas excessive movement due toligamentous laxity.


James Waslaski

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.


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Figure 3-41 Gastrocnemius Stretch.

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JW ComplicatedKnee