- Hello, massage nerds,
I'm so excited today to be talking about
ways to massage the knee.
Somebody requested, one of my viewers requested this video,
so this one's for you, and I really appreciate that,
because we get so many people walking in
that have knee problems,
and a lot of times that's something
that we can help them with,
and a lot of times it's not,
and it's good to know the difference
of when you need to refer out.
So, some of the things that you must know
is that you never put direct pressure
on the knee and push down.
That's a no-no.
Some of the things that you need to look out for is,
is there swelling?
Is there redness, is there heat?
Because that means that something's going on,
so be careful with that.
If it's normal pain, you know,
maybe from hypertonic muscles,
or just ligaments that are a little bit tight, or tendons,
we can help them,
but if you feel that it's beyond your scope of practice,
please don't hesitate to refer them out.
So the patella, also the kneecap, same name,
is the largest sesamoid bone.
It is embedded in tendons,
so it's the most complex joint in the body,
and it's also the largest.
So it's exciting to talk about the knee,
and to tell you about all the ligaments,
I know all of you are, it's so complex,
it took me a long time to kinda learn it.
You know, there's two have rings,
the meniscus, and they are, you know, fibro cartilage,
which is the strongest cartilage in your body.
You have that in between each vertebrae,
you have it in the knee,
and you have it in your pubis symphisis,
so it is very strong cartilage.
It also has four ligaments.
Remember ligaments attach bone to bone,
tendons attach muscle to bone.
So the four ligaments of the knee
are the ACL and the PCL,
which is the anterior cruciate ligament
and the posterior cruciate ligament.
And these are for movements, anterior and posterior.
And then the tibial collateral ligament,
and the fibular collateral ligament,
those are for side to side movements.
And they're also known as a lateral
or medial collateral ligaments.
So those are the ligaments
that if they ever get torn or injured, you know,
that's beyond our scope,
that's when they need to go to the doctor.
But sometimes the muscles are really hypertonic,
and that's what's causing some knee pain,
like you've got your patellar tendonitis,
popliteus, popliteal is in the back of the knee, tendonitis,
iliotibial band, right here on the side,
a lot of times the IT band is what keeps your knee braced
so it doesn't go out,
and a lot of times when that's really tight,
it could be some issues with the adductors,
like they're fighting between the adductors
and the iliotibial band,
they're fighting with each other
to pull the knee out if they are off balance,
or the hamstrings and the quads might be off balance,
this is why sometimes athletes
or people that work out,
they work out one set of muscles more than the other,
and this really throws your leg off,
and your balance off,
one may be more hypertonic than the other.
So, those are the things that you need to look out for.
You know, you've got hamstring tendinitis,
quads tendonitis, gastrocnemius tendonitis,
you've got Baker's cyst and the back of the joint,
and that feels like a swelling,
and that's from the semimembranosus muscle,
and could also be a herniated tendon.
So there's a lot of things to keep in mind,
and to look out for, and be careful with,
so I'm gonna talk you through the massage,
and some things to look out for.
Okay, so now you have your model,
or actually, I'm sorry, your client.
So you wanna start first with some effleurage,
remember, you can do hand over hand effleurage,
you wanna make sure and get the gastrocnemius here.
You know, the soleus and the gastrocnemius, a lot of times,
if they're hypertonic, they pull on the knee.
Now, the gastrocnemius and the soleus
are in the posterior part, but I'm getting it
as I go here, like the condyles,
right here where they insert, I'm getting the condyles.
I'm using the client's body weight
to put a little pressure and massage that out,
cause a lot of times it is the gastrocnemius,
and the soleus right here,
you can put your thumbs on either side and go up
to get to the gastrocnemius right here.
And, like I said, the quads, really, a lot of times,
if they're hypertonic, and your legs off balance,
if these are really strong, and your hamstrings are not.
And look, when she flexes right here,
you can see the vastus lateralis,
look at this nice vastus lateralis,
and the iliotibial band inserts right here.
The iliotibial band inserts here
and it keeps your knee from going out laterally,
so if this is really tight,
then this side is being stretched,
so you wanna make sure that you work both sides.
So this is one way that you can do some effleurage,
just to start warming it up, then you do your petrissage.
You can also do separating of the muscles here.
I don't wanna give you my back,
but you can lift, your grasping him pulling up.
This'll separate the quads, the vastus lateralis,
vastus intermedius, vastus medialis, and the rectus femoris.
Now for somebody, if you have a bigger person
that really needs a little deeper work,
then you can use your forearm, you know,
and move your whole body.
You don't do this,
because eventually that's gonna hurt your shoulder,
so you wanna just move your whole body.
