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I have recently asked all my clients about their knee pain. They had not perceived massage as able to offer effective relief as they frequently thought it was bone or cartilage pain.
The following, is a suggested method you can try, on a big cross section of your clients from athletes to chronic pain sufferers.
First practice this during "swap treatments " with your fellow massage therapists, so as to gain confidence and become practiced in it's delivery. Ideally you should have a background in deep tissue, sports or remedial massage techniques because it does require good thumb and finger strength/sensitivity. The main focus of the techique should be to use fingertip and thumb frictions on the tendons and ligaments mediallly and laterally (over femur and tibia condyles) approx 4 inches either side of the knee joint. Ideally this should take you no more than an average 12 mins to perfect (for both knee's) and is very time effective.
Client lies prone with the shins suported by a pillow. Having used effleurage and petrissage to warm up the muscles of the thigh and calf the therapist then sits at the side of couch inline with the knees. Place your hands on the knee nearest to you, use your fingertips to begin gently palpating and frictioning the medial hamstings, sartorius and gracilis tendons. Note how "bunched up" and "numb" they feel. The client will ( even using a consistant/set amount of pressure ) at first report no pain, then (after 10/25 secs) report how very rapidley raw the area is now becoming (you may even have to back off the pressure).
By frictioning cross fiber/tendon then in line with the fiber/tendon you begin to separate out (release the "bunching") of these tendons. A good visual is to imagine the tendons as guitar strings that insert into one spot that are clogged with adhesions and stuck together. Its your job to release/separate them.(see/feel what you find, let your intuition and client feedback guide you).
Now do the same on the lateral side using thumb pressure frictions for ITB and laterall hamstrings and collateral ligament.
Repeat for the other knee.
The above should yield good results, for those of you famillar with MFR and/or ishemic compression these can also be used proximal to the joint crease on the medial and lateral sides. NOTE never use pressure proximal to the knee joint crease posterior/popliteal fossa area.
As always, be wary of compressing nerves (especially laterall knee) any tingling/zinging or sharp pain into calf or foot then stop treatment. All normal contraindications apply (especially if client has varicose veins , peripheral vascular disease).
What you can expect.
Although this technique can feel sore/raw at the time, very few will experience much soreness afterwards (if they do then they should apply ice for short periods)
So far feedback has been very good = those that suffered the deep aching/arthritic type pain report a great reduction when doing those activity's that used to cause it, eg slow walking round shops/exhibitions standing for long periods. Athletes report increased propioception/biomechanics.
When having the treatment yourself, try this simple test as a comparison for before and after treatment.
Balancing on one leg slowly take the other leg through as wide a range of movement as feels comfortable to perform without over balancing. Then after treatment (walk around a bit first ) perform the same. Hopefully you will discover a big difference in knee stability that will encourage you to adopt/adapt this into your sessions........and if the knees are working better then the pelvis is working better and the spine and the..............
Let me know any misgiving's you have re technique, and also how you got on when you used it.
Please ask your clients about their knee pain as the above is much more common than you might think.