Treating Leg. Knee and Foot Pain through Advanced Massage Techniques
How many people out there do you know complaining about their aching knees? Or the arthritis that wakes them in the night and just makes them feel miserable? Or the runners with the Achilles problem that stops them taking part in their favourite sport? Or the Saturday amateur footballer who is unable to play any more because they just keep pulling that groin..or hamstring.or quadriceps? Or the sprained ankle that never feels right and just keeps getting re-injured?
Quite a few potential clients out there if you know how to treat them, don't you think? Massage therapy can be amazingly effective for these and many other conditions if you have a few simple advanced soft tissue techniques under your hands and the confidence to know what you are doing. This article will look at a few common conditions of this important area and quite simply how you can get results in your treatments leading to happy clients and a thriving practice.
Muscle Strain
Muscle strain is very common in the upper leg muscles such as the hamstrings, quadriceps or adductors ("groin strain"), especially in clients partaking in sports.
A strain is a tearing of the musclo -tendinous unit and should not be confused with a sprain, which is damage to a ligament. Strains are classified as mild (first degree); moderate (second degree) or severe (third degree) depending on the severity of damage to the muscle fibres.
The adductor muscles are quite susceptible to muscle strains especially as they are often hypertonic (tight) and are often not stretched properly prior to athletic activity. Often clients will report a specific incident that caused the strain such as kicking a ball or suddenly changing direction when running and feeling the muscle "go".
Treatment: Massage therapists often feel uncomfortable about treating these injuries, especially groin strain, due to the sensitive nature of the region. It is important to maintain professionalism with adequate draping and good client communication. If necessary the client can be shown how to treat trigger points in the area themselves.
If the injury is in an acute stage (i.e.: it occurred within last 2-3 days and there is redness or swelling) the usual treatment of RICE (rest, ice, compression and elevation) would be indicated. Although regular massage techniques are contraindicated in an acute stage, energy techniques can help to bring down swelling and help to speed healing. After the acute stage, massage techniques can focus on addressing the site of tissue tearing through the use of Swedish based techniques such as effleurage, cross fibre friction to the site of the strain and advanced techniques such as trigger point therapy and myofascial release. It is important to be able to release any trigger points in the area as they can contribute to pain and muscle shortening which may have led to the original injury. The treatment should also focus on restoring and increasing range of motion through stretching techniques such as PNF or active isolated stretching. The client should also be taught stretches to carry out at home.
Knee problems
Knee problems tend to be very common; many people who are actively involved in sports have ended up with a knee injury at one time or another and it is very common to see footballers, runners and squash players with their knees strapped up. There are also millions of people in the UK with chronic unrelenting pain from osteoarthritis in the knees. Often people feel that there is nothing that can be done and just give up their favourite sport and resign themselves to a lifetime of inactivity. Appropriate massage therapy can reduce or eliminate pain and restore function and range of motion to enable people to enjoy their lives once more.
Osteoarthritis (OA) in the knee
The Arthritis Research Campaign ( www.arc.org. uk ) estimate that approximately 13 million people in the UK suffer from arthritis. The cost of arthritis to the nation is shocking. 206 million working days were lost in the UK in 1999-2000 - equivalent to a loss of production of £18 billion.
The estimated direct cost to health and social services was £5.5 billion. The cost of prescription costs alone added up to £341 million and hip and knee replacements cost £405 million.
OA is degeneration of the joint and is very common in the knees. Massage therapy and exercise have traditionally been used to treat arthritis in cultures around the globe for thousands of years. The ancient Chinese and Hippocrates around 400 BC mention rubbing and "friction" to ease joint pain from arthritis. Despite this, many massage therapists in the UK feel unconfident about treating arthritic pain, believing that it is contraindicated or that they may cause further damage.
Women in general are twice as likely to have OA in the knee as men. Pain is local to the joint and worse on climbing or standing.
Treatment
The focus of treatment for OA in the knees would be to reduce stiffness, pain, oedema (swelling) and spasm and restore range of motion. Although it is obviously not possible to repair the deterioration in the joint through massage, it is believed that a lot of the pain from arthritis can be due to trigger points or spasm in the muscles surrounding the joint. Massage can play a very helpful role in decreasing or eliminating this pain and reducing the compressive forces on the joint that have contributed to the problem. Massage treatment should be focussed on the muscles above and below the knee joint; Swedish techniques such as effleurage and petrissage can be helpful in reducing hypertonicity of muscles and trigger points should be treated with muscle stripping or ischemic compression.
Provided no inflammation is present, deep moist heat is very helpful in reducing pain and enhancing the treatment; aromatherapy or other topical applications may also be helpful.
Myofascial techniques and advanced stretching are also supreme in pain relief and restoring range of motion and function.
Patella tendinosis ("tendinitis")
This very common injury is also known as "runners knee", "jumpers knee" or "bikers knee." The injury is usually perceived as a generalised ache in the front of the knee just below the kneecap and is often aggravated by activity (especially climbing or descending stairs) and subsides with rest.
Patella tendinosis is actually a strain of the patella tendon that crosses over the kneecap. The patella tendon serves all 4 quadriceps muscles at the front of the thigh and is one of the strongest and thickest tendons in the body.
Note that the term "tendinosis" is now considered more accurate than "tendinitis" indicting a degenerative condition of the tendon rather than an inflammatory condition. Research into the cellular pathology of tendonitis has repeatedly demonstrated that inflammation is not present in the tendon pathology of most common repetitive stress injuries.
Treatment
Although this injury is now believed not to involve inflammation, ice has nevertheless been found effective in the treatment of tendinosis. This is because ice is a vasoconstrictor and one of the keystones of this problem is abnormal development of vascularity in the injury site.
Since a primary problem in tendinosis is the excess tension in the quadriceps leading to the strain, soft tissue techniques focus attention on releasing this muscle group. This can be done by Swedish massage techniques, myofascial work, trigger point therapy and stretching.
Deep transverse friction has also been found helpful in the treatment of this condition. Recent research indicates that this may help stimulate collagen production in the damaged fibres. Several minutes of friction to the patellar tendon can be used in addition to the techniques mentioned above. The client should be encouraged to rest as the tendon goes through its healing process. The healing period may be longer than anticipated because of the slow metabolic rate in tendon tissue. Too much activity done too soon is likely to cause a flare up in symptoms.
The importance of trigger points in leg pain
Any discussion of common pain syndromes should always include the likelihood of trigger points being responsible for the problem. Pain in knee joints is often nothing more than referred pain from trigger points; such pain can be just as debilitating than the pain from a damaged joint. Even when the knee joint has sustained a genuine injury, trigger pints in associated muscles nearly always contribute to a major part of the pain. Trigger points in the quadriceps are often the primary cause of knee pain and are often mistaken for tendinosis, bursitis or arthritis of the knee.
Want to learn more?
If you are interested in the treatment of pain and the techniques mentioned in this article,
our 3 day foundation course in Holistic medical massage will enable you to master the theory and application of these advanced bodywork approaches so that you can immediately incorporate them into your existing massage practice. We also offer a 2 day course specialising in the treatment of leg, knee and foot pain.
About Jing
Jing Advanced Massage and training is an organisation dedicated to excellence in all aspects of postgraduate massage training. Based in Brighton we offer courses around the country. Please call or check our website for further information and course dates.
www.jingmassage.com
info@jingmassage.com
Tel: 01273 628942
Copyright Jing Advanced Massage October 2005. Text Rachel Fairweather. Photos Meghan Mari