Use your legs, use the pressure of your legs
to move back and forth.
You know, you can do it and move the leg
a little bit more medially,
so you can get to the lateral side,
or you can go with this one here too.
And like I said, you move your whole body,
you don't wanna just move, you know, the arm.
So make sure that it's not the quads or the hamstrings.
You must work the posterior leg too
to make sure that it's not coming from the legs,
that it's pulling on the knee.
So once you get to the knee, like I said,
you never wanna put direct pressure on it.
If they have a fracture, or if they have any torn ligaments,
you could do more damage, so if it feels hot,
if it's red, or if it's swollen, you must refer them out
to a orthopedic doctor, or just a regular doctor.
One of the techniques that you use
is that you can brace with your left hand,
hold the knee, the knee cap, the patella,
and then with, you know, I use this like a piggyback,
both fingers like a piggyback,
and you go right underneath,
like you're trying to massage on the lateral side.
So which ligament you would be getting from here,
the lateral collateral ligament, or the fibular,
cause remember the fibula's on this side.
Or, the medial, I'm holding the knee,
holding it here, steady,
the medial collateral ligament.
And she's got some crepitus right around here,
I can feel some crunching, that's the crepitus.
So I'm massaging right up to the medial collateral ligament.
And if it hurts, you keep it to the pain level
of the client.
And then the quad tendon, look at this,
you can really see it on her.
So you wanna make sure you can do some cross friction here.
And on the top right here.
Or you can use also use your piggyback right here.
You can do a little bit of friction too,
warm it up.
Actually friction should have been done at the beginning
to warm it up.
We can do some circular movements around the patella.
Now the meniscus are too deep,
you're really not gonna be able to work anything,
you know, the meniscus have ring discs
that are inside, and then you've got your ACL also,
and we really can't get to the ACL,
so you just kind of move the knee around little bit,
you always wanna just do it gently.
After you've loosened it up, you can do little bit
of movement, lateral and medial,
or superior and inferior, just to see if it,
just to get a little bit of movement in there,
and get the muscles, actually,
and the ligaments and the tendons
to loosen up a little bit.
You can do some friction with the palms of your hand,
all I'm doing is just doing a little bit of friction,
right around the knee.
And you can also do some leg movements, you know,
but I would have to have her,
what I would do is I would get the client's left hand,
if I could have your left hand,
and then you can hold this right here.
And then you can lift and, you know
test to see the anterior crucial ligament,
where your crucial ligament moves the patella,
anterior and the posterior cruciate ligament
moves the patella posterior,
it keeps it from going to the extreme.
So it keeps it from getting hyperextended,
that's what the anterior cruciate ligament do,
and the posterior ligament do.
And you can test it, you know.
Of course, really an orthopedic doctor should be doing this,
but once you've worked the knee out,
you can move it gently,
just to see how it feels on the client.
And then once you relax it,
you can go back, do your friction,
and again, you do these movements
like maybe 30 seconds max, you know, 15 to 20,
depending on how much they're hurting, or what's going on.
You know, the quads tendon here, it crosses the knee,
and it inserts right here at the tibial tuberosity,
so you can do some cross friction,
or the piggyback, depending.
On bigger clients, or clients that have, you know,
bigger bulkier muscles,
you might wanna use even like your fist,
forearms, even around here,
you wanna make sure and get the tibialis anterior.
A lot of times, these muscles are the ones
that are pulling down on the knee,
if these are really hypertonic, they'll pull down,
like runners, runners get problems with the knee,
especially if the IT band is pulling it out
or the adductors too.
So if these are hypertonic,
then it's pulling the knee towards the medial part.
So you wanna make sure and balance and work
and check out every muscle,
is it the quads, is it the hamstrings
is that the IT band, is it the adductors,
is that the gastrocnemius and the soleus,
is it the tibialis anterior?
So you wanna just, at the end,
you wanna just bring it all together
with some nice deep effleurage.
You can do one-handed effleurage,
get their blood circulating.
You always skip pressure over the knee.
And if you work in the popliteal, the back, the popliteal,
you never wanna put pressure on the soft area,
only the origins and attachments right behind the knee,
but never in the middle part
where you have the veins, you have vessels, blood vessels,
and nerves going right behind the knee
in the soft area, in the popliteal area.
You never wanna put direct pressure on that.
So, I hope that really helps you,
these are some knee movements
that you can take to your practice, to your clients,
try them all out, and see how that works for you
and see if you can help your clients.
And don't forget to refer out
if you feel that it's beyond your scope of practice,
make sure you refer them out to an orthopedic doctor.
Till the next time, create a great day.