JW LowerExtremity

Integrated Manual Therapy & Orthopedic Massage

For Complicated Lower Extremity 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 Lower Extremity Conditions Today’s 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 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 clinical conditions of the lower extremity such as hyperpronation,

excessive supination, Achilles tendinosis, plantar fascial pain, tarsal tunnel syndrome,

posterior tibial stress syndrome, anterior lateral compartment syndrome, fixated ankle

joints, joint arthritis, morton’s neuroma, bunions, hammer toes, flat feet, and ankle

sprains and strains. 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. He’s served as AMTA Sports massage Chair

and FSMTA Professional Relations Chair. He’s 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

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 ManagementJames Waslaski

Lower Leg, Ankle, and Foot Conditions

4


Chapter Outline

• Twelve-Step Approach to Lower Leg, Ankle, and Foot Conditions

• Achilles Tendinosis• Gastrocnemius Protocol to Address

Achilles Tendon Pain• Soleus Protocol• Posteromedial Shin Splints


Chapter Outline

• Flat Feet and Fallen Arches and Hyperpronation

• Plantar Fasciitis• Anterior Compartment Syndrome (ACS)• Anterolateral Shin Splints• Inversion Ankle Sprain and Strain• Stress Fracture


Learning Objectives

• Choose the appropriate massage modality or treatment protocol for each specific clinical condition of the lower leg; Based on restoring normal range of motion throughout the body, and normal muscle resting lengths


Learning Objectives

• The focus is to work on the contracted muscle groups typically short and —gastrocnemius, soleus, and tiblialis posterior—before working on the weak, inhibited antagonists—tibialis anterior, extensor digitorum longus, extensor hallucis longus, and peroneals


Learning Objectives

• This will ensure–Structural integration—balance of the

opposing muscle groups–That the therapist eliminates the

underlying soft-tissue cause of the lower leg conditions before addressing the clinical symptoms

• Restore pain-free ankle joint normal range of motion

• Create ankle stability

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Learning Objectives

• Differentiate between soft-tissue problems caused by–Myofascial restrictions–Muscle–tendon tension–Trigger point tension–Strained muscle fibers–Sprained ligaments–Nerve compression–Bony fixations


Learning Objectives

• Teach the client self-care stretching and strengthening exercises (if needed) to perform at home to maintain musculoskeletal balance and pain-free movement following therapy


Figure 4-1 Lower Leg Muscles


Figure 4-2 Ankle Plantar Flexion, 30–50 Degrees.


Figure 4-3 Ankle Dorsiflexion, 20–30 Degrees.


Figure 4-5 Ankle Eversion at Subtalar Joint 15–20 Degrees.

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Figure 4-5 Ankle Eversion at Subtalar Joint15–20 Degrees.


Figure 4-16A Muscle Resistance Test, Soleus.


Figure 4-6 Myofascial Spreading, Gastrocnemius.


Figure 4-7 Compression, Gastrocnemius.


Figure 4-8 Cross-Fiber Gliding Strokes and Trigger Point Work, Gastrocnemius.


Figure 4-9A Arthrokinetics, Compression.

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Figure 4-9B Arthrokinetics, Decompression.


Figure 4-10 Gastrocnemius Stretch.


Figure 4-13 Myofascial Release of Soleus.


Figure 4-14 Ankle Distraction and Traction.


Figure 4-15 Soleus Stretch.


Figure 4-16A Muscle Resistance Test, Soleus.

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Figure 4-16B Multidirectional Friction, Soleus.


Figure 4-17 Eccentric Muscle Contraction, Soleus.


Figure 4-18B Myofascial Release, Right Achilles Tendon.


Figure 4-19 Tibialias Posterior Review.


Figure 4-21 Myofascial Release, Tibialis Posterior.


Precautionary Note

• There is an accupressure point approximately four fingers above the medial malleolus and a reflexology point between the malleolus and calcaneus. Avoid direct pressure on these areas on pregnant women.

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Figure 4-22 Posterior Tibialis Stretch.


Figure 4-25 Compression and Myofascial Spreading, Foot Muscles.


Figure 4-26 Massage Intereoseus Membrane Using Long Bones of Foot.


Figure 4-29 Bunion.


Figure 4-28A Arthrokinetics, Gentle Compression.


Figure 4-28B Arthrokinetics, Traction.

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Figure 4-23 Plantar Fascial Pain is not usually red, swollen and inflamed.


Figure 4-27 Stretch Muscles and Plantar Fascia of the Foot by Extending the Toes.


Figure 4-24 Muscle Resistance Test for Plantar Fascial Strain.


Figure 4-32 Multidirectional Friction, Plantar Fascia Strain.


Figure 4-33 Eccentric Muscle Contraction,Plantar Fascia Strain.


Precautionary Note

• When you take a client’s ankle out of inversion and plantar flexion, this may lower the arch and change the foot strike. For clients who wear hard orthotics in their shoes, this can create increased pressure on the plantar fascia. Make sure they are aware of this and consult their podiatrist.

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Figure 4-35 Muscle Resistance Test on Anterior Compartment Muscles.


Figure 4-34 Anterior Compartment Muscles.


Figure 4-36 Retinaculum Release.


Figure 4-38 Compression Broadening.


Figure 4-39 Release Intermuscular Septums.


Figure 4-42A Ankle Decompression.

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Figure 4-42B Traction Hip, Knee, and Ankle.


Figure 4-44 Ankle Ligaments.


Figure 4-53 Lateral Leg Muscles.


Figure 4-45 Muscle Resistance Test, Ankle Strain.


Figure 4-46 Myofascial Release, Lateral Lower Leg.


Figure 4-47 Compression Broadening, Lateral Lower Leg.

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Figure 4-49 Muscle Resistance Test, Ankle Strain.


Figure 4-50 Multidirectional Friction.


Figure 4-51 Eccentric Muscle Contraction.


Figure 4-44 Ankle Ligaments.


Figure 4-52 Eccentric Ligament Technique.


Stretching (Client Self-Care)

• Goal: for the client to perform stretches suggested by you to create normal muscle resting lengths in shortened or contracted muscle groups, and restore normal range of motion to the joint.

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Figure 4-54 Gastrocnemius Stretch.


Figure 4-55 Soleus Stretch.


Figure 4-56 Stretch posterior tibialis to correct supination. Stretch Peroneals to correct hyper-pronation!


Strengthening (Client Self-Care)

• Goal: to strengthen weak, inhibited muscle groups around a joint creating muscle balance throughout the —structural integration.


Precautionary Note

• To prevent reinjury after treating a strain, have the client refrain from beginning a strengthening program for 7 to 10 days, or until he or she is pain-free. To facilitate healing, have the client stretch the tight antagonist muscles, taking the tension off the injured muscles until pain-free strengthening can begin.


Figure 4-57 Strengthen Peroneals to stabilize lateral ankle.

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Figure 4-58 Strengthen Posterior Tibialisto correct hyper-pronation problems..


Figure 4-59 Strengthen Tibialis Anterior for anterior compartment syndrome clients.

